摘要
[目的]
本实验的目的是观测第一腰椎和第一骶椎之间(L_1～S_1)关节突关节的形态、位置与周围组织的毗邻关系以及支配神经的位置和走行,为微创治疗关节突关节源性腰腿痛提供形态学依据。
[方法]
1.选取15具(30侧)经福尔马林固定的成人腰部脊柱区标本,逐层解剖,对关节突关节形态、位置及周围组织的毗邻关系进行详细的描述和测量,并观察腰神经后内侧支及外侧支的位置和走行。
2.观察50例成人脊柱干燥骨骼标本的腰椎关节突关节类型。
3.收集300例成人的腰椎X线正位片,观察髂嵴的最高连线与棘突的关系。
[结果]
1.腰椎关节突关节位于棘突正中线的两侧,其关节范围位于上位椎体棘突中点与下位椎体棘突上缘之间。腰椎关节突关节上缘到后正中线的距离(mm)依次为13.27±0.92、15.01±1.27、17.03±1.86、19.64±2.48、23.41±2.65,到体表的距离(mm)依次为32.39±1.93、35.35±1.97、39.29±1.78、43.68±2.98、46.83±1.56;下缘到后正中线的距离(mm)依次为12.94±0.90、14.40±1.88、15.91±2.24、18.09±3.04、22.77±2.86;到体表的距离(mm)依次为32.63±1.75、36.09±1.77、39.92±1.57、44.73±1.52、46.70±1.51。
2.腰神经后内侧支走行在上关节突与横突根部形成的骨沟内,经骨纤维管转向内下后方。骨纤维管到后正中线的距离(mm)依次为20.91±1.09、22.51±1.48、24.83±1.51、27.29±1.25、29.28±0.93;到体表的距离(mm)依次为29.49±1.57、33.48±1.76、37.52±1.26、40.42±1.57、42.24±1.66。
3.腰神经后外侧支穿出后向外下与横突相交,走行在横突背面。横突点到后正中线的距离(mm)依次为22.62±1.26、24.35±1.19、26.88±1.50、30.17±1.72、32.26±1.51;到体表的距离(mm)依次为31.55±1.78、35.67±1.77、38.65±1.38、42.51±1.39、45.97±1.37。
4.L_1～S_1关节突关节类型主要为平面型(39%)和上凹面型(58%),而下凹面型(2%)和双凹面型(1%)少见。
5.髂嵴的最高连线与棘突正中线相交的位置男性以在L_4棘突为主;女性L_4-L_5间隙为主。
[结论]
1.腰椎关节突关节的穿刺应在相应棘突间隙中点外12.94±0.90～22.77±2.86mm处垂直进针,进针深度为32.63±1.75～46.70±1.51mm。
2.腰神经后内侧支穿刺点应在相应棘突间隙中点外20.91±1.09～29.28±0.93mm处垂直进针,进针深度为29.49±1.57～42.24±1.66mm。
3.腰神经后外侧支穿刺点应在相应棘突下缘外22.62±1.26～32.26±1.51mm处,进针深度为31.55±1.78～45.97±1.37mm。
[Objectivel
Observe the morphous,position of lumbar zygapophyseal joints and govern nerves and their relations with surrounding tissues,and provide morphological evidence and anatomic data.
[Method]
1.To choose 15(30 sides) lumbar spinal columns of formalin-treated adult corpses,step by step anatomise zygapophysial joints,then described and measured its mophous,position, the connection with surrounding tissues and position,Courser of govern nerves.
2.Observe the type of 50 lumbar zygapophysial joints and desiccated adult spinalis skeleton specimens.
3.To collect 300 orthophoric radiographs of adult lumbar,and observe the connection between the top line of iliac crest and vertebral segment.
[Result]
1.zygapophysial joint is in the two sides of midline of the processus spinosus,its artic amplitude is between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it.The distance between superior border of lumbar' zygapophysial joint and posterior median line are as follows(mm):13.27±0.92、15.01±1.27、17.03±1.86、19.64±2.48、23.41±2.65,to the body surface are as follows(mm):32.39±1.93、35.35±1.97、39.29±1.78、43.68±2.98、46.83±1.56;between the inferior border and posterior median line are as follows(mm):12.94±0.90、14.40±1.88、15.91±2.24、18.09±3.04、22.77±2.86,to the body surface are as follows(mm):32.63±1.75、36.09±1.77、39.92±1.57、44.73±1.52、46.70±1.51.
2.Between superior articular process and transverse process,there is lumbar nerve of posterior media branch into the bone groove,through the osteo-fibrous canal under the rear running inwards.The distance between osteo-fibrous canal and posterior median line are as follows(mm):20.91±1.09、22.51±1.48、24.83±1.51、27.29±1.25、29.28±0.93;to the body surface are as follows(mm):29.49±1.57、33.48±1.76、37.52±1.26、40.42±1.57、42.24±1.66.
3.The lateral branch of lumbar posterior divisions pass obliquely outward behind the Intervertebral foramina cross with the backside of transverse process.The distance between transverse process and posterior median line are as follows(mm):22.6±1.26、24.35±1.19、26.88±1.50、30.17±1.72、32.26±1.51;to the body surface are as follows(mm): 31.55±1.78、35.67±1.77、38.65±1.38、42.51±1.39、45.97±1.37.
4.There is 31%planar type and 69%concave type of L_1-S_1 zygapophyseal joints,few down(2%)and dual concave type(1%).
5.Between the top line of iliac crest and spinous process midline,male is in L4 spinous process,but female is the L4-5 interstice.
[Conclusion]
1.The puncture of lumbar zygapophyseal joints should,perpendicular needle insertion at the outside of corresponding spinous process interstice midpoint(12.94±0.90～22.77±2.86)mm,the depth of needle insertion is(32.63±1.75～46.70±1.51)mm.
2.The puncture of medial branch of lumbar posterior divisions should perpendicular needle insertion at the outside of corresponding spinous process interstice midpoint (20.91±1.09～29.28±0.93)mm,the depth of needle insertion is(29.49±1.57～42.24±1.66) mm.
3.The puncture of lateral branch of lumbar posterior divisions should perpendicular needle insertion at the outside of corresponding spinous process inferior border(22.62±1.26～32.26±1.51)mm,the depth of needle insertion is(31.55±1.78～45.97±1.37)mm.
引文
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