| Objective: The Angle and distance of acupotomological access to different areas of the foramina via the external foraminal orifice and the parameters of the bony structure associated with the external foraminal orifice were quantified.The correlation between the bony structure associated with the external foraminal orifice and acupotomological approach was analyzed from multiple parameters,and the influence of the bony structure around the external foraminal orifice on the acupotomological approach due to the difference of its anatomical characteristics was summarized.To explore the operation plan and applicable type range of acupotomology transforaminal approach in the treatment of lumbar intervertebral disc herniation,and to provide accurate data and theoretical support for clinical acupotomology treatment of lumbar intervertebral disc herniation.Methods: Fifty-two sets of adult dry vertebral bone specimens(male 27,female 25)were selected,and the specimens were complete without injury,lumbar disease records,traumatic deformity,surgical history,and bone structural abnormalities.Intervertebral foramen area in vertebral specimens,measured with electronic vernier card and protractor L3/4 and L4/5 intervertebral foramen and bony structure around the related parameters and the different partition simulation of needle knife in the Angle,slope and near distance,finally using the statistical software for statistical analysis of relevant data to explore L3/4,L4/5 intervertebral foramen mouth around osseous effect of needle knife in the road.Results: 1.Results of bony structural parameters around the external foramina: The distance between the outer edge of the superior articular process,the inferior articular process,the transverse process and the posterior midline as well as the overall average distance between the height difference of the upper vertebra were as follows: L4(22.58±1.86 mm,20.59±2.13 mm,43.62±2.58 mm,47.65±2.12mm),L5(25.72±2.37 mm,22.82±2.97 mm,45.69±3.53 mm,47.90±2.41mm).There were significant differences in segment and sex between groups(p < 0.05).The overall average distance from the spinous process to the superior pedicle notch is: L4(47.65±2.12mm),L5(47.90±2.41mm).There was no significant difference in segmental comparison(p > 0.05),but there was significant difference in gender(p < 0.05).2.The results of the parameters of needle knife approach in each region of intervertebral foramen: the overall average degrees of needle knife approach angle in entrance area,central region(medial side of pedicle),central region(lateral side of pedicle)and exit area of intervertebral foramen were respectively: L4(68.51±1.51°,61.71±1.77°,17.68±0.70°,11.56±1.25°),L5(77.94±3.03°,59.76±2.03°,18.21±0.90°,12.12±1.38°);The overall average bypass distances of the needle knife approach in the four survey areas are: L4(79.38±3.04 mm,46.40±1.11 mm 、 18.79±2.02 mm,16.57±1.60mm),L5(77.94±3.03 mm,46.31±1.49 mm,19.73±1.89 mm,17.55±1.59mm).The results of segmental comparison showed that there was no significant difference in the approach angle and side opening distance in the central area(lateral pedicle)(p > 0.05),but there were significant differences in the other three approaches(p < 0.05).In the sex comparison,there was only significant difference in the entrance angle and side opening distance of the intervertebral foramen(p < 0.05),but there was no significant difference in the other three items(p > 0.05).The overall average degree of the upper inclination angle of the needle knife is: L4(7.43±0.83°),L5(7.52±1.07°).There was no significant difference in segment and sex between groups(p > 0.05).There was no significant difference in the above parameters between the two sides(p > 0.05).3.Results of linear correlation analysis: The distance from the outer edge of the superior articular process to the posterior median line in male,female and L5 segment of L4 segment was correlated with the distance of needle knife approach in the entrance area of intervertebral foramen,central area(medial side of pedicle),central area(lateral side of pedicle)and exit area(bilateral).The distance from the inferior articular process to the posterior median line of the inferior articular process in L4 and L5 women was correlated with the distance of needle knife approach in the entrance area of intervertebral foramen,central area(medial side of pedicle),central area(lateral side of pedicle)and exit area(bilateral).There was little correlation between the distance parameters from the outer edge of the transverse process to the posterior median line and the needle knife approach parameters in L4 and L5 segments.Conclusions: 1.The observation of dry skeletal vertebrae of lumbar vertebrae can clearly describe the distribution range of intervertebral disc herniation in different regions of intervertebral foramen,and further standardize the puncture path of needle knife in different regions of intervertebral foramen,which has important guiding significance for needle knife operation.2.The bony structures of the superior and inferior articular processes,transverse processes and spinous processes of L4~L5 are relatively fixed in space and closely related in anatomical structure,which can be used as the inherent reference of needle knife approach.3.The transverse distance parameters of the upper and lower articular processes from L4 to L5 are strongly correlated with knife approach approach parameters in different areas of the foramina,which can provide a numerical reference for the location of needle knife approach.The correlation between transverse process length and knife approach approach parameters is weak,and its reference value to knife approach approach is small.In clinical practice,the puncture location of knife approach approach should be adjusted according to the transverse distance of the superior and inferior articular processes of different individuals,but the influence of gender and segment factors should be paid attention to.4.The measurement of related parameters of needle knife approach in different regions of intervertebral foramen of L3/4 and L4/5 can provide theoretical data reference for the scheme design of needle knife targeted treatment of different types of lumbar disc herniation.5.The needle knife through the intervertebral foramen approach should pay attention to the depth of the needle and the angle with the sagittal plane of the human body.Improper grasping may damage the intestine or important nerves and blood vessels before and after the vertebral body.Needle knife surgery for the release of the entrance of the intervertebral foramen and the central region(the medial area of the pedicle),especially in the area near the posterior midline,should be accurately located under the guidance of imaging. |
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