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目的:为下腰椎椎间盘镜手术入路提供解剖学依据。方法:20具L3～S1成人尸体标本,观测黄韧带、椎板、神经根、椎间盘之间的解剖关系。结果:①L3～L5下关节突外缘到棘突根部距离分别(11.44±1.67)、(14.67±1.76)和(19.90±1.70)mm;②L3～L5黄韧带椎板附着处到椎板下缘距离分别(14.14±2.40)、(11.80±2.41)和(4.85±2.07)mm;③L3～L5椎板下缘与相应椎间盘上缘垂直距离分别(11.56±2.07)、(9.25±2.82)和(0.51±3.12)mm;④L4～S1椎板上缘到相应神经根出硬膜的垂直距离分别(5.27±1.66)、(-6.76±4.36)和(-12.35±4.94)mm;⑤L4～S1神经根出硬膜到上位椎间盘下缘的垂直距离分别(8.14±2.72)、(0.86±4.98)和(-8.61±3.39)mm;⑥L3～L5神经根出硬膜到下位椎间盘上缘垂直距离分别(11.14±2.80)、(13.30±3.81)和(18.42±4.51)mm。结论:掌握下腰椎不同节段解剖特点,有利于椎间盘镜下手术工作通道的放置和操作的顺利进行。
Objective: To provide anatomical basis for lower lumbar discoscopic approach. Methods: Twenty adult cadavers aged from L3 to S1 were selected to observe the anatomy of the ligamentum flavum, lamina, nerve root and intervertebral disc. Results: (1) The distance from the outer edge of the articular process to the base of the spinous process in L3 ~ L5 was (11.44 ± 1.67) mm, (14.67 ± 1.76) mm and (19.90 ± 1.70) mm, respectively. (11.5 ± 2.07), (9.25 ± 2.82) and (0.51 ±) respectively, and the mean distance between the lower edge of L3 ~ L5 lamina and the upper edge of the corresponding disc were (14.14 ± 2.40) and (11.80 ± 2.41) 3.12) mm respectively; ④ The vertical distances from the upper edge of lamina L4 ~ S1 to the corresponding dural roots were 5.27 ± 1.66, 6.76 ± 4.36 and -12.35 ± 4.94 mm, respectively; (8.14 ± 2.72), (0.86 ± 4.98) and (-8.61 ± 3.39) mm, respectively; (6) The vertical distance from the dural edge of L3 ~ L5 nerve root to the lower edge of the lower disc were (11.14 ± 2.80 ), (13.30 ± 3.81) and (18.42 ± 4.51) mm respectively. Conclusion: To master the anatomical features of different segments of lower lumbar spine is conducive to the placement and operation of the operating channel under the microscope.