腰椎关节突关节的应用解剖与在微创术中的定位价值

The minimally invasive surgery positioning value and applied anatomy of lumbar zygapophysial joint

目的通过解剖标本和影像资料测量腰椎关节突关节及毗邻结构的相关数据,探讨关节突关节作为腰椎微创术中重要解剖定位标志的可行性。方法收集新鲜成年人体腰椎标本10具20侧,共计80个节段。腰椎X线影像资料50例,200个节段。以关节突关节最高点（Highest point of lumbar zygapophysial joint,HP）作为测量中心,从微创手术应用解剖的角度,分别观测HP与手术相关结构的距离和角度。结果 HP至腰神经距离随椎间隙向下,数值逐渐增大,而角度趋于变小;HP至邻近椎间盘的距离,向下逐渐增大;HP和相邻椎间盘中平面垂直距离为0.8～1.5 mm,HP垂直高度位于椎间盘厚度范围内。结论腰椎关节突关节具备位置稳定、显露简单、容易辨认、对应关系易于掌握、准确性高的特点。是理想的解剖标志。在临床腰椎后路微创手术中可发挥一定的解剖定位作用。

Objective To explore the feasibility of lumbar zygapophysial joint is an important anatomical markers for minimally invasive posterior lumbar surgery by measurement and observation of the human anatomy specimens and the X-ray image data. Methods To collect 10 fresh adult human lumbar spine specimens （20 sides）, 80 segments and 50 parts of the lumbar spine X-ray image data. From the focus point of applied anatomy, the highest point of lumbar zygapophysial joint（HP）was used as a center to observe and measure the lumbar facet joints and adjacent anatomy-structures. Results The distance of from HP to Rami ventrales nervorum lumbalium was lower and larger, and the angle was smaller. The distance of from HP to intervertebral disc of lumbar vertebrae was gradually increased. The difference in height of HP and Midplane of lumbar intervertebral disc was 0.8-1.5 mm, the height of liP variations on the vertical axis did not exceed the scope of thickness of lumbar intervertebral disc. Conclusions Through research, lumbar zygapophysial joint has some characteristics, including stable position, easy exposure, easy identification and high accuracy. It is an ideal anatomic landmarks. There is a good anatomical localization effect in the lumbar posterior minimally invasive operations.