经偏斜的椎弓根通道进行上位椎间盘刮除的解剖学研究  

An anatomical study of the upper lumbar discectomy through the deflective pedicle channel

作　　者：吴胜林[1] 徐德鑫[1] 翟成磊[1] 

机构地区：[1]吉林大学第四医院骨科,长春130011

出　　处：《中国骨与关节杂志》2014年第11期852-855,共4页Chinese Journal of Bone and Joint

基　　金：吉林省科技厅登记成果项目(2013084)

摘　　要：目的：探讨经偏斜的椎弓根该通道行椎间盘髓核摘除的可行性。方法选取6具成人尸体脊柱标本，取 T10以下8个节段建立达上位椎间盘的椎弓根通道，描记可刮除的椎间盘范围并进行图像处理，计算每个椎间盘被刮除的面积占该节段椎间盘总面积的比值，再分别计算前、后部椎间盘被刮除的面积各占前部及后部的比值。结果可刮除面积占总面积的百分比从T10～11到L4～5依次为（16.96±0.54）%、（21.67±0.26）%、（21.52±1.13）%、（21.96±0.87）%、（22.64±1.04）%、（26.51±1.02）%、（33.87±1.32）%，趋势为逐渐递增，到L5～S1又明显减低，为（24.28±1.24）%。前、后可刮除面积占前、后总面积百分比的分析结果为：T10～11前方比值（15.40±1.62）%，后方比值（24.57±0.60）%；T11-12前方比值（20.75±0.86）%，后方比值（23.96±1.18）%；T12～L1前方比值（17.77±1.36）%，后方比值（24.33±1.08）%；L1～2前方比值（20.22±1.42）%，后方比值（25.06±1.22）%；L2～3前方比值（21.55±0.25）%，后方比值（22.26±0.85）%，后方比值均大于前方比值，但差异无统计学意义（P＞0.05）。结论经偏斜的椎弓根通道到达上位椎间盘，行T10～11到L4～5节段椎间盘髓核摘除，具有可操作性，其中L4～5间隙在该椎弓根通道下摘除髓核的可操作性最大。Objective To describe the range of the upper intervertebral disc through the delfective pedicle channel and to explore the feasibility of discectomy through the channel.Methods Six adult spinal specimens were taken from cadavers and the pedicle channel reaching the upper intervertebral disc was made in 8 segments below the 10th thoracic vertebra. Image processing was performed for the range of the disc which was striken off. The ratio of the scraped area and the total area of the segment was calculated, and also the ratio of the scraped area and the total area of the front part and the rear part.Results The ratio of the scraped area and the total area was gradually increased from T10-11 to L4-5 and signiifcantly reduced in L5-S1, which was （ 16.96±0.54 ） %, （ 21.67±0.26 ） %, （ 21.52±1.13 ） %, （ 21.96±0.87 ） %, （ 22.64±1.04 ） %, （ 26.51±1.02 ） %, （ 33.87±1.32 ） % and （ 24.28±1.24 ） % respectively. The ratios of the scraped area and the total area of the front part and the rear part in T10-11 were （ 15.40±1.62 ） % and （ 24.57±0.60 ） %, which were （ 20.75±0.86 ） % and （ 23.96±1.18 ） %, （ 17.77±1.36 ） % and （ 24.33±1.08 ） %, （ 20.22±1.42 ） % and （ 25.06±1.22 ） %, （ 21.55±0.25 ） % and （ 22.26±0.85 ） % in T11-12, T12-L1, L1-2 and L2-3 respectively. The ratio of the rear part was greater than that of the front part from T10-11 to L2-3.Conclusions The discectomy from T10-11 to L4-5 can be performed through the delfective pedicle channel reaching the upper intervertebral disc, and the most satisfactory results can be found in the intervertebral space of L4-5.

关 键 词：椎间盘 刮除术 解剖学 尸体解剖 

分 类 号：R687.3[医药卫生—骨科学] R322[医药卫生—外科学]