Anatomical And Clinical Application Of Modified Kambin Triangle Into Quadrilateral In The Protection Of Nerve Structure In MIS-TLIF

Objective:To study the anatomy of "Kambin triangle" in the safe working area of lumbar intervertebral foramen through surgical patients and cadavers,so as to provide anatomical reference for clinical lumbar fusion via intervertebral foramen.Methods:operation group:20 patients with lumbar degenerative change diagnosed in our hospital were randomly selected for mis-tlif operation.The bottom edge and height of Kambin triangle on the affected side of the operation segment were measured,and the area of Kambin triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin triangle into a rectangle,measure the length of the bottom edge and height again,calculate the area,and compare the two groups of data.Specimen group:six complete cadaveric specimens were taken,the soft tissue of the lumbar back was removed,the transverse process,upper and lower articular processes and part of the lamina were bitten,the area of the lumbar Kambin triangle was completely exposed,the bottom edge and height of the Kambin triangle were measured,and the area of the Kambin triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin triangle into a rectangle,measure the length of the bottom edge and height again,calculate the area,and compare the two groups of data.Results:in the operation group,the average height of Kambin triangle was(8.07 ±1.30)mm,and the average height of modified quadrangle was(10.89 ± 1.64)mm,P<0.05.The height of modified quadrangle was significantly higher than that of Kambin triangle.The average bottom of Kambin triangle was(6.93 ± 1.02)mm,and the average bottom of improved four corners was(9.68 ± 1.36)mm,P<0.05.The bottom edge of improved four corners was significantly larger than that of Kambin triangle;The average area of Kambin triangle is(28.30 ± 7.76)mm2.The area of improved four corners was(105.07 ± 19.96)mm2,P<0.05.The area of improved four corners was significantly larger than that of Kambin triangle.Sample group:the average height of Kambin triangle was(11.20 ± 2.10)mm,and the average height of modified four corners was(11.19 ± 1.93)mm,P>0.05.The average bottom of Kambin triangle was(10.78 ± 1.95)mm,and the average bottom of improved four corners was(12.14±1.78)mm,P<0.05.The bottom edge of improved four corners was significantly larger than that of Kambin triangle;The average area of Kambin triangle is(61.79 ± 20.71)mm2.The area of the improved four corners was(137.71 ±38.20)mm2,P<0.05,and the area of the improved four corners was significantly larger than that of the Kambin triangle.Conclusion:in the lumbar intervertebral foramen,there is a narrow right angle triangle area surrounded by the traveling nerve root,dural sac and the upper end plate of the lower vertebral body.If the traveling nerve root is pulled and fixed,and the traditional Kambin triangle becomes a quadrilateral,the bottom edge of the Kambin triangle area can be significantly lengthened and the area can be significantly expanded,which can be operated more safely.