腰椎间盘高度与椎间孔相关的解剖学研究  

Anatomical study of correlation between lumbar disc heights and intervertebral foramen and nerve roots

作　　者：郝毅 郑海潮[2] 任国良[2] 茹选良[1] 赵正旭[1] 

机构地区：[1]浙江医院骨科,浙江杭州310013 [2]浙江大学医学院解剖教研室

出　　处：《中国骨伤》2006年第11期641-644,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的动态观察腰椎间盘高度丢失、造成腰椎间孔狭窄和神经根压迫的形态学变化,为临床诊断和治疗提供解剖学依据。方法采用6具正常成人腰椎解剖标本(L1-S1),腰椎间盘正常自然高度为对照组(A组);用同一标本行腰椎间盘切除,椎间隙分别插入4、3、2和1mm厚度的硅胶垫片,并且轴向施加压力,为4个实验组(B、C、D、E组)。然后动态观察和测量腰椎间孔大小与神经根受压迫的情况。结果直接观察和测量结果显示A组神经根位于椎间孔的上1/2;脊神经前根直径由L1(1.1±0.3)mm逐渐增大到L5(2.0±0.9)mm;脊神经后根直径由L1(2.0±1.1)mm逐渐增大到L5(3.8±0.4)mm;背根神经节最大直径由L1(3.9±0.8)mm逐渐增大到L5(7.1±0.9)mm。在椎间孔矢状面上脊神经前根位于背根神经节的腹侧5或7点钟处。B组全部腰椎间孔矢状径缩小,但是神经根未受压迫。C组L3,4、L4,5和L5S1椎间孔出现垂直狭窄,椎间盘膨出将神经根向头侧抬起,上位椎体的椎弓根下缘下移,神经根和脊神经节受到垂直方向压迫。D组L4,5和L5S1神经根和脊神经节受到来自前方的腰椎间盘和后方黄韧带以及下位腰椎的上关节突的横向压迫。A组与E组相比较,神经根袖与硬膜囊的夹角L3由33.6°±6.5°增大到39.7°±7.1°,L4由29.3°±7.5°增大到40.1°±5.2°和L5由20.1°±5.3°增大到46.2°±7.3°。结论下腰椎间盘高度≤3mm可以作为椎间孔狭窄诊断的参考标准。对于非手术失败的病例,手术行椎间孔减压,恢复椎间隙高度以及腰椎稳定性是治疗椎间孔狭窄的关键。Objective：To observe the morphological changes and the result of disc height vertical loss in lumbar spine and provide the anatomy basis for clinical diagnosis and treatment of stenosis of intervertebral foramina and compression of nerve roots. Methods： Six adult cadaveric lumbar spine of L1 to S1 were measured to dynamicly evaluate the anatomic relations of the vertical and sagittal dimensions of the intervertebral foramens to the adjacent neural structures. There were 6 cadavers with normal disc space height in the control group （group A）. As test groups （group B,C,D,E） ,the same cadavers were used after disc removal,4,3,2 and 1 mm silicone rubber discs were inserted and pressured in axial respectively. Results ： For group A, the nerve roots were located in the upper part of the foramina,and pass across the foramina obliquely. The diameter of the ventral root gradually increased from L1（ 1.1±0. 3） mm to L5 （2.0±0. 9） mm. The diameter of the dorsal root gradually increased from L1 （2.0 ± 1.1 ） mm to L5 （3.8±0.4） mm. The major dorsal root ganglion gradually increased from L1 （3.9± 0. 8 ） mm to L5 （7. 1±0.9） mm. On the sagittal aspect of the foramina,the ventral root were located in 5：00 or 7：00 of the dorsal root ganglion. For group B, the vertical dimensions of all the foramina were reducted, but the nerve root were not oppressed. For group C,the foramina of L3,4 ,L4,5 and L5S1 became narrower vertically, the nerve root and nerve root ganglion were oppressed between the protrudent disc and the inferior border of the foramen. For group D, sagittal oppression occurred in the nerve root of L4 and L5. Compared with group A in group E,the frontal angle of the nerve root of L3 from（33.6°±6. 5°） aggrandized to （39. 7°±7.1°） ,L4 from （29. 3°±7. 5°） aggrandized to （40. 1°±5.2°） and L5 from （20. 1°±5.3°） aggrandized to （46. 2°±7. 3°）. Conclusion：Disc height ≤3 mm may be used as reference standard for the diagnosis of the foramina

关 键 词：腰椎 椎间盘 解剖学 

分 类 号：R681.504[医药卫生—骨科学]