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目的探讨腰椎KadishⅡ型的神经根变异的镜下解剖,掌握镜下神经根变异的识别防止神经根损伤。方法回顾性分析本院自2008-08—2012-08进行所有MED手术,术中利用显微内窥镜系统(MED)及影像采集系统,手术显露硬膜囊及神经根,并用MED内镜采集系统记录手术图片及录像。结果 KadishⅡ型的神经根变异在临床上很少见,在内镜下由于上关节和黄韧带的覆盖,镜下很难发现,只有彻底切除黄韧带和部分上关节突时才能充分显露,在椎间盘摘除时,不充分显露时易造成灾难性后果,神经根变异与移行椎呈正相关。结论腰椎KadishⅡ型的神经根变异给临床上造成困难,临床上患者可以出现单间隙椎间盘突出压迫2根神经根,出现2根神经根的症状,镜下解剖可以让术者更深刻更直观地理解神经根、硬膜囊、椎间盘之间的关系。同时该类变异与腰椎骶化有相关性。
Objective To investigate the microscopic anatomy of radicular Kadish type Ⅱ nerve root mutation and to master the identification of nerve root mutation under microscope to prevent nerve root injury. Methods A retrospective analysis of our hospital from 2008-08-2012-08 all MED surgery, intraoperative use of microendoscopic system (MED) and image acquisition system, surgery revealed the dural sac and nerve root, and MED endoscopic acquisition System records surgical pictures and videos. Results Kadish Ⅱ type of nerve root mutation is clinically rare in the endoscope due to the coverage of the upper joints and the ligamentum flavum, the microscope is difficult to find, only the complete removal of the ligamentum flavum and some can be fully exposed, in the intervertebral disc Removal, when not fully revealed easily lead to catastrophic consequences, nerve root mutation and posterior translation was positively correlated. Conclusion Kadish Ⅱ type of radiculopathy in the lumbar vertebra has clinical difficulties. Clinically, patients may have single gap disc herniation to compress two radicles and two radicles. The microscopic anatomy can make the surgeon understand more deeply and intuitively Nerve root, dural sac, disc between the relationship. At the same time, this type of mutation is associated with lumbar sacralization.