| Objective:From the lumbar spine anatomy to observe the relevant measure of L4, L5 nerve root, L4 / 5 intervertebral foramen, L4 / 5 disc and L5 superior articular process in the L4, L5 vertebral level and the close relationship by transforaminal discectomy mirror .Also we observe the distance between the structure and anatomy to explore the L4/L5 segment by transforaminal discectomy surgery mirrors the security of the scope, and use the conclusion in clinical to observe the clinical efficacy,clinical treatment.Method:Anatomic group: make lumbar specimens, observe gross structure around L4/5 intervertebral space, measure the distance between L5 nerve root and adjacent intervertebral disk, the vertical distance between the midpoint of the superior articular process of L5 and the L4 exporting nerve root,the included angle between L4 never root and midline, Piercing, to the vertex of the midpoint of the superior articular process of L5 and 35 degrees with the horizontal, the recent distance and the farthestdistance between the midpoint of the superior articular process of L5 and L4/5 intervertebral disk , intervertebral foramen antero-posterior diameter et al. Analyze related data with statistics in order to explore the safety range of lumbar nucleus pulposus enucleation via intervertebral foramen with minimal invasive surgery.Clinical group:Collect the clinical data of 30 lumbar intervertebral disc herniation patients who receive a treament with lumbar nucleus pulposus enucleation via intervertebral foramen with minimal invasive surgery from 2010.1 to 2010.6 in our department.Analyze preoperative VAS, postoperative VAS afer a month of the operation, postoperative VAS after three months and nine months of the operation with statistics. At last,evaluate clinical curative effect and feasibility follow the VAS standards.Result:Anatomic group: There are not statistic difference between left and right of the L4/5 segment (P>0.05). There are also not statistic difference between man and women(P>0.05). The distance between L5 superior articular process anterior border midpoint and L4 nerve exit root is 13.51mm±1.19 and intervertebral foramen antero-posterior diameter is 10.57mm±1.22,L4/L5 intervertebral foramen area of 82.46mm2±1.91 is larger than the channel area of 44.14 mm2.It illustrates that it can contain work channel . Sleeve over the work for the vertices of facet angle with the horizontal swing can not be over 45.84。±1.93, not less than 30.58。±2.07, ensuring that the work sleeve can go straight around the disc without damaging important structures. With an angle of 35. Piercing, arriving after the midpoint of the front facet depth to the disc that is 15.37mm±1.12, 48.76mm±1.45 in depth to wear clothing that disc.The distance between L5 nerve root out of dural sac and the inferior border of adjacent intervertebral disk fluctuates is 3.43mm±2.31,it become the anatomical basis of L5 nerve root compressed from the front or shoulder.Clinical group:all of the operations are filished uccessfully, operation time fluctuates at 50 ~ 110min, average for 70min, the lost blood volume in operation is rarely few,so it is hard to estimate.The symptoms of lumbago,leg pain significantly relieved after operation.Three patients'lower limb appear of"sun seared syndrome"in a week after the operation.But through the treatment such as nutrition nerve, acetanilide detumescence, physiotherapy treatment and so on, the symptoms is relieved in a week after those treatment. All patients were followed up at different time points after surgery were followed up for low back pain and leg pain VAS score was significantly lower than before surgery.Conclusion:Based on anatomy measurement data analysis, lumbar nucleus pulposus enucleation via intervertebral foramen with minimal invasive surgery is feasible. In clinical, using this operation method to therapy lumbar intervertebral disc herniation is safety and effective.
|
PDF Full Text Request