本文選題：腰痛　切入點：針刀入路　出處：《山西中醫(yī)學院》2016年碩士論文　論文類型：學位論文

【摘要】：目的通過對10具經(jīng)過防腐處理的成年男性尸體進行解剖研究,對成年男性腰神經(jīng)后外側(cè)支及其有關結構進行了解剖觀測,探討導致腰神經(jīng)后外側(cè)支神經(jīng)卡壓癥的解剖學機制及小針刀治療此癥的手術入路特點,尤其是針刀在體表定位及針刀進刀方向選擇,注意避免損傷的結構,為臨床治療腰椎神經(jīng)后外側(cè)支神經(jīng)卡壓癥提供解剖學數(shù)據(jù)。方法本課題通過對10具經(jīng)過防腐處理的成年男性尸體進行解剖(確保進入本課題的尸體符合相關標準),仔細觀察腰椎旁淺層、深層的肌肉以肌肉的分布、循行特點,以及所支配該肌肉的神經(jīng)、血管等走行,重點觀察腰神經(jīng)后外側(cè)支深部的行程及其分支分布規(guī)律,并測量腰神經(jīng)后外側(cè)支骨纖維管的長度、橫徑、縱徑,并對腰神經(jīng)后外側(cè)支骨纖維管距離體表的深度和其距后正中線的距離進行了測量,并對測量的數(shù)據(jù)進行統(tǒng)計學分析。結果(1)同一尸體兩側(cè),腰神經(jīng)后外側(cè)支骨纖維管的長度、橫徑、縱徑、距離體表深度及距后正中線距離差異無統(tǒng)計學意義。(2)腰神經(jīng)后外側(cè)支骨纖維管長度為(1.67±0.79)mm,橫徑為(22.70±6.10)mm,縱徑為(3.34±1.32)mm,距離體表深度為(37.59±7.50)mm,距后正中線距離為(30.20±6.21)mm。(3)通過解剖研究發(fā)現(xiàn),從L1~L3橫突的外側(cè),L3橫突投影與腎臟臟器相互重迭,尤其是右側(cè)腎臟,并且觀察發(fā)現(xiàn)腰神經(jīng)后外支骨纖維管位于椎旁肌肉(豎脊肌)深面,故針刀入路治療腰椎疾病一定要把握適當?shù)纳疃?30.87~45.09)mm,應明確針刀貼近骨纖維管后在進行具體的操作,以避免損傷周圍重要臟器。結論(1)同一尸體兩側(cè),腰神經(jīng)后外側(cè)支骨纖維管的長度、橫徑、縱徑、距離體表深度及距后正中線距離差異無統(tǒng)計學意義(P0.05);(2)腰神經(jīng)后外側(cè)支骨纖維管的體表定位,通過解剖可以得知骨纖維的位置在同序數(shù)腰椎棘突中點水平成18°~26°角的外上方,距離后正中線外(26.71~36.41)mm的交點外側(cè)定位,從L1~L5夾角逐步減小,而距后正中線的距離逐漸增大。(3)臨床針刀治療腰神經(jīng)后外側(cè)支卡壓癥時,要使針刀入口線沿著腰神經(jīng)后外側(cè)支骨纖維管長軸,與后中線夾角42°~48°的外下方向,自上而下夾角逐步變小。于上述位點垂直進刀(30.87~45.09)mm深達后外支骨纖維管,使刀口順骨纖維管長軸方向縱切1~3次,即與深層胸腰筋膜之纖維束垂直方向縱切。
[Abstract]:Objective to observe the posterior lateral branch of lumbar nerve and its related structures in 10 adult male cadavers treated with anticorrosion. To explore the anatomical mechanism of nerve compression of the posterior lateral branch of the lumbar nerve and the characteristics of the surgical approach for the treatment of the disease, especially the location of the needle knife on the body surface and the choice of the direction of the knife feed, and to pay attention to the structure of the injury. Methods 10 adult male cadavers treated with anticorrosion were dissected (to ensure that the cadavers entering the subject met the relevant standards) in order to provide anatomical data for the treatment of lumbar nerve posterolateral nerve entrapment. Look closely at the superficial layers of the lumbar vertebrae, The deep muscles are characterized by the distribution of muscles, along the course, as well as the nerves and blood vessels that dominate the muscles. The distribution of the deep branches of the posterior lateral branch of the lumbar nerve is mainly observed. The length, transverse diameter and longitudinal diameter of the fibrous canal of the posterior lateral branch of the lumbar nerve were measured. The depth of the fibrous canal of the posterior lateral branch of the lumbar nerve from the body surface and the distance from the posterior median line to the bone fiber tube of the posterior lateral branch of the lumbar nerve were measured. The measured data were analyzed statistically. Results 1) the length, transverse diameter and longitudinal diameter of the fibrous canal of the posterior lateral branch of the lumbar nerve on both sides of the same cadaver. There was no significant difference in the distance between the body surface depth and the distance from the posterior median line. The length of the fibrous canal of the posterior lateral branch of the lumbar nerve was 1.67 鹵0.79 mm, the transverse diameter was 22.70 鹵6.10 mm, the longitudinal diameter was 3.34 鹵1.32 mm, the distance from the posterior midline was 37.59 鹵7.50 mm, and the distance from the posterior median line was 30.20 鹵6.21 mm. The projection of L3 transverse process of L1 and L3 transverse process overlapped with the renal organs, especially the right kidney. It was observed that the osseous fibrous canal of the posterior branch of the lumbar nerve was located on the deep side of the paravertebral muscle (Vertical Spinal muscle). Therefore, it is necessary to grasp the appropriate depth of 30.87 ~ 45.09 mm in the treatment of lumbar disease by needle knife approach, and make sure that the needle knife is close to the osseous fibrous tube and carry out specific operation to avoid the injury of important organs around the body. Conclusion No 1) both sides of the same corpse should be treated. There was no significant difference in length, transverse diameter, longitudinal diameter, distance from body surface depth and distance from posterior median line to the length, transverse diameter, longitudinal diameter of the fibrous canal of the posterolateral branch of the lumbar nerve, and there was no significant difference in the body surface location of the fibrous canal of the posterior lateral branch of the lumbar nerve. Anatomical analysis shows that the position of the bone fiber is located on the outer upper side of 18 擄/ 26 擄angle at the middle point of the spinous process of the lumbar vertebrae at the same ordinal number, and the lateral position of the intersection point at 26.71 ~ 36.41 mm away from the posterior median line decreases gradually from the angle between L _ 1 and L _ 5. The distance from the posterior median line to the posterior median line gradually increased. 3) in the treatment of lumbar nerve posterolateral branch entrances along the long axis of the posterior lateral branch of the lumbar nerve, the angle between the needle and the posterior midline is 42 擄or 48 擄. The angle from top to bottom becomes smaller gradually. At the above site, the vertical feed is 30.87 ~ 45.09 mm deep to the outer branch of bone fiber tube, and the cutting edge is longitudinal cut 1 ~ 3 times along the long axis of the bone fiber tube, that is to say, vertical longitudinal cutting with the fiber bundle of the deep thoracolumbar fascia.
【學位授予單位】：山西中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9

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