脊柱腰部退行性变对腰神经根通道的影响

目的通过对脊柱腰部形态结构退变的观测,综合评判其对腰神经根通道的影响,进而探讨中老年人腰神经根受压之好发部位。方法本课题以20具中老年尸体的脊柱腰部为着眼点,以腰神经根为主线,探寻腰神经根毗邻结构之退变规律及其影响。结果椎间盘、椎间关节与黄韧带的退变常导致下腰区椎管侧部之椎间盘-黄韧带间距变窄,可使L4、L5脊神经节及椎间静脉下支在椎间管内口处受压;尚可使L5、S1神经根之硬膜囊外部分在其同序数上一位盘带间受压。盘带间距变窄可导致椎管后天性狭窄,嵌夹压迫处在硬膜囊内最外侧角的腰、骶神经根。结论脊柱腰部退行性变是导致中老年慢性腰腿痛即老年性腰椎病最常见且最重要的原因。

IMPACTING OF DEGENERATIVE CHANGES AT THE LUMBAR SEGMENTS OF SPINAL COLUMN TO THE LUMBAR NERVE ROOT CHANNELS

Objective To observe the degenerative changes of the lumbar segments of spinal column, comprehensively evaluate the impact of degenerative changes to the lumbar nerve root channels, and then investigate the most common compressed site of lumbar nerve roots in the elderly. Methods To explore the impact of the lumbar degenerative changes to the lumbar nerve roots; the subject focused on the lumbar segments of spinal column in 20 elderly corpse, the main clue was the lumbar nerve roots. Results The degenerative changes of the intervertebral disc, intervertebral joint and flaval ligament often led to the narrowing distance between the intervertebral disc and the flaval ligament at vertebral canalis sidepiece in the below lumbar region. L4,L5 spinal ganglia and the inferior branch of intervertebral vein were compressed at the endostoma of intervertebral canal; and , L5 , Sj nerve roots were compressed at the epidural part between the intervertebral disc and the flaval ligament. More noteworthy, the narrowing distance between the intervertebral disc and the flaval ligament could lead to the acquired stenosis of lum- bar canal. The place that the lumbar and sacral nerve roots were incarcerated and oppressed was at the most lateral angle in the dual sac. Conclusion The degenerative changes of the lumbar segments of spinal column is the most common and important reason of the chronic low back pain in the elderly, i.e. the senile lumbar spondylosis.