超声引导下针刀松解兔腰椎黄韧带的解剖学研究

Anatomic study of ultrasound-guided acupotomy release of rabbits lumbar ligamentum flavum

目的通过兔腰椎解剖结构及黄韧带形态探讨超声引导下针刀松解兔腰椎黄韧带的入路方式。方法测量6只3月龄雄性新西兰兔L_(5)、L_(6)和L_(7)椎体棘突高度、乳突高度、椎板间隙长度、宽度;6只3月龄雄性新西兰兔,超声探头横轴放置测量棘突与乳突夹角;超声探头纵轴放置棘突旁以平面内进针方式,松解L_(4/5)、L_(5/6)和L_(6/7)节段两侧黄韧带,测量针刀进针深度、进针角度、进针点距后中线的垂直距离和距骶骨角水平线的垂直距离,对数据进行分析,并解剖观察针刀路径。结果L_(5)、L_(6)和L_(7)椎体乳突高度、棘突高度比较,差异无统计学意义(P>0.05);L_(5)~L_(7)椎间隙长度及宽度逐渐增大,黄韧带中部较厚,其次为内侧,外侧相对较薄。超声横轴测量L_(5)、L_(6)和L_(7)椎体两侧的棘突与乳突间夹角比较,差异无统计学意义(P>0.05)。超声引导下针刀纵轴入路抵达黄韧带后,留针后测得的L_(4/5)、L_(5/6)和L_(6/7)节段左右两侧进针点与后正中线的垂直距离、针刀进针深度、针刀与水平线所成夹角即针刀的进针角度比较,差异均无统计学意义(P>0.05)。L_(6/7)左侧、右侧进针点骶骨角水平线的垂直距离均短于L_(4/5)、L_(5/6),L_(5/6)左侧、右侧进针点骶骨角水平线的垂直距离均短于L_(4/5),差异有统计学意义(P<0.05)。径中未观察到明显的血管和神经,硬脊膜完整。结论超声引导下针刀松解兔腰椎黄韧带的平行纵轴入路较为安全有效,L_(4/5)、L_(5/6)和L_(6/7)节段存在解剖差异,针刀进针角度应根据具体情况进行调整。

Objective To explore the approach of acupotomy release rabbit lumbar ligamentum flavum under ultrasound guidance,according to the anatomical structure of the rabbit lumbar spine and the shape of the ligamentum flavum.Methods The height of spinous process,mastoid process,length,and width of lamina space of L_(5),L_(6),and L_(7)vertebrae in six male New Zealand rabbits aged three months were measured;the six 3-month-old male New Zealand rabbits were measured with the ultrasound probe vertical.The lateral axis of the posterior midline was placed,and the angle between the spinous process and the mastoid process was measured under ultrasound.The longitudinal axis of the ultrasonic probe was placed beside the spinous process to release the ligamentum flavum on both sides of L_(4/5),L_(5/6),and L_(6/7)segments in a plane way the acupotomy insertion depth,insertion angle,the vertical distance from the insertion point to the posterior midline and the vertical distance from the horizontal line of the sacral angle were measured,after the measurement,the data was analyzed and the anatomical structure of acupotomy path was observed.Results There was no significant difference in mastoid hight and spinous process height among L_(5),L_(6),and L_(7)vertebrae(P>0.05).The length and width of the L_(5)-L_(7)intervertebral space gradually increased,and the middle part of the yellow ligament was thicker,followed by the medial part,and the lateral part was thinner.There was no significant difference in the angle between spinous process and mastoid process on both sides of L_(5),L_(6)and L_(7)vertebrae measured by ultrasonic transverse axis(P>0.05).After the longitudinal approach of the needle knife arrived at the yellow ligament under ultrasound guidance,there was no statistical significance in the vertical distance between the insertion points of the left and right sides of the L_(4/5),L_(5/6)and L_(6/7)segments measured after needle retention,the insertion depth of the needle knife,the angle between the needle knife and the horizontal line,namely the insertion angle of the needle knife(P>0.05).The vertical distance of the horizontal line of the sacral angle at the left and right needle insertion points of L_(6/7)was shorter than L_(4/5)and L_(5/6),and the vertical distance of the horizontal line of the sacral angle at the left and right needle insertion points of L_(5/6)was shorter than L_(4/5),the differences were statistically significant(P<0.05).No obvious blood vessels and nerves were observed in the puncture path,and the dura was intact.Conclusion It is a safe approach to release the rabbit ligamentum flavum with acupotomy when the ultrasound probe is placed parallel to the longitudinal axis.The needle insertion angle should be adjusted according to the anatomical differences of L_(4/5),L_(5/6),and L_(6/7)segments.