腰椎弓根延长术截骨部位与神经根关系的解剖学研究
The anatomic study of relations between the lumbar pedicle-lengthening osteotomy site and the adjacent nerve roots
目的 观察腰椎弓根延长术截骨部位与其毗邻神经根的解剖关系，为腰椎弓根延长术离断椎弓根提供解剖数据。 方法 16例成人防腐脊柱标本， 自T12~S1去除软组织、棘突、椎板、关节突关节、横突， 充分暴露硬膜囊、神经根和腰椎弓根， 精细磨削椎弓根至椎弓根-椎体连接处，测量该部位椎弓根上缘至上位神经根下缘的间距(PSRD)，椎弓根下缘至下位神经根上缘的间距(PIRD)，椎弓根内缘至硬膜囊外缘或内侧神经根外缘的间距(PMRD)，椎弓根外缘至外位神经根内缘的间距(PLRD)，所有解剖参数都做双侧测量。 结果 腰椎弓根至上、下、内、外神经根的间距范围分别是4.9~8.6 mm，1.0~2.5 mm，0~1.6 mm，0.7~11.5 mm，左、右两侧数据无显著性差异(P>0.05)，男、女之间数据无显著性差异(P>0.05)。 结论 腰椎弓根截骨延长时，截骨部位的内缘和下缘毗邻的神经根相对于上缘和外缘损伤可能性大，透视下对椎弓根内缘和下缘截骨时要十分小心。
Objective The purpose of this research was to determine the anatomic relations between the lumbar pedicle-lengthening osteotomy site and the adjacent nerve roots and to provide anatomic parameters for the lumbar pedicle-lengthening osteotomy procedure. Methods Sixteen adult embalmed cadavers were used for this study of the lumbar spine. After removal of soft tissue, spinous processes, laminae, facets and transverse processes of T12~S1 vertebrae, the dural sac, nerve roots and lumbar pedicles were exposed. Lumbar pedicles were carefully ground to the junction of the pedicle and vertebral body. The direct measurements, including the distance from the superior border of the pedicle to inferior limit of the adjacent nerve root (PSRD), the distance from the inferior border of the pedicle to the superior limit of the adjacent nerve root (PIRD), the distance between the medial border of the pedicle and the lateral limit of the dural sac or adjacent nerve root (PMRD) and the distance from the lateral border of the pedicle to the medial limit of the adjacent nerve root (PLRD) were made bilaterally. Results Average distance from the lumbar pedicle to the adjacent nerve roots superiorly, inferiorly, medially and laterally at all levels ranged from 4.9 to 8.6 mm, 1.0 to 2.5 mm,0 to 1.6 mm, 0.7 to 11.5 mm, respectively. There was no significant difference between left and right for PSRD, PIRD, PMRD and PLRD (P>0.05). There was also no significant difference between the males and females (P>0.05). Conclusion Lumbar adjacent nerve roots medially and inferiorly were injured more easily than the superiorly and laterally. The osteotomic procedure to the medial and inferior pedicle bone edge should be performed more carefully under the fluoroscopic guidance.
Lumbar pedicle; / Nerve root; / Pedicle-lengthening; / Applied Anatomy
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