经椎板间隙溶核术的CT解剖学探讨

目的：为经椎板间隙行胶原酶溶核术避免损伤硬膜囊提供解剖学依据。方法：CT测量54例成人腰椎管及相应节段硬膜囊的横径，并计算两者之间的间隙值。结果：椎管的横径逐渐增宽，而相同节段的硬膜囊横径却是逐渐减小，两者间的差值也是逐渐增大。除L3/4和L4／5节段的硬膜囊横径差异无显著性外，其余3个节段的3个观测指标均有显著的统计学意义。特别是在L5、S1节段显得更为明显，但并不是所有患者都符合这个规律。结论：经椎板间隙行胶原酶溶核术有其解剖学依据，但由于有些个体解剖结构的变异，使得仅以腰椎的X线片作为依据进行操作，就有可能伤及硬脊膜。

CT anatomical study on intervertebral discolysis with collagenase via space between vertebral laminae

Objective: To provide anatomical basis and feasibility for intervertebral discolysis with collagenase via space between vertebral laminae so as to avoid damaging dura mater of spinal cord. Methods: Transverse diameters of vertebral canal and spinal dura mater sac were measured on CT images of lumbar spine in 54 cases. The space between two transverse diameters was calculated. Results:The transverse diameters of vertebral canal gradually increased from L_ 3/4 to L_5/S_1, whereas transverse diameters of spinal dura mater sac gradually decreased, and the space between two transverse diameters gradually increased in the same segments. The largest segment was L_5/S_1. Significant differences were detected in them ( P < 0.01) . However some cases had obvious variations. Conclusion: The intervertebral discolysis with collagenase via space between vertebral laminae has the anatomical foundation. Because of the variating, spinal dura mater sac can be injuried during puncture according to the X plain film in individual cases. The further studies are necessity.