下腰椎脊神经根发出部位与盘黄间隙解剖关系的临床研究

目的 探讨下腰椎脊神经根分出部位与盘黄间隙的解剖关系在腰椎退行性疾病的应用.方法 回顾性分析167 例经后路手术治疗存在盘黄间隙狭窄的下腰椎退行性疾病患者的临床资料.根据术前MRI显视和术中所见,将下腰椎脊神经根分出部位与盘黄间隙的解剖关系分为三种类型,Ⅰ型：分出部位在盘黄间隙上缘或以上;Ⅱ型：分出部位在盘黄间隙中部区域;Ⅲ型：分出部位在盘黄间隙下缘或以下;盘黄间隙狭窄分为轻度（2～5 mm）和重度（小于2 mm）.对不同类型及分度进行统计学分析.结果 Ⅰ型（88节段）：L3～40节段、L4～521节段、L5S167节段;Ⅱ型（69节段）：L3～44节段、L4～554节段、L5S111节段;Ⅲ型（33节段）：L3～416节段、L4～517节段、L5S10节段;各型节段间隙差异均有统计学意义（P＜0.05）.各型所占轻、重度盘黄间隙狭窄数差异有统计学意义（P＜0.05）.结论 下腰椎脊神经根发出部位在盘黄间隙从L3～4到L5S1有上移的趋势;Ⅰ型和Ⅱ型患者轻度下腰椎盘黄间隙狭窄易出现神经根性症状,Ⅲ型患者常表现为重度盘黄间隙狭窄.明确脊神经根发出的部位与盘黄间隙之间的关系,有利于明确相关腰椎退行性疾病的部位诊断和减压范围.

Anatomic Relationship Clinical Research of the Lumbar Spinal Nerve Root Out Position and Intervertibral Disk-flavum Ligamentum Space

Objective To study the anatomic relationship of lumbar spinal nerve root position and intervertibral disk-fla- rum ligamentum space（DFLS） in lumbar degenerative disease. Methods The clinical data of posterior operation in the treat- ment of existing DFLS stenosis lumbar degenerative diseuse of 167 cases were retrospectively analyzed. According to MRI pre- operative and intraoperative findings, the lumbar spinal nerve root out position and intervertibral disk-flavum ligamentum space anatomic relationship were divided into three types：spinal nerve root out position in DFLS on edge or above for type I ,spinal nerve root out position in DFLS central area for type I1 ;spinal nerve root out position in DFLS lower margin or below for type HI. The DFLS in 2 - 5 mm was be diagnosed as light stenosis, and DFLS 〈 2 mm was diagnosed as severe stenosis Different types and dividing were conducted by the statistical analysis. Results Type I included 88 segments, among them there were 0 L3 - 4 segments, 2 L4 _ 5 segments,7 L5 $6 segments ; Type 11 have 69 segments, including 4 L3 _ 4 segments,45 L4_ 5 segments, 11 L5 S~ segments ;Type mincluded 33 segments,including 16 L3 -4 segments, 17 L4_5 segments,O L5 S1 segments. There were sta- tistical difference in the segment each type And there were statistical difference in the ratio of the number of light/severe DFLS stenosis between Type I , type II and type lU Conclusion The lumbar spinal nerve of position in lumber DFLS has up trend from L3-4 to L5S1 Type I and type 11 patients with light DFLS stenosis prone to lumbar nerve root symptoms Type m patients frequently displayed as severe DFLS stenosis The relationship between spinal nerve root out of position and DFLS is helpful to site diagnosis and decompression range in lumbar degenerative disease.