Applied anatomy of intrusive operations of lumbar intervertebral foramen

Objective:To provide anatomical datum for intrusive operations of lumbar intervertebral foramen,especially that using acupuncture-knife as intrusive tool.Methods:To dissect 10 antisepsis cadavers and observe the exposed blood vessels,ligaments,nerves and their adjacent relations in L1/2~L5/S1intervertebral foramen.Results:Lumbar intervertebral foramen exit zones were almost sealed by nerves and blood vessels.There were two zones with relatively no blood vessel and nerve(triangular working zones)located in the midpoint of the distance between two adjacent roots of transverse processus,and clung to lamina of vertebral arch,and they were also found upon the margo superior of the root of transverse processus,but the ascending lumbar vein or(and)the rami anastomoticus between the remi inferior of intervertebral vein and lumbar veins were observed in 12%triangular working zones upon the margo superior of root of transverse processus.Conclusions:"Triangular working zone"was relatively avascular zone.Pay attention to the possibilty of presence of blood vessels on the entrance passage of intrusive operations on lumbar side rear.The needlepoint should be pierced at the midpoint of the distance between two adjacent roots of transverse processus and cling to the outer edge of lamina of vertebral arch when doing the foraminal lumbar puncture.As lumbar intervertebral foramina exit zone was almost sealed by nerves and blood vessels,blind incising and debonding with acupuncture-knife in this area was relatively much more dangerous.

Observation and measurement of applied anatomical features for thoracic intervertebral foramen puncture on computed tomography images

BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.

Differential diagnosis of cervical nerve compression syndrome of the external intervertebral foramen

The aim of the present research is to study the mechanism of cervical nerve compression syndrome of the external intervertebral foramen and its differential diagnosis with cervical spondylosis.Diagnostic treatment with muscle relaxant,vasodilator,neurotrophic medicine and celecoxib(COX)-2 inhibitor were performed in 20 patients with cervical nerve compression syndrome of the external intervertebral foramen and 20 patients with cervical spondylosis confirmed by operation.Diagnostic local block therapy was performed additionally in cases showing little effect after diagnostic treatment.All the patients were followed up postoperatively for more than one year.Fifteen cases with cervical nerve compression syndrome of the external intervertebral foramen were healed by the diagnostic treatment.The other five cases had a short-term remission and there was no recurrence after diagnostic local block therapy.Diagnostic treatment led to short-term alleviation of the symptom in 20 cases with cervical spondylosis confirmed by operation,the results of which was far from satisfactory and operation was undertaken finally in all the 20 cases.The etiology of cervical nerve compression syndrome of the external intervertebral foramen lies in the compression of the cervical plexus,brachial plexus and cervical dorsal rami by the tendinous decussating fibers of the scalenus anticus,medius,minimus and the posterior muscles of the neck.Diagnostic treatment was propitious to differentiate cervical nerve compression syndrome of the external intervertebral foramen from cervical spondylosis.

Effects of percutaneous intervertebral foraminal BEIS technique on patients with lumbar disc herniation

Objective:To compare the application effects of percutaneous percutanuous intervertebral foraminal BEIS(Broad Easy Immediate Surgery)technique on patients with lumbar disc herniation.Methods:Eighty-six patients with lumbar disc herniation treated in the Seventh People’s Hospital of Zibo City from Mary 2016 to May 2019 were selected and divided into control group and study group according to the simple randomization of random number table method,with 43 cases in each group.Patients in control group were treated with lamina fenestration while patients in study group were treated with percutanuous intervertebral foraminal BEIS technique.The surgical status and hospital stay,complications,pain[Visual Analogue Scale(VAS)score],Oswestry Disability Index(ODI)score and quality of life[MOS 36-item Short From Health Survey(SF-36)]were compared between the two groups.Results:The surgical time in study group was longer than that in control group,and the incision length was shorter than that in control group,and the fluoroscopy frequency was more than that in control group,and the intraoperative blood loss was less than that in control group,and the hospital stay was shorter than that in control group(P<0.05).There were no significant differences in the incidence rates of postoperative complications between the two groups(P>0.05).There were statistically significant differences in the between-group effects,timepoint effects and interaction effects of VAS pain score(P<0.05),and the VAS pain score in study group at 24 h and 1 w after surgery was significantly lower than that in control group(P<0.05).There were no statistically significant differences in the group-between effects and interaction effects of ODI score(P>0.05),and there were statistically significant differences in the time-point effects(P<0.05).There were statistically significant differences in the betweengroup effects,time-point effects and interaction effects of SF-36 score(P<0.05).The ODI score at 3 months after surgery in study group was lower than that in control group while the SF-36 score was higher than that in control group(P<0.05).Conclusion:Compared with traditional lamina fenestration,percutanuous intervertebral foraminal BEIS technique has the advantages of less trauma and quicker postoperative recovery in the treatment of lumbar disc herniation.Self-made simple locator can reduce the fluoroscopy frequency,improve the accuracy of positioning,further reduce surgical trauma and promote recovery of patients.

微创经肌间隙入路椎间孔椎体间融合术治疗下腰椎退变性疾病的评价

目的报道经多裂肌间隙入路椎间孔椎间融合术治疗下腰椎退变性疾患的临床效果。方法2010年4月至2012年4月对27例患者经多裂肌间隙入路椎间孔椎间融合术治疗下腰椎退变性疾病。其中男性12例,女性15例,年龄58.2岁（46~74岁）。极外侧型椎间盘突出7例,椎间盘开窗摘除术后复发3例,退变性腰椎不稳17例。结果切口长度4.2 cm（4.0~4.5 cm）,手术时间90 min（70~160 min）,术中出血量130 ml（90~2500 ml）。随访8~20个月,无严重并发症,27例均获骨性融合。末次随访时患者VAS腿痛评分从术前平均（7.4±1.1）分降至（2.4±1.3）分,VAS腰痛评分从术前平均（6.7±1.3）分降至（1.8±1.5）分。临床疗效评定：优22例,良3例,可2例,优良率92.6%。结论经多裂肌间隙入路椎间孔椎间融合术具有创伤小、时间短、出血少、并发症少、疗效确切等优点,在合理选择适应证的情况下是一种理想的下腰椎融合方法。

经椎旁椎间孔注射参麦注射液治疗腰椎间盘突出症临床观察

目的:比较经椎旁椎间孔注射参麦注射液、曲安奈德及参麦注射液加曲安奈德混合液对腰椎间盘突出症的疗效。方法:将90例腰椎间盘突出症患者随机分为中药组(A组)、西药组(B组)和中西药组(C组),每组均为30例。中药组经椎旁椎间孔注射参麦注射液4ml、2%利多卡因1ml,西药组经椎旁椎间孔注射曲安奈德1ml、2%利多卡因1ml,中西药组经椎旁椎间孔注射参麦注射液3ml、曲安奈德1ml、2%利多卡因1ml。结果:中药组和西药组比较差异无统计学意义(P>0.05),中西药组与中药组和西药组比较差异有统计学意义(P<0.05)。结论:经椎旁椎间孔注射参麦注射液对腰椎间盘突出症有较好疗效。

经皮椎间孔镜下TESSYS技术治疗腰椎椎间孔狭窄的早期临床疗效观察

目的探讨经皮椎间孔镜下TESSYS技术治疗腰椎椎间孔狭窄引发腰腿痛的短期疗效。方法选取2012年3月至2014年9月本院收治腰椎椎间孔处狭窄的患者30例,均选择经皮椎间孔镜下TESSYS技术治疗。术前、术后及末次随访时应用视觉模拟评分(VAS)评估疼痛程度,应用日本骨科协会(JOA)评分评估腰椎功能改善情况。结果术前及末次随访评分的比较所有患者术中即感觉症状明显缓解。VAS评分由术前(8.13±1.21)分减少至(2.81±1.49)分,JOA评分由术前(10.77±4.21)分升高至(26.30±3.55)分。结论 TESSYS技术治疗腰椎椎间孔处狭窄,有安全性高,具有手术时间短、出血少、并发症少、患者易接受等优点。

L_4～L_5和L_5～S_1旁椎间孔注射穿刺入路的应用解剖研究

目的行L4～L5和L5～S1节段旁椎间孔注射穿刺入路确定安全范围。方法以30例X线胶片的缩放比例作为参照依据,12侧标本模拟试验穿刺入路解剖。结果后正中线旁开2.0～2.5 cm处穿刺入路,在L4～L5椎间孔下半部分,即L4神经根下方(10.6±1.4)mm和L5神经根上缘至相应椎弓根下切迹间距(1.9±0.7)mm,是行椎间孔外口注射的安全区。结论标本后正中线旁开2.0～2.5 cm的范围穿刺与临床采用X光胶片推算出体表实际距离基本一致。由此旁椎间孔穿刺入路能避开重要的血管神经,L4～L5椎间孔直达安全三角工作区;L5～S1安全三角区范围消失,L5神经根上缘至相应椎弓根下切迹间距为注射区。

经皮椎间孔入路内窥镜治疗腰椎间盘突出症的临床疗效及微创性对比研究

目的对经皮椎间孔入路内窥镜与传统后路开放手术的临床疗效及微创性进行评估。方法选择2008年10月到2009年4月于我院接受手术的腰椎间盘突出症患者,根据病情及自身选择等因素分为试验组和对照组,试验组采取经皮椎间孔镜下椎间孔入路腰椎间盘切除术,共33例;对照组采取传统后路开放手术,共37例。对两种术式系列指标包括术中出血量、手术持续时间、切口长度、术后下床时间、术后住院天数、并发症,及视觉模拟评分、Macnab评分以及白细胞数、中性粒细胞数、血红细胞沉降率、血浆C反应蛋白、卧位血浆醛固酮、血浆血管紧张素Ⅱ、血浆肾素活性进行测量比较分析,并行统计学处理。结果 1试验组较对照组切口小,术中出血量少,住院天数少,手术时间短,术后下床时间早,两组结果差异有统计学意义(P<0.05)。2两组术后1月、末次随访VAS评分和术前相比明显下降,两组术后1月、末次随访VAS评分较术前相比明显升高;两组术前、术后1月、末次随访VAS评分差异无统计学意义(P>0.05)。3试验组Macnab评分,术后1月优良率90.9%,截止末次随访优良率94.0%;对照组,术后1月优良率91.9%,截止末次随访,优良率94.6%。4术后1d、术后5d对照组较试验组血液沉降率、C反应蛋白、卧位血浆醛固酮、血浆血管紧张素Ⅱ、血浆肾素活性较对照组明显增加,差异无统计学意义(P>0.05),而白细胞数、中性粒细胞数差异无统计学意义(P>0.05)。结论对经皮椎间孔入路内窥镜治疗腰椎间盘突出症与传统后路开放手术相比切口小,术中出血量少,住院天数少,手术时间短,术后下床时间早、对机体的干扰相对小,应激反应更小,疗效相当。

椎间孔镜下改良TESSYS技术联合270°神经根减压治疗腰椎管狭窄症疗效观察

目的探讨椎间孔镜下改良TESSYS技术联合270°神经根减压治疗腰椎管狭窄症的临床疗效。方法回顾性分析三门峡市中心医院2012年1月至2015年1月收治的123例腰椎管狭窄症患者的临床资料,其中行经椎间孔腰椎椎体间融合术(TLIF)治疗61例(对照组),行椎间孔镜下改良TESSYS技术联合270°神经根减压治疗62例(观察组),比较2组患者手术创面面积、术中出血量、手术时间、卧床时间及住院费用;术前及术后7 d和3、6、12个月,使用视觉疼痛模拟评分(VAS)法评估患者术后腰腿疼痛情况,使用OSWESTRY功能障碍指数(ODI)评估患者腰椎功能改善情况。结果与对照组比较,观察组患者手术创面面积小(P<0.05),术中出血量少(P<0.05),手术时间、卧床时间短(P<0.05),住院费用低(P<0.05)。2组患者术前VAS评分和ODI比较差异无统计学意义(P>0.05);观察组患者术后7 d VAS评分和ODI显著低于对照组(P<0.05);而术后3、6、12个月2组患者VAS评分和ODI比较差异无统计学意义(P>0.05)。结论椎间孔镜下改良TESSYS技术联合270°神经根减压治疗腰椎管狭窄症具有手术创面面积小、术中出血量少、手术时间短、住院费用低等优点。

椎间孔阻滞治疗腰椎间盘突出症的临床疗效研究

目的探讨椎间孔阻滞治疗腰椎间盘突出症(LDH)的临床疗效。方法50例LDH患者椎间孔阻滞治疗(B组),50例硬膜外腔注药治疗法为对照组(C组)。参照JOA标准对100例患者自觉症状、临床检查的改善程度进行治疗前后对照比较。结果两组均有较好的疗效,但B组的不良反应发生率小于C组(P<0.05);治疗次数明显少于C组(P<0.01)。结论椎间孔阻滞治疗LDH是疗效好且简便的方法。

横突在经椎间孔脊柱内窥镜手术中的作用

目的分析横突在经腰椎间孔脊柱内窥镜手术中的作用。方法通过一定纳入标准筛选2015年9月至2016年5月接受椎间孔镜治疗的腰椎间盘突出症患者,以横突为参照物制定手术方案,通过术前术后VAS、ODI评分的配对t检验评价手术效果。结果手术患者共68例,男42例,女26例;年龄28~53岁,平均年龄38岁;其中腰3/4节段3例,腰4/5节段41例,腰5/骶1节段24例。均成功利用横突实施手术。术前VAS、ODI评分值与术后6个月VAS、ODI评分值比较差异有统计学意义(P<0.05)。结论横突在椎间孔扩大成形过程中,可作为骨性标志参考,帮助评估骨钻安全位置,完成椎间孔扩大成型。

大鼠鞘内给药方法比较及改进

目的通过实验对比研究,介绍一种损伤少、稳定可靠、可持续性给药的鞘内给药方法。方法大鼠72只随机分为6组:4组手术处理组(经枕寰膜置管组、经枕寰膜置管+微型渗透泵组、经腰椎椎间孔置管组、经腰椎椎间孔置管+微型渗透泵组)和2组假手术对照组(经枕寰膜置管假手术组、经腰椎椎间孔置管假手术组)。置管组导管游离端固定于皮肤。观察术后大鼠体质量、致瘫、致死、脱管等一般状态,同时检测手术前后转棒持续时间、机械刺激缩足反射阈值及热刺激缩足反射潜伏期行为学变化。结果经枕寰膜置管大鼠近50%致死、致瘫、一般状态不良(体质量严重下降、口鼻炎性分泌物)。经枕寰膜置管+微型渗透泵组大鼠情况类似。经腰椎椎间孔置管组大鼠未见致死、致瘫及体质量下降,但1/3发生脱管。腰椎椎间孔置管+微型渗透泵组大鼠未见致死、致瘫及体质量下降,全部未脱管。经枕寰膜置管可致大鼠转棒运动能力显著低于术前和对照组,其热刺激缩足反射潜伏期和机械刺激缩足反射阈值均显著低于术前和对照组。经腰椎椎间孔置管对大鼠转棒运动能力和基础痛阈均无明显影响,与对照组和术前自身比较差异均无显著性。结论经腰椎椎间孔置管结合微型渗透泵方法是鞘内给药损伤少、稳定可靠的最佳方法。

椎间孔注射配合三维快牵引治疗腰椎间盘突出症临床研究

目的:研究椎间孔注射配合三维快牵引治疗腰椎间盘突出症的临床疗效。方法:将120例确诊的腰椎间盘突出症患者随机分为治疗组和对照组,每组60例。治疗组采用在突出侧腰椎间孔注射2%利多卡因+曲安奈得,同时配合三维快牵引治疗;对照组采用三维快牵引配合静滴20%甘露醇+地塞米松治疗。评定采用日本骨科学会(JOA)下腰痛评分表和目测类比评分量表(VAS),比较2组疗效。结果:2组患者治疗7d后疼痛明显改善,VAS评分较治疗前明显下降,JOA评分较治疗前明显提高。组内与治疗前比较(P<0.05),与对照组比较(P<0.05),差异均有统计学意义。按分级疗效评定,治疗组优41例,良16例,可2例,差1例,有效率为98.3%,优良率为95%。对照组优19例,良22例,可16例,差3例,有效率为95%,优良率为68.3%,2组优良率比较,差异有显著性意义(P<0.01)。结论:①椎间孔注射配合三维快牵引治疗腰椎间盘突出症可使患者腰腿痛迅速缓解,功能显著改善。②该项技术具有安全有效,操作简单,易学易用等特点,在临床治疗腰椎间盘突出症的研究领域中,具有一定推广应用价值。

椎板间孔扩大术在腰椎间盘突出症的应用

腰椎间盘突出症是常见病,但术后效果不佳或手术失败率仍较高。在不影响脊柱稳定性的基础上,我们选择了椎板间孔扩大术用于手术治疗腰椎间盘突出症,并取得了满意的效果,该手术尤其适用于合并腰椎管狭窄的病人。

DSA引导颈椎间孔入路胶原酶溶解术的临床研究及护理

目的：探讨DSA引导经颈椎间孔穿刺注射胶原酶治疗颈椎间盘突出症的疗效、安全性及护理。方法：对26例颈椎间盘突出症患者在DSA定位后用5—7号穿刺针自颈部侧方穿刺，通过相应椎间孔上部达硬膜外侧前间隙，注入胶原酶溶液1200U，并给予围手术期的护理，随访观察疗效。结果：26例均成功，随访6个月-1年，优良率92．3％，无一例并发症发生。结论：DSA引导下经椎间孔穿刺注射胶原酶治疗颈椎间盘突出症安全有效快速经济，围手术期护理是取得手术成功的重要措施。

颈椎间孔韧带的解剖特点及其临床意义

神经根型颈椎病是临床常见疾病,可引起上肢感觉或运动障碍,其病因可能是神经根受到各种直接机械压迫[1]。神经根自硬膜囊发出后向外下方走行,经椎间孔出椎管,椎间孔内软组织增生、肥厚、粘连等病理改变均可使经过该处的神经根受到压迫,导致出现相应的临床症状如放射性上肢疼痛、麻木或无力等。想要更清楚地了解神经根卡压的机制,需要对颈椎间孔区域进行更加深入的解剖学研究。掌握颈椎间孔韧带的解剖特点有助于提高神经根型颈椎病的诊断和治疗水平,在该区域手术操作时尽可能地减少医源性损伤。有关胸腰椎(T1~5)的椎间孔韧带研究证明其韧带起到限制神经根移位并防止拉伤的作用[2~4]。然而,目前关于颈椎间孔韧带的研究尚少。本文结合国内外文献资料,对颈椎间孔韧带的相关知识作一综述。

CT引导下颈椎椎间孔入路胶原酶溶解术的探讨

目的研究CT引导F经颈椎椎间孔穿刺注射胶原酶治疗颈椎间盘突出症的安全性及疗效。方法对18例颈椎间盘突出症患者在CT扫描定位后用5～7号穿刺针自颈部侧方穿刺,通过相应椎间孔上部达硬膜外侧前间隙,注入胶原酶溶液1200u,随访观察疗效。结果18例均成功,随访6～12月,优良率88.9%,无一例并发症发生。结论CT引导下经椎间孔穿刺注射胶原酶治疗颈椎间盘突出症安全有效,值得进一步研究。

基于椎间盘切除及融合术的椎间孔减压术治疗神经根型颈椎病的疗效分析

为了治疗神经根型颈椎病,分析椎间孔内神经根受压因素,指导临床选择合理的减压方式。本研究通过影像学资料测量颈椎病患者椎间孔面积,评估椎间孔内神经根受压程度及受压因素。共收治2011年1月至2016年1月间的47例椎间孔内神经根受压所致的单侧神经根型颈椎病前路减压手术患者,根据术前影像学资料受压因素分为：单纯椎间盘突出致压组（Ⅰ组）,共21例;骨性压迫组26例（Ⅱ组）。两组患者均给予前路椎间盘切除植骨融合内固定术,其中单纯椎间盘压迫组给予前路椎间盘切除术,椎间盘合并骨性狭窄组在椎间盘切除基础上行椎间孔减压术。采用Surgimap软件Ⅰ组通过MRI（T2W1矢状面）,Ⅱ组通过CT（二维重建矢状面,骨窗）测量患者病变节段两侧椎间孔的面积,将两组患者手术前健侧与患侧的椎间孔面积进行对比,术后患侧椎间孔面积与术前进行比较。比较两组患者术前及术后6月VAS评分和NDI评分,47例患者均获得6～12月随访。实验证实所有患者临床根性症状缓解,均无感染、内固定松动、食管瘘等并发症,这也说明术前根据影像学测量神经根型颈椎病患者椎间孔面积,评估压迫程度,分析压迫因素,可以选择不同方式的减压手术。