【作者】 钱宇；

【导师】 范顺武；

【作者基本信息】 浙江大学 ， 外科学， 2002， 硕士

【摘要】 实验设计 在成人新鲜尸体下腰骶椎标本上研究椎间孔的形态，建立椎间盘高度丢失的生物力学实验模型，并在此模型上研究椎间盘高度与椎间孔形态的相关性变化。背景资料 椎间孔是椎管侧方的窗口，神经根从硬膜囊发出，通过椎间孔，离开椎管。正常椎间孔有足够的空间容许神经根通过，但当椎间孔的形态发生改变，截面积缩小时可卡压神经根。在下腰椎，神经根的截面积与椎间孔面积的比值大于上腰椎，因此发生椎间孔狭窄神经根卡压的概率更高。在腰椎退变过程中，小关节的半脱位、黄韧带的增生肥厚和椎间盘纤维环的膨突等病理变化改变了椎间孔的形态，增加了椎间孔狭窄、神经根卡压的危险性，特别是椎间盘高度的丢失与椎间孔狭窄发生的关系尤为密切。国外已经有学者注意到了椎间孔形态与椎间盘高度之间的相关性，也做了一些研究。但在脊柱标本上系统研究椎间盘高度丢失和椎间孔形态相关性变化在国内外文献上尚未见报道。目前国内由于对椎间孔狭窄的发生机理及其相关因素的研究和认识较少，特别是椎间盘高度的丢失在椎间孔狭窄的发生中所起的作用及两者的相关性未得到系统的认识，限制了临床上对椎间孔卡压征的准确诊 浙江人学硕土学位论义 一 断和正确治疗。 目的 研究下腰椎椎间孔的形态及其与椎间盘、神经根的懈剖关系以及当椎间盘高 度丢失时椎间孔形态的相关性变化。 方法 取正常成年男性新鲜尸体 h腰椎标本 8具（L3～敝肾），剔除周围肌肉，保留 韧带利神经，保存下－20℃冷藏箱中待用。解冻后观察椎间孔和神经根的解剖形态及 二者解剖关系。用游标 F尺测量椎间孔的各个尺径。摄 X线侧位和双侧 15”斜位片， 测量计算椎间盘高度和椎间孔高度。将标本置于力学测试装直中，纵向加载500牛 顿，观察测量椎间孔的形态和尺径。摄X线侧位片和双侧15“斜位片，测量计算椎 间盘高度和椎间孔高度。在椎间盘前方切开纤维环，摘除髓核。同法纵向加载300 牛顿和 500牛顿，观察测量椎间孔的形态和尺径。摄 X线侧位片和双侧 15”斜位片， 测量计算椎间盘高度和椎间孔高度。记录各组数据，川 SPSS 0刀 FOR WINDOWS 软件进行统计分析。 结果 在无加载的囱然状态下，椎间孔上大下小，Y倒直的泪滴形，神经根位丁椎 间孔上部，周围有脂肪组织包绕、填充。L。；。椎间孔高度为 16l 4士 2．24mm，最人宽 度为门人 土2．06mm，最小宽度为 5．49士 1二smm，椎间盘前高为 9．5士 1．90mm，后 高为6．84士1．36mm：LSSI椎间孔高度为 15．22士2．16min，最人宽度为 10．43土2刀smm， 最小宽度为 6．86上 1．26mm，椎间盘前高为 10刀8士2．olrnm，后高为 6刀9士 1．32mm。 在椎间盘完整的状态卜，加载500牛顿椎间孔仍为倒直的泪滴形，未见明显的小关 节半脱位、黄韧带皱缩、纤维环膨突等形态改变。神经根仍位丁椎间孔上部，加载 二 过程中神经根周围的脂肪组织无明显被压迫、排挤现象。L4。椎间孔高度较加载前t“”’一”’一’—”—一’‘’”“””“———””—””—————－‘””””’－“－－－，。·——－—－————－ 丢失 10．75％，最人宽度丢失 11．60％，最小宽度无统计学差别，椎间盘前高无统计 学差别，后高丢失门．99％；LSSI椎间孔高度丢失16．11％，最大宽度丢失门339％， 最小宽度无统计学差别，椎间盘前高无统计学差别，后高丢火 11．82。破坏椎间盘， 3 浙江大学硕士学位论文 摘除髓核，加载300－500牛顿后，椎间盘纤维环逐渐向椎间孔内膨突，小关节半脱 位，黄韧带皱缩，使椎间孔缩小，变形。神经根与前方的纤维环和后方黄韧带更贴 近，并破二者推挤向同位椎弓根的下缘。加载过程中神经根周罔的脂肪组织被压迫、 排挤出椎间孔。加载300牛顿时，L。／s椎间孔高度较加载前丢失26刀9％，最大宽度 丢夫门．85％，最小宽度无统计学差别，椎间盘前高壬人16．63％，后高丢大41刀8： L。S；椎间孔高度丢人26．63％，最大宽度丢夫13．98％，最小宽度无统计学差别，椎 间盘前高丢失26．49％，后高丢失33．33％。加载500牛顿时，L4／5椎间孔高度较加载 前丢失 34．44％，最大宽度丢失 ZI．更多还原

【Abstract】 Study Design. Study of morphological characteristics in cadaveric lowlumbosacral vertebrae spines was performed. Model of disc heightsloss was created and foramina change in the process of the loss ofdisc heights on this model were studied.Objective. To study the morphological characteristics of foramina oflow lumbar and the anatomic relationships between foramina and discsand nerve roots, and their changes in the process of the loss of discheights.Summary of background data. Foramina are lateral "windows" ofspinal canal. The lumbar nerve roots pass through the foramina afteroriginating from the thecal sac. Normally, there is enough space withinforamina to allow nerve roots to pass through. In degenerative lumbar, subluxation of facet joint, lateral bulging of anulus fibrosis and hypertrophic ligamentum flavum increase the risk of foraminal stenosis and nerve roots trapment. Especially, the loss of disc height is always associated with foraminal stenosis. In low lumbar spines, the ratio of the cross-sectional area of nerve roots to cross-sectional area of foramen is higher than upper lumbar. It becomes the cause of higher accidence of nerve roots compression in low lumbar spines. Few studies have focused on the relationship between the loss of disc heights and morphological characteristics and dimensions of foramina. Methods. Eight fresh cadaver lumbar spines (L3~Sacrum) were obtained for study. Surrounding musculature was cleaned, and the ligaments and nerve were reserved. The specimens were stored at -20 "C until tested. After they were completely thawed at room temperature, the morphological characteristics of foramina and nerve roots and their anatomic relationship were observed. The dimensions of foramina were measured with a calliper. Each specimen was taken lateral and 15?oblique radiograph to measure the discs and foraminal heights. Then specimens were placed on the special biomechanical instrument and loaded 500 Newton. The morphological characteristics and dimensions of foramina and the discs heights were studied again. Anulus fibrosises were cut open in the anterior section and nucleus pulposus were removed. Loaded 300 and 500 Newton, the morphologicalcharacteristics and dimensions of foramina and the disc heights were studied again. All the data were recorded Statistical analysis was done with SPSS 10.0 FOR WINDOWS software.Results. In the natural condition without any loaded, the foramina (Us and LsSi) were inverted teardrop-shaped, and nerve roots were located in upper section of foramina surrounded by fat. The foraminal heights wasl 6.14 02.24mm in U/s, and 15.22 .16mm in L5Si; max width was 11.19.06mm in U/s, and 10.4?.08mm in L5Si; min width was 5.4?1.35mm inU/s, and 6.86+1.26mm inL5Sr, anterior disc height was 9. ?1.90mm in L45, and 10.8 ?.01 mm in L5Si; posterior disc height was .84?1.36mm in U/s, and6.09?1.32mm in L5Si. Loaded 500 Newton, the foramina were still inverted teardrop-shaped. The foraminal height lost 10.75% in U/s, and 16.11% in LsS max width Iost11.60% in Us, and 11.39% in LsSi; min width was of no statistical difference in U/s and in L5Si; anterior disc height was of no statistical difference in U/s and in L5Si; posterior disc height lost 11.99% in U/s, and lost 11.82% in L5Si. Nerve roots were still located in upper section of foramina without obviously-crushed fat. After nucleus pulposus were removed and loaded, lateral bulging annulus fibrosis, subluxating facet joint and shrunken ligamentum flavum made foramina change into pear-shaped. Nerve roots got close to anterior annulus fibrosis and posterior ligamentum flavum, and were compressed against the superior pedicle by them. Surrounding fat was crushed obviously.Loaded 300 Newton, the foraminal height lost 26.09% in U/s, and 26.63% in L5Si; max width lost 17.85% in U/s, and 13.98% in L5Si; min width was of no statistical difference in L4/5 and in L5S1; anterior disc height lost 16.63% in U/s, and 26.49% in L5S1, posterior disc height lost 41.08% in U/s, and更多还原