单侧双通道内镜下定位上腰椎神经根、椎间隙
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滨州医学院附属医院

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国家重点研发计划资助项目;山东省自然科学基金资助项目;山东省医药卫生科技发展计划项目;滨州医学院科技计划项目


The upper lumbar nerve root and intervertebral space were located under unilateral biportal endoscopic
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Binzhou Medical University Hospital

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    摘要:

    [目的]通过数字解剖学方法探讨单侧双通道内镜(UBE)下上腰椎神经根、椎间隙毗邻关系,为UBE治疗上腰椎椎管狭窄症(LSS)提供依据。[方法]21例LSS行腰椎CTM,图像导入Mimics软件建立三维模型,测量相关参数:椎板下缘与下关节突内侧缘交点(A)和椎板上缘与上关节突内侧缘交点(B)分别至硬脊膜外侧缘(a1、b1)、神经根起点下缘(a2、b2)、上位腰椎下终板(a3、b3)、下位腰椎上终板(a4、b4)、同序数腰椎下关节突外侧缘与峡部人字嵴交点(X)水平距离(a5、b5);B至同序数腰椎弓根下缘垂直距离(b6);神经根起点下缘至上位腰椎下终板(n1)、下位腰椎上终板距离(n2)。[结果]L1/2-L3/4神经根起点下缘均远离椎间隙,节段越低、越靠近椎间隙(P<0.05)。A、B均在椎间隙以下、神经根起点下缘以上;投影在硬脊膜外侧缘以内。节段越低、a5、b5、b6越大(P<0.05)。[结论]上腰椎有明显解剖学特点。LSS上下减压范围大,同侧相邻节段减压、开窗略大可致半椎板缺损;向外减压必使部分下关节突、峡部缺损。建议UBE同侧潜行、必要时对侧减压以确保脊柱稳定性。

    Abstract:

    [Objective] To investigate the relationship between the nerve roots and the intervertebral space of the upper lumbar spine under unilateral biportal endoscopic(UBE) by digital anatomical method, and to provide theoretical basis for the treatment of upper lumbar spinal stenosis (LSS) with UBE. [Methods] Lumbar CTM was performed on 21 patients with LSS. The images were imported into Mimics software to establish a 3D model, and related parameters of upper lumbar spine were measured: Points of intersection between lower edge of upper lumbar lamina and medial edge of lower articular process (A) and intersection of upper edge of lower lumbar lamina and medial edge of superior articular process (B) to lateral edge of dural membrane (a1, b1), lower edge of nerve root origin (a2, b2), lower endplate of upper lumbar spine (a3, b3), and upper endplate of lower lumbar spine (a4, b4), respectively. The horizontal distance (a5, b5) between the lateral edge of the inferior articular process of lumbar spine and the intersection of the isthmus bone crest (X); Vertical distance from point B to the lower edge of the same ordinal lumbar pedicle (b6); The lower edge of the nerve root origin was located at the upper lumbar endplate (n1) and the distance to the lower lumbar endplate (n2). [Results] In L1/2-L3/4 segment, the lower edge of the nerve root origin originated from far below the intervertebral space level. The lower the segment, the closer the lower edge of the nerve root origin was to the intervertebral space level (P<0.05). Both A and B were located below the intervertebral space, above the lower edge of the starting nerve root, and the projection was within the lateral edge of the dural membrane. The lower the segment, the larger a5, b5, b6 (P<0.05). [Conclusion] There are obvious anatomical characteristics of the upper lumbar spine. The upper and lower LSS decompression range is large.Simultaneous decompression of adjacent segments on the same side and slightly larger window opening can cause one side of the lamina defect. External decompression must result in partial defects of the inferior articular process and lumbar isthmus. It is recommended that UBE decompress ipsilateral and contralateral when necessary to ensure spinal stability.

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  • 收稿日期:2022-01-30
  • 最后修改日期:2022-01-30
  • 录用日期:2022-05-11
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