经上关节突基底部脊柱微创通道建立的临床解剖学研究

doi:10.13418/j.issn.1001-165x.2026.4.03

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中国临床解剖学杂志 ›› 2026, Vol. 44 ›› Issue (4) : 387-394. DOI: 10.13418/j.issn.1001-165x.2026.4.03

断层影像解剖

经上关节突基底部脊柱微创通道建立的临床解剖学研究

李佳伟^1#，张静^2#，籍庆余¹，田博文³，李筱贺³*，张凯⁴*

作者信息 +

Clinical anatomical study of minimally invasive spinal corridor establishment via the base of the superior articular process

Li Jiawei^1#, Zhang Jing^2#, Ji Qinyu¹, Tian Bowen³, Li Xiaohe³*, Zhang Kai⁴*

Author information +

文章历史 +

摘要

目的通过对203例样本L3~5椎体上关节突解剖参数进行影像学测量，探讨于L3~5椎体上关节突基底建立脊柱内镜微创安全通道的可行性。方法从内蒙古地区两家三级医院收集 203例腰椎CT资料，不限性别，年龄在 20~79 岁，分为3组，20~39岁（A组）、40~59岁（B组）、60~79岁（C组）。影像资料以 DICOM 格式导入 Mimics 21.0软件中，采用多人重复测量并取平均值的方法测量3项参数，包括上关节突基底左右径、上关节突前后径及穿刺角度，比较同年龄段同性别同椎体两侧上关节突基底间参数的差异、同年龄段同椎体不同性别间参数的差异、同年龄段同性别不同椎体间参数的差异、同性别同椎体不同年龄段间参数的差异。结果同椎体两侧上关节突间各解剖参数差异无统计学意义。同年龄段同椎体不同性别间前后径差异有统计学意义，且男性大于女性；A组内同椎体不同性别间左右径比较差异无统计学意义，但B及C组内同椎体不同性别间比较差异有统计学意义，且男性大于女性；同年龄段同椎体不同性别间穿刺角度的差异参差不齐。同年龄段同性别不同椎体间穿刺角度的差异有统计学意义，且下位椎体上关节突穿刺角度较上位椎体大；其他两项解剖参数在不同椎体间差异参差不齐。前后径同性别同椎体不同年龄间比较，大部分组间差异无统计学意义；左右径同性别同椎体不同年龄间比较，大部分组间差异有统计学意义；穿刺角度同性别同椎体不同年龄间比较，组间差异参差不齐。结论从解剖角度而言，我们认为于L3~5椎体上关节突基底部层面在上关节突内建立脊柱内镜微创安全通道是可行的。

Abstract

Objective To evaluate the feasibility of establishing a safe minimally invasive endoscopic spinal channel via the base of the superior articular processes at the L3-5 vertebral levels, by performing radiographic measurements of the anatomical parameters of these processes in 203 samples. Methods CT data of 203 cases of lumbar vertebrae were collected from two tertiary hospitals in Inner Mongolia, with no restriction on gender and age ranging from 20 to 79 years. The participants were divided into three groups based on age: Group A (20-39 years), Group B (40-59 years), and Group C (60-79 years). The radiological data was imported into Mimics 21.0 software in DICOM format. Three parameters were measured, including the left-right diameter, anterior-posterior diameter, and puncture angle of the base of the superior articular process, using a multi-operator repeated measurement approach with the average value. The following parameter differences: (1) between the bilateral bases of the superior articular processes of the same vertebra in subjects of the same age and gender; (2) between genders for the same vertebra within the same age group; (3) between different vertebrae in subjects of the same age and gender; and (4) between different age groups for the same vertebra and gender; were compared. Results There were no statistically significant differences in anatomical parameters between the superior articular processes on both sides of the same vertebral body. For the same vertebral body and age group, there were significant differences in the anterior-posterior diameter, with males having larger values than females. There were no significant differences in the left-right diameter between genders in Group A, while in Groups B and C the differences between sexes for the same vertebral body and age group were statistically significant, with males having larger values than females. There was no consistent pattern of differences in the puncture angle between genders for the same vertebral body and age group. There were significant differences in the puncture angle among different vertebra bodies in subjects of the same age and gender, and the puncture angle at the superior articular process of the lower vertebrae was larger than that of the upper vertebrae, the other two anatomical parameters showed varying degrees of differences across different vertebral levels. Comparisons of the anterior-posterior diameter between the same gender and vertebral bodies among different age showed no significant differences in most cases. Comparisons of the left-right diameter between the same gender and vertebral bodies among different age showed significant differences in most cases, while differences in the puncture angle were inconsistent among different age groups. Conclusions From an anatomical perspective, it is feasible to establish a safe minimally invasive endoscopic spinal channel within the superior articular process at the basal level of the L3-5 vertebral bodies.

导出引用

李佳伟, 张静, 籍庆余, 田博文, 李筱贺, 张凯. 经上关节突基底部脊柱微创通道建立的临床解剖学研究[J]. 中国临床解剖学杂志. 2026, 44(4): 387-394 https://doi.org/10.13418/j.issn.1001-165x.2026.4.03

Li Jiawei, Zhang Jing, Ji Qinyu, Tian Bowen, Li Xiaohe, Zhang Kai. Clinical anatomical study of minimally invasive spinal corridor establishment via the base of the superior articular process [J]. Chinese Journal of Clinical Anatomy. 2026, 44(4): 387-394 https://doi.org/10.13418/j.issn.1001-165x.2026.4.03

中图分类号： R323.43 R602

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