腰椎软组织针刀松解术的临床解剖学研究

Clinical anatomic study of acupotomy lysis in lumbar soft tissue

目的:研究针刀松解腰椎软组织的穿刺路径,为针刀松解关节突关节和椎间孔外口治疗腰椎间盘突出症提供解剖学依据。方法:选取未经福尔马林固定过的人体标本12具(男8具,女4具),平均年龄为(73.42±16.11)岁,标本来源于北京大学基础医学院遗体捐献中心,研究时间为2016年9月至2018年1月。利用针刀松解腰椎关节突关节和椎间孔外口横突根上缘,测量并分析人体标本上针刀路径相关数据,进行解剖观察验证入路安全性。结果:针刀松解关节突关节在L3～S1节段的进针深度(A)平均为(50.01±7.40)mm,进针点至相应节段棘突距离(B)平均为(51.06±6.23)mm,针刀与水平位夹角(D)在L3/L4、L4/L5节段间约为55°,在L5/S1节段约为60°。针刀松解L3/L4、L4/L5椎间孔外口横突根上缘,A平均为(57.86±7.04)mm、B平均为(56.92±5.39)mm、D平均为(59.02±5.98)°。该入路穿过皮肤、浅筋膜、胸腰筋膜、竖脊肌、多裂肌,到达关节突关节,肉眼观察未发现血管、神经损伤。结论:临床解剖学证实针刀可以到达关节突关节和椎间孔外口横突根上缘,该入路相对安全,值得临床推广。

Objective:To explore the anatomical path of soft tissue on lumbar spine with acupotomy,and a safer and reliable treatment of lumbar disc herniation with anatomic basis study.Methods:Cadavers including 4 females and 8 males with(70.50±14.17)years old in an average without formalin fixation were selected.The specimens were derived from the Donor Center of School of Basic Medical Sciences,Peking University,study started from September 2016 and ended at January 2018.The needle joints were used to loosen the lumbar facet joints and the intervertebral foramen.The data related to the cadavers was measured and analyzed,and the safety of the approach was verified by anatomical observation.Results:The depth of needle insertion(A)of the facet joint in the L3 to S1 segment was(50.01±7.40)mm,and the distance from the needle point to the corresponding segment of the spinous process(B)was(51.06±6.23)mm.The angle of the needle of the horizontal position(D)was 55°between the L3/L4 and L4/L5 segments and 60°between the L5/S1 segments.Loosening the upper edge of the transverse root of the L3/L4 and L4/L5 intervertebral foramen,the A was(57.86±7.04)mm,and the B was(56.92±5.39)mm,the D was(59.02±5.98)°on average.The approach through the skin,superficial fascia,thoracolumbar fascia,erector spinae,multi-cleft muscles,reaching the facet joints,no significant blood vessels,nerve damage and bleeding in the soft tissue of the intervertebral foramen were observed.Conclusion:Clinical anatomy confirmed that the needle knife can reach the superior edge of the facet joint and the transverse root of the intervertebral foramen.The approach is relatively safe and worthy of clinical promotion.