腰神经后支及其骨纤维管的应用解剖

目的：探讨腰神经后支与骨纤维管解剖结构,为临床准确诊断腰腿痛等疾病及合理实施治疗方案提供解剖学资料。方法：将纳入标准的15具尸体解剖并观察腰神经后支的走行、分支、分布及与其周围有关的解剖结构,用游标卡尺测量腰神经后支骨纤维管的长度、出口的纵径和横径。结果：腰神经后支主干长（6.03±1.23）mm,直径（1.18±0.09）mm,腰神经后内侧支、后外侧支起始处的直径分别为（0.83±0.21）mm、（0.46±0.57）mm;腰神经后支骨纤维管为腰神经后支骨纤维孔的延续,走行向后,上壁前缘为横突间韧带的镰状缘、后外侧部有上关节突副突间韧带覆盖,下壁为下位椎骨横突的上缘,内侧壁为下位椎骨上关节突的外缘与横突根部之间的骨面,外侧壁为横突间韧带的内侧缘;腰神经后支骨纤维管平均长度为（5.72±0.94）mm,腰神经后支骨纤维管出口分为近圆型、近椭圆型、裂隙型3型。结论：腰神经后支骨纤维管为狭窄、坚固管道,对穿过其中的腰神经后支起到保护作用;腰神经后支走行、分支均经过骨纤维管,任何一处病变均会导致腰神经后支发生卡压;腰神经后支及其骨纤维管与后正中线的距离、与体表的深度为临床经皮行微创脊椎内固定术、针刀松解腰神经后支骨纤维管、缓解腰神经后支卡压张力、选择性定点封闭穿刺术等操作提供依据。

An Anatomical Study of Lumbar Posterior Rami Fibers and Their Bony Canals

Objective： To explore the anatomical structure of lumbar posterior rami fibers and their bony canals in order to provide solid data for clinical assessment of pain syndromes in the lower extremities and the establishment of the therapeutic regimen design for them. Methods： In 15 cadavers that met the criteria for this study,the lumbar posterior rami fibers were dissected,with the characteristic structure,distribution and the manner of branching of these nerve fibers,and their surrounding structures observed. The length,transverse and longitudinal diameters of the nerve fibers were measured using the sliding caliper. Results： The length of the lumbar posterior primary rami is（ 6. 03 ± 1. 23） mm and the diameter is（ 1. 18 ± 0. 09） mm. The diameters of the lumbar posterior primary rami and lateral branch are（ 0. 83 ± 0. 21） mm and（ 0. 46 ± 0. 57） mm,respectively. The lumbar posterior rami canal is the posterior extension of the bony opening for the lumbar posterior rami. The canal is formed as follows,the anterior border of the roof is the falciform margin of the intertransverse ligaments; the posterolateral portion is covered by the articular process of the superior interprocess ligament; the floor is the superior border of the hypostasy spondylous; the medial wall is the bone surface between the exterior margin of the hypostasy prezygapophysis and the root of processus transverses; the lateral wall is the medial margin of the intertransverse ligaments. The average length of lumbar posterior rami canal is（ 5. 72 ±0. 94） mm. There are 3 shapes of exit for the lumbar posterior rami oval,elliptical and fissure. Conclusion： The lumbar posterior rami canal is narrow and solid; it functions to protect the lumbar posterior ramus that passes through it. The primary fibers as well as the branches of the lumbar posterior rami pass through the bony canal; any pathologic conditions affecting the shape of the canal will also induce compression on the nerve fibers. The distance between the lumbar posterior ramus and its bony canal and the posterior median line,and its depth from the body surface,can provide useful information for planning of such interventions as minimally-invasive internal fixation,small needle-scalpel procedure to relieve compression of the lumbar posterior rami fiber and selective procedures of fixed-point occlusion.