脊柱腰段断面解剖观测及临床意义

目的旨在为脊柱腰段病变的影像诊断和手术治疗提供形态学依据。方法 30例横断面标本,观测椎体、椎弓根、椎孔、椎弓板等结构。结果椎体横、矢径,以及椎孔横径存在性别差异(男性女性,P0.0001),但椎孔矢径无性差(P=0.6441),而不同椎体间椎孔矢径存在差异(P=0.0349),不同椎体的横、矢径存在显著差异(P0.0001);脊椎指数均1:4.5,且存在性别差异(P0.0001),不同腰椎间有显著性差异(P=0.0018);腰椎椎板夹角变化较大(70°～90°),同椎骨A、B两个断面该角的大小具有显著性差异(P0.0001),但无性差、各椎体间也无显著性差异;椎弓根横径、OE径存在性别差异(男性女性,P0.0001),不同椎体的该两径存在显著差异(P0.0001),但该两径值的侧差无显著性差异(P0.6070);Z角在不同腰椎间存在显著性差异(P0.0001),但无性差、侧差(性别P=0.4153,侧差P=0.7579)。结论⑴不同性别、不同腰椎间的形态数据存在显著差异;⑵椎体横、矢径,椎孔横、矢径,脊柱指数,椎弓板夹角均可作为诊断腰椎孔狭窄的参考指标;⑶椎弓根螺钉选择需结合术前影像测量。

Sectional anatomy of the lumbar spine and its clinical significance

Objective　To explore sectional anatomy of lumbar spine, and provide morphologic basis for diagnosing and treating lumbar spinal diseases.　Methods　Vertebral body, the pedicle of vertebral arch, vertebral foramen and lamina of vertebral arch on 30 sectional lumbar spinal specimens were observed and analyzed. Results　For different lumbar vertebrae, there was a significant sex difference（P＜0.05 or P＜0.0001）for transverse and sagittal diameters of vertebral body, transverse diameter of vertebral canal, spine index, transverse diameter of pedicle of vertebral arch, the length of OE, but not for sagittal diameter of vertebral canal and  the angle of Z. There was no significant difference among bilateral transverse diameter of pedicle of vertebral arch, and the length of OE in lumbar vertebrae. There was no significant difference for sex and position except that were between cross-sectional A and cross-sectional B at the angle of bilateral vertebral plate, which ranged from 70° to 90°. All of lumbar spinal indexes were less than 1:4.　Conclusions　The results show that, for different lumbar vertebrae, there is a significant sex difference for main morphologic parameters. Some parameters, such as the transverse diameter and sagittal diameter of vertebral body, the spine index, the angle of bilateral vertebral plate, the transverse diameter and sagittal diameter of vertebral canal, are valuable for evaluating the stenosis of vertebral foramen. It is vital to analyze imaging data before selecting optimal translaminar screw.