针刀松解腰椎黄韧带的临床解剖学研究

Clinical anatomic study of acupotomy lysis in lumbar ligamentum flavum of human

目的探索针刀松解腰椎黄韧带的解剖路径,为腰椎间盘突出症及椎管狭窄的临床治疗提供一种更安全可靠的中医微创治疗方法。方法选取未经福尔马林固定的人体标本10例(男6例,女4例),年龄60~90岁,平均(70.50±14.17)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~2018年1月,根据人体解剖结构的体表标志定位,以垂直人体纵轴方向从关节突关节至棘突方向进针及平行人体纵轴方向从棘突旁开约一横指点由尾侧向头侧进针两种方式,松解L3/L4、L4/L5、L5/S1三个节段的腰椎黄韧带,测量进针角度、针刀进针深度、进针点距棘突旁开距离、进针点距骶骨角距离,对所得数据进行处理和分析。结果解剖穿刺路径中未观察到明显的血管和神经,且解剖后硬脊膜完整。标本左右侧测量数据差异无统计学意义(P>0.05);垂直纵轴入路的进针深度小于平行纵轴入路的深度(P<0.01),垂直纵轴入路的旁开距离大于平行纵轴入路(P<0.01);L3/L4、L4/L5、L5/S1的垂直与水平纵轴入路测量数据显示,三个节段的进针角度、进针深度及距棘突距离差异无统计学意义(P>0.05)。结论针刀松解黄韧带的垂直纵轴入路方式优于平行纵轴入路方式;临床进行治疗前,可参考本研究所得垂直纵轴入路方式的测量结果,更准确地定位针刀松解腰椎黄韧带的进针点。

Objective To explore the anatomical path of acupotomy for lumbar ligamentum flavum(LF)and provide a safer and reliable minimally invasive treatment of Chinese medicine for lumbar disc herniation(LDH)and lumbar spinal stenosis(LSCS).Methods Ten cadavers including 4 females and 6 males with age from 60 to 90 years old[(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 from September 2016 to January 2018.According to the body surface of the human anatomy,the first approach was to insert the needle from the facet joint to the spinous process in the direction of the vertical axis of the vertical body.The second direction was parallel to the longitudinal direction of the human body from the side of the spinous process and a transverse direction from the tail side to the head.Those methods loosened L3/L4,L4/L5,L5/S1 three segments of ligamentum flavum.The angle for acupotomy and the depth of needle penetration,the distance between the puncture point and spinous process,and the distance between the puncture point and cornua sacralia on cadavers were measured.The resulting data was processed and analyzed.Results After dissection,no obvious blood vessels and nerves were observed in the paracentesis path,and the spinal dural membrane was intact.There was no significant difference between the left and right measurement data(P>0.05).The penetration depth of the vertical longitudinal axis approach was less than the depth of the parallel longitudinal axis approach(P<0.01).The distance between the puncture point and cornua sacralia for the vertical longitudinal axis was greater than that of the parallel longitudinal axis(P<0.01).Vertical and parallel longitudinal axis measuremented of L3/L4,L4/L5,and L5/S1 showed no significant difference in needle insertion angle,needle depth,and spinous process distance for the three segments(P>0.05).Conclusion The vertical longitudinal axis approach of loosening the ligamentum flavum by the needle knife is better than the parallel longitudinal axis approach.Before clinical treatment,reference can be made to the measurement results obtained in this study to obtain a more accurate insertion point for lumbar ligamentous ligament release.