腰椎间孔镜的应用解剖

Applied anatomy for transforaminal endoscopic lumbar surgery

目的为不同节段腰椎间孔镜手术提供解剖学依据。方法 10具成人脊柱腰骶段(L_1~S_1)标本,观测L_(1/2)~L_5/S_1椎间孔高、椎间孔安全三角、椎管内安全三角的形态。结果①L_(1/2)~L_5/S_1椎间隙水平中线与椎间孔安全三角高的交点到出行神经根的距离为(4.75±0.80)、(6.42±0.44)、(7.30±0.82)、(7.74±0.52)、(4.68±1.27)mm;②L_(1/2)~L_5/S_1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到出行神经根的距离为(4.02±0.78)、(4.67±0.65)、(5.17±0.91)、(6.16±0.74)、(5.48±0.61)mm;③L_(1/2)~L_5/S_1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到硬膜囊/走行神经根的距离为(3.89±0.61)、(4.39±0.71)、(5.17±0.97)、(6.58±0.70)、(6.22±1.20)mm。结论掌握腰椎不同节段的解剖特点,有利于椎间孔镜手术时合适尺寸工作套管的选取。

Objective To provide data for transforaminal endoscopic lumbar surgery at different levels. Methods Anatomic structures, including the height of intervertebral foramens,the morphology of safety triangle of intervertebral foramen and safety triangle of spinal canal on 10 adult cadaver spine specimens（L1S1） were observed and measured. Results ① The vertical dimension between the intersection of a horizontal line drawn through the middle of disc space and the tip of the safety triangle of intervertebral foramen and the exiting nerve root at L1/2L5/S1were（4.75 ± 0.80）,（6.42 ± 0.44）,（7.30 ± 0.82）,（7.74±0.52） and（4.68±1.27） mm; ② The distance between the intersection of a horizontal line drawn through the middle of posterior margin of disc and the vertical line drawn through the medial one third of the pedicle and the exiting nerve root at L1/2L5/S1were（4.02±0.78）,（4.67±0.65）,（5.17±0.91）,（6.16±0.74） and（5.48±0.61） mm; ③ The distance between the intersection of a horizontal line drawn through the middle of posterior margin of disc and the vertical line drawn through the medial one third of the pedicle and the thecal sac/traversing nerve root at L1/2L5/S1were（3.89 ± 0.61）,（4.39 ± 0.71）,（5.17 ± 0.97）,（6.58 ± 0.70） and（6.22 ± 1.20）mm. Conclusions Understanding detailed anatomic features of lumbar vertebrae is valuable for choosing a suitable working cannula during transforaminal endoscopic lumbar surgery.