腰椎椎间孔成形靶区三维解剖形态学分型及临床意义

刘汯林, 胡宇翔, 黄澄宇, 高梓博, 肖扬, 苏裕航, 赵乾皓, 周贤熙, 刘晓生, 曾小龙, 祁冀, 林定坤, 马春媚, 李永津

doi:10.13418/j.issn.1001-165x.2026.1.01

中国临床解剖学杂志 >

2026 , Vol. 44 >Issue 1: 1 - 8

DOI: https://doi.org/10.13418/j.issn.1001-165x.2026.1.01

应用解剖

腰椎椎间孔成形靶区三维解剖形态学分型及临床意义

展开

1. 广州中医药大学第二临床医学院，广东广州 510405； 2. 广东省中医院骨伤科专科医院，广东广州 510120； 3. 广东省中医证候临床研究重点实验室，广东广州 510120； 4. 广东省中医院老年骨折科，广东广州 510120； 5. 广州中医药大学基础医学院实验教学中心，广东广州 510006； 6. 广州中医药大学基础医学院人体解剖学系，广东广州 510006

刘汯林（2002-），男，广东广州人，研究生，研究方向：中西医结合防治脊柱脊髓疾病，E-mail: 1669164262@qq.com

收稿日期: 2025-05-28

网络出版日期: 2026-01-30

基金资助

国家自然科学基金（82274554, 82205150）；广东省科技计划项目（2023B1212060063）；广东省中医院中医药科学技术研究专项（YN2024MS001）；广东省中医药科学院优秀青年人才青苗计划项目（SZ2024QN03）

收起

Three-dimensional anatomical morphological classification and clinical significance of lumbar foraminoplasty target area

Expand

1. The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2. Orthopaedic Hospital of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China; 3. Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou 510120, Guangdong Province, China; 4. Department of Geriatric Fracture, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China; 5. Experimental Teaching Center, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 6. Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China

Received date: 2025-05-28

Online published: 2026-01-30

Fold

摘要

目的探讨腰椎椎间孔成形靶区的三维形态学特征及其临床意义，为脊柱内镜下经椎间孔入路腰椎间盘切除术中精准椎间孔成形提供解剖学依据。方法选取122例腰椎上关节突，采用高精度三维扫描技术重建椎间孔成形靶区，测量椎间孔成形靶区线性参数：AB（上关节突腹侧至椎体后缘距离）、CD（上关节突基底部至上终板距离）、EF（椎弓根宽度）、 R1（AB/CD比值）。基于形态特征对椎间孔成形靶区进行解剖学分型，测量靶区三维体积及关节面面积。结果椎间孔成形靶区分为3种形态：Ⅰ型（类梯形，50%）、Ⅱ型（窄柱形，32%）、Ⅲ型（丘陵形，18%）。Ⅰ型AB最长、R1值居中、体积最大；Ⅱ型AB最短、EF最宽、R1值最低；Ⅲ型CD最短、关节面面积最小、R1值最高。各分型间参数差异显著（P<0.05）。结论腰椎椎间孔成形靶区形态可分为3种，以Ⅰ型为主，多维度参数可量化靶区空间特征与生物力学潜力，对精准椎间孔成形具有一定的临床参考意义。

关键词： ; 腰椎; ; ; 上关节突; ; ; 椎间孔成形; ; ; 应用解剖; ; ; 分型

本文引用格式

刘汯林, 胡宇翔, 黄澄宇, 高梓博, 肖扬, 苏裕航, 赵乾皓, 周贤熙, 刘晓生, 曾小龙, 祁冀, 林定坤, 马春媚, 李永津 . 腰椎椎间孔成形靶区三维解剖形态学分型及临床意义[J]. 中国临床解剖学杂志, 2026 , 44(1) : 1 -8 . DOI: 10.13418/j.issn.1001-165x.2026.1.01

Abstract

Objective To investigate the three-dimensional morphological classification of lumbar foraminoplasty target area and their clinical significance, providing an anatomical basis for precise foraminoplasty in transforaminal endoscopic lumbar discectomy. Methods A total of 122 lumbar superior articular processes were selected, and foraminoplasty target area was reconstructed using high-precision three-dimensional scanning technology. Linear parameters of the target area were measured: AB (distance from the ventral side of the superior articular process to the posterior edge of the vertebral body), CD (distance from the base of the superior articular process to the superior endplate), EF (pedicle width), and R1 (AB/CD ratio). Anatomical classification of foraminoplasty target area was performed based on morphological characteristics, and the three-dimensional volume and articular surface area of the target area were measured. Results Foraminoplasty target area was divided into three morphological types: Type I (trapezoid-like type, 50%), Type II (narrow-columnar type, 32%), and Type III (hilly-shaped type, 18%). Type I had the longest AB, moderate R1 ratio, and largest volume. Type II had the shortest AB, widest EF, and lowest R1 ratio. Type III had the shortest CD, smallest articular surface area, and highest R1 ratio. Significant differences in parameters were observed among three types (P<0.05). Conclusions The morphology of target area for lumbar transforaminal foraminoplasty can be divided into three types, with type I being the most common. Multi-dimensional parameters can quantify the spatial characteristics and biomechanical potential of target area, which has certain clinical reference significance for precise transforaminal foraminoplasty.

Key words： Lumbar vertebra; ; ; Superior articular process; ; Foraminoplasty; ; ; Applied anatomy; ; ; Classification

参考文献

[1] 陈文锦, 张树军, 彭伟, 等. 单侧双通道内镜下与经皮椎板间入路内镜下椎间盘切除术治疗L5/S1椎间盘突出症的短期临床疗效比较 [J]. 中国临床解剖学杂志, 2023, 41(5): 593-598. DOI: 10.13418/j.issn.1001-165x.2023.5.16.
Chen WJ, Zhang SJ, Peng W, et al. Short-term clinical efficacy comparison of unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for L5/S1 lumbar disc herniation [J]. Chin J Clin Anat, 2023, 41(5): 593-598. DOI: 10.13418/j.issn.1001-165x.2023.5.16.
[2] Cunha C, Silva A J, Pereira P, et al. The inflammatory response in the regression of lumbar disc herniation [J]. Arthritis Res Ther, 2018, 20(1): 251. DOI: 10.1186/s13075-018-1743-4.
[3] Hasan S, White-Dzuro B, Barber JK, et al. The Endoscopic Trans-Superior Articular Process Approach: A Novel Minimally Invasive Surgical Corridor to the Lateral Recess [J]. Oper Neurosurg (Hagerstown), 2020, 19(1): E1-E10. DOI: 10.1093/ons/opaa054.
[4] Zhang Y, Song J, Lin W, et al. Transforaminal endoscopic lumbar discectomy with two-segment foraminoplasty for the treatment of very highly migrated lumbar disc herniation: a retrospective analysis [J]. BMC Surg, 2024, 24(1): 113. DOI: 10.1186/s12893-024-02379-2.
[5] 张黎明, 杨晋才. 腰椎间孔区解剖结构特点与临床应用研究进展 [J]. 实用骨科杂志,2020,26(1): 44-47, 67. DOI:10.13795/j.cnki.sgkz. 2020.01.011.
Zhang LM, Yang JC. Research progress on anatomical characteristics and clinical application of lumbar intervertebral foramen area [J]. J Pract Orthop, 2020, 26(1): 44-47, 67. DOI: 10.13795/j.cnki.sgkz. 2020. 01.011.
[6] 刘汯林, 陈凯, 高梓博, 等. 椎间孔成形在脊柱内镜下经椎间孔入路腰椎间盘切除术中的精准应用及展望 [J]. 实用医学杂志, 2025, 41(8): 1123-1129. DOI: 10.3969/j.issn.1006-5725.2025.08.006.
Liu HL, Chen K, Gao ZB, et al. Research progress of intervertebral foramen shaping in transforaminal endoscopic lumbar discectomy via the intervertebral foramen approach [J]. J Pract Med, 2025, 41(8): 1123-1129. DOI: 10.3969/j.issn.1006-5725.2025.08.006.
[7] 吴忌, 李越, 楚福明, 等. 内镜可视化“V”区解剖引导下椎间孔成形术 [J]. 中国矫形外科杂志, 2020, 28(15): 1418-1421. DOI:10.3977/j.issn.1005-8478.2020.15.17.
Wu J, Li Y, Chu FM, et al. Endoscopic foraminoplasty under visual“V”zone anatomic guidance for lumbar lateral recess stenosis [J]. Chin J Orthop Surg, 2020, 28(15): 1418-1421. DOI:10.3977/j.issn.1005-8478.2020.15.17.
[8] Senoo I, Espinoza Orías A A, An HS, et al. In vivo 3-dimensional morphometric analysis of the lumbar foramen in healthy subjects [J]. Spine (Phila Pa 1976), 2014, 39(16): E929-E935. DOI: 10.1097/brs.0000000000000399.
[9] Qiao P, Xu T, Zhang W, et al. Foraminoplasty affects the clinical outcomes of discectomy during percutaneous transforaminal endoscopy: a two-year follow-up retrospective study on 64 patients [J]. Int J Neurosci, 2021,131(1): 1-6. DOI: 10.1080/00207454.2020. 17329 68.
[10]Li ZZ, Hou SX, Shang WL, et al. Modified Percutaneous Lumbar Foraminoplasty and Percutaneous Endoscopic Lumbar Discectomy: Instrument Design, Technique Notes, and 5 Years Follow-up [J]. Pain Physician, 2017, 20(1): E85-E98.
[11]Yang JS, Chu L, Chen CM, et al. Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year Follow-Up [J]. Biomed Res Int, 2018, 2018: 7692794. DOI: 10.1155/2018/7692794.
[12]Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases [J]. Spine (Phila Pa 1976), 2006, 31(24): E890-E897. DOI: 10.1097/01.brs.0000245955.22358.3a.
[13]李瑞, 孙兆忠, 房清敏, 等. 椎间孔镜TESSYS技术上关节突磨削程度对腰椎稳定性的影响 [J]. 中国矫形外科杂志, 2018, 26(10): 898-903. DOI:10.3977/j.issn.1005-8478.2018.10.08.
Li R, Sun ZZ, Fang QM, et al. Effect of grinding ratio of superior articular process through transforaminal endoscopic spine system on lumbar stability [J]. Chin J Orthop Surg, 2018, 26(10): 898-903. DOI:10.3977/j.issn.1005-8478.2018.10.08.
[14]苏军强, 赵斌, 王永峰, 等. 脊柱内镜不同程度椎间孔一次成形对腰椎稳定性影响 [J]. 临床骨科杂志, 2020, 23(3): 449-53. DOI: 10.3969/j.issn.1008-0287.2020.03.054.
Su JQ, Zhao B, Wang YF, et al. Effects of different degrees of foraminoplasty just once via percutaneous endoscopic lumbar discectomy on lumbar spine stability [J]. J Clin Orthop, 2020, 23(3): 449-453. DOI: 10.3969/j.issn.1008-0287.2020.03.054.
[15]Li J, Li H, He Y, et al. The protection of superior articular process in percutaneous transforaminal endoscopic discectomy should decreases the risk of adjacent segment diseases biomechanically [J]. J Clin Neurosci, 2020, 79: 54-59. DOI: 10.1016/j.jocn.2020.07.025.
[16]Wang Y, Kahaer A, Shi W, et al. Morphometric measurement of lumbar pedicle in different regions: a systematic review [J]. J Orthop Surg Res, 2023, 18(1): 30. DOI: 10.1186/s13018-023-03499-w.
[17]Yu CC, Yuh RT, Bajwa NS, et al. Pedicle Morphometry of Lumbar Vertebrae: Male, Taller, and Heavier Specimens Have Bigger Pedicles [J]. Spine (Phila Pa 1976), 2015, 40(21): 1639-1646. DOI: 10.1097/brs.0000000000001086.
[18]Calek AK, Tsagkaris C, Fasser MR, et al. Biomechanical limitations of partial pediculectomy in endoscopic spine surgery [J]. Spine J, 2023, 23(7): 1088-1095. DOI: 10.1016/j.spinee.2023.02.005.
[19]丛志超, 许德荣, 周传利, 等. 两种可视化关节突成形技术治疗腰椎间盘突出症的早期临床疗效比较 [J]. 中华骨与关节外科杂志, 2021, 14(7): 592-529, 610. DOI: 10.3969/j.issn.2095-9958.2021.07.03.
Cong ZC, Xu DR, Zhou CL, et al. Comparison of early clinical efficacy of two endoscopic techniques for lumbar disc herniation [J]. Chin J Bone Joint Surg, 2021, 14(7): 592-599, 610. DOI: 10.3969/j.issn.2095-9958.2021.07.03.
[20]刘东东, 王立飞, 宇尧. 经皮内镜下2种椎间孔成形术治疗腰椎间盘突出症的对比研究 [J]. 颈腰痛杂志, 2020, 41(5): 556-559. DOI:10.3969/j.issn.1005-7234.2020.05.011.
Liu DD, Wang LF, Yu Y. A comparative study on two kinds of percutaneous endoscopic lumbar foraminotomy for lumbar disc herniation [J]. J Cervicodynia Lumbodynia, 2020, 41(5): 556-559. DOI:10.3969/j.issn.1005-7234.2020.05.011.
[21]马学晓. 侧入路脊柱内镜技术的理念变迁 [J]. 西安交通大学学报（医学版）, 2022, 43(1): 13-17. DOI: 10.7652/jdyxb202201003.
Ma XX. Conceptual development of lateral approach percutaneous spinal endoscopy [J]. J Xi'an Jiaotong Univ (Med Sci), 2022, 43(1): 13-17. DOI: 10.7652/jdyxb202201003.
[22]孙宜保, 祝孟坤, 常晓盼, 等. 区域穿刺可视化椎间孔成形术在经皮脊柱内镜治疗腰椎间盘突出症的临床应用 [J]. 颈腰痛杂志, 2021, 42(2): 189-193. DOI: 10.3969 /j.issn.1005-7234.2021.02.011.
Sun YB, Zhu MK, Chang XP, et al. Clinical application value of regional puncture and visual foraminoplasty in the treatment of lumbar disc herniation with endoscopic surgery [J]. J Cervicodynia Lumbodynia, 2021, 42(2): 189-193. DOI: 10.3969 /j.issn.1005-7234. 2021.02.011.
[23]余洋, 谭彪, 杨世鹏, 等. 经皮内镜可视化椎间孔成形技术治疗腰椎间盘突出症 [J]. 中国微创外科杂志, 2018, 18(9): 779-782, 786. DOI: 10.3969/j.issn.1009-6604.2018.09.003.
Yu Y, Tan B, Yang SP, et al. Percutaneous Endoscopic Visual Foraminoplasty in the Treatment of Lumbar Disc Herniation [J]. Chin J Min Inv Surg, 2018, 18(9): 779-782, 786. DOI: 10.3969/j.issn.1009-6604.2018.09.003.
[24]王海莹, 吕冰, 李辉, 等. 脊柱-骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响 [J]. 中国骨伤, 2021, 34(11): 1016-1019. DOI：10.12200/j.issn.1003-0034.2021.11.006.
Wang HY, Lv B, Li H, et al. Effect of spinopelvic sagittal parameters and facet joint angle on degenerative lumbar spondylolisthesis [J]. China J Orthop Trauma, 2021, 34(11): 1016-1019. DOI：10.12200/j.issn.1003-0034.2021.11.006.
[25]Shi H, Li S, Liu S, et al. Facet joint tropism, pelvic incidence and intervertebral height index: associations with facet joint osteoarthritis in lumbar spinal stenosis [J]. Spine J, 2024, 24(2): 317-324. DOI: 10.1016/j.spinee.2023.10.001.
[26]Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans [J]. Eur Spine J, 2004, 13(2): 137-146. DOI: 10.1007/s00586-003-0586-z.
[27]Masharawi Y, Rothschild B, Salame K, et al. Facet tropism and interfacet shape in the thoracolumbar vertebrae: characterization and biomechanical interpretation [J]. Spine (Phila Pa 1976), 2005, 30(11): E281-E292. DOI: 10.1097/01.brs.0000164098.00201.8d.
[28]孙颉玮, 冯法博, 王俊, 等. 基于3D slicer比较两种椎间孔成型方法对上关节突的影响 [J]. 浙江临床医学, 2023, 25(8): 1175-1176, 1179.
Sun JW, Feng FB, Wang J, et al. Comparison of two foraminoplasty methods on the superior articular process based on 3D Slicer [J]. Zhejiang J Clin Med, 2023, 25(8): 1175-1176, 1179.
[29]李菁菁, 李雨桐, 梁平, 等. 定量计算机断层扫描在骨密度与腰椎小关节突退变及参数的相关性研究 [J]. 中国医学装备, 2025, 22(4): 53-57. DOI: 10.3969/j.issn.1672-8270.2025.04.011.
Li JJ, Li YT, Liang P, et al. Study of the correlation between bone density and degeneration parameters of small articular process of lumbar vertebra based on QCT [J]. China Med Equip, 2025, 22(4): 53-57. DOI: 10.3969/j.issn.1672-8270.2025.04.011.
[30]段春岳, 吕红斌, 胡建中. 基于影像学及计算机图像处理方法研究活体腰椎小关节结构三维分布 [J]. 医用生物力学, 2012, 27(2): 159-165. DOI: 10.16156/j.1004-7220.2012.02.004.
Duan CY, Lv HB, Hu JZ. In vivo study on three-dimensional structure of lumbar facet joints based on computer-assisted medical image processing method [J]. J Med Biomech, 2012, 27(2): 159-165. DOI: 10.16156/j.1004-7220.2012.02.004.

Options

文章导航

模态框（Modal）标题

摘要

本文引用格式

Abstract

参考文献