| 265 | 7 | 15 |
| 下载次数 | 被引频次 | 阅读次数 |
目的：通过对尸体标本进行解剖，对腰椎间孔安全工作区“Kambin三角”进行解剖学研究，为临床经Kambin三角入路腰椎融合术提供解剖学参考。方法：取5具完整尸体标本，切除腰背部软组织，咬除横突、上下关节突及部分椎板，完全暴露腰椎Kambin三角区域，测量Kambin三角的底边、高，并计算Kambin三角面积；利用克氏针，牵拉固定出行神经根，使Kambin三角成一长方形，再次测量底边及高的长度，并计算面积，并将两组数据进行比较。结果：Kambin三角的高平均为（11.20±2.10）mm，改良四角的高平均为（11.19±1.93）mm，两者具有显著相关性，但差异无统计学意义（P>0.05）。Kambin三角的底平均为（10.78±1.95）mm，改良四角的底平均为（12.14±1.78）mm，两者具有显著相关性，且改良四角的底边明显大于Kambin三角的底边，差异具有统计学意义（P<0.05）。Kambin三角的平均面积为（61.79±20.71）mm2，改良四角面积为（137.71±38.20）mm2，两者具有相关性，且改良四角面积明显大于Kambin三角面积，差异具有统计学意义（P<0.05）。结论：在腰椎椎间孔中存在一个由出行神经根、硬膜囊及下位椎体上终板围成的狭小的直角三角区域，若将出行神经根牵拉固定，使传统的Kambin三角变成一四边形，则可使Kambin三角区域的底边明显变长，面积显著扩大，可以更为安全地进行手术。
Abstract：Objective:To study the " Kambin′s triangle " in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through Kambin ′s triangle approach through the anatomy of cadavers.Methods:A total of five 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 vertebral lamina were bitten,the Kambin′s triangle area of the lumbar spine was completely exposed,the bottom edge and height of the Kambin′s triangle were measured,and the area of the Kambin′s triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin ′s 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:The average height of the Kambin′s triangle was(11.20±2.10)mm,and the average height of the improved four corners was(11.19±1.93)mm. The height of the improved four corners was slightly shorter than that of the Kambin ′s triangle. There was a significant correlation between the two,but the difference was not statistically significant. The average bottom of Kambin′s triangle is(10.78±1.95)mm,and the average bottom of improved four corners is(12.14±1.78)mm. The length of the bottom edge of improved four corners is greater than that of Kambin ′s triangle. There is a significant correlation between them,and the difference is statistically significant;The average area of Kambin′s triangle is(61.79±20.71)mm2,and the area of improved four corners is(137.71±38.20)mm2. The area of improved four corners is significantly larger than that of Kambin ′s triangle. There is a significant correlation between the two,and the difference is statistically significant. Conclusion:There is a narrow right angle triangle area surrounded by traveling nerve root,dural sac and superior endplate of lower vertebral body in the lumbar intervertebral foramen. If the traveling nerve root is pulled and fixed to turn the traditional Kambin ′s triangle into a quadrilateral,the bottom edge of the Kambin′s triangle area can be significantly longer and the area can be significantly expanded,which can be operated more safely.
1 LM Tumialán,Madhavan K,Godzik J,et al.The history of and controversy over Kambin′s triangle:A historical analysis of the lumbar transforaminal corridor for endoscopic and surgical approaches[J].World Neurosurg,2019,123:402-408.
2 Mobbs RJ,Phan K,Malham G,et al.Lumbar interbody fusion:techniques,indications and comparison of interbody fusion options including PLIF,TLIF,MI-TLIF,OLIF/ATP,LLIF and ALIF[J].J Spine Surg,2015,1(1):2.
3 Zhang H,Zhou CL,Wang C,et al.Percutaneous endoscopic transforaminal lumbar interbody fusion:Technique note and comparison of early outcomes with minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis[J].Int J General Med,2021,14:549-558
4 Hardenbrook M,Lombardo S,Wilson MC,et al.The anatomic rationale for transforaminal endoscopic interbody fusion:a cadaveric analysis[J].Neurosurg Focus,2016,40(2):E12.
5 Villavicencio AT,Burneikiene S,Roeca CM,et al.Minimally invasive versus open transforaminal lumbar interbody fusion[J].Surg Neurol Int,2010,1(1):12.
6 Jacquo TF,Gastambide D.Percutaneous endoscopic transforaminal lumbar interbody fusion:is it worth it?[J].Int Orthop,2013,37(8):1507-1510.
7杨晋才，张黎明，尹鹏，等.腰椎出口神经根与上关节突毗邻关系的CT观察[J].中国脊柱脊髓杂志，2018,28(10):888-894.
8吴波，赵庆豪，周潇齐，等.腰椎间孔镜的应用解剖[J].中国临床解剖学杂志，2017,35(1):5-8
9 Ozer AF,Suzer T,Can H,et al.Anatomic assessment of variations in Kambin′s triangle:A surgical and cadaver study[J].World Neurosurg,2017,100:498-503.
10 Simon JI,Mc Auliffe M,Smoger D.Location of radicular spinal arteries in the lumbar spine from analysis of ct angiograms of the abdomen and pelvis[J].Pain Med,2015,17(1):2201-2211.
11 Yuan SG,Wen YL,Zhang P,et al.Ligament,nerve,and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina[J].Int Orthop,2015,39(11):2135-2141.
12丁一，杨晋才，张黎明，等.正常腰神经根磁共振神经成像临床影像学特点研究[J].首都医科大学学报，2019,40(5):769-775.
13 Hoshide R,Feldman E,Taylor W.Cadaveric analysis of the Kambin′s triangle[J].Cureus,2016,8(2):e475.
14刘德隆，田世杰，苏庆军，等.腰神经根解剖及其在经皮穿刺腰椎间盘摘除术中的临床意义[J].临床骨科杂志，1999,2(2):88-91.
15 Lertudomphonwanit T,Keorochana G,Kraiwattanapong C,et al.Anatomic considerations of intervertebral disc perspective in lumbar posterolateral approach via Kambin′s triangle:Cadaveric study[J].Asian Spine J,2016,10(5):821-827.
16 Foley KT,Gupta SK.Percutaneous pedicle screw fixation of the lumbar spine:Preliminary clinical results[J].J Neurosurg Spine,2002,97(1):7-12.
17钱济先.正确把握MIS-TLIF技术[J].中国脊柱脊髓杂志，2014,24(5):393-394.
18薛文，王栋，杨阳，等.脊柱微创术后椎旁肌缺血坏死2例[J].中国骨伤，2018,31(11):1046-1048.
19 Yoo JS,Min SH,Yoon SH,et al.Paraspinal muscle changes of unilateral multilevel minimally invasive transforaminal interbody fusion[J].J Orthop Surg Res,2014,9(1):130.
20苏锴，栾继耀，张忠民，等.微创经椎间孔腰椎椎体间融合术与传统开放手术的疗效和对多裂肌损伤的对比研究[J].中国骨与关节杂志，2018,7(9):687-692.
21 Vasilikos I,Fistouris P,Krüger M,et al.How safe is minimally invasive TLIF for octogenarians?-A perioperative complication analysis[J].World Neurosurg,2020,139:e754-e760.
22 Osman SG.Endoscopic transforaminal decompression,interbody fusion,and percutaneous pedicle screw implantation of the lumbar spine:a case series report[J].Int JSpine Surg,2012,6:157-166.
23丁一，杨晋才，尹鹏，等.经皮脊柱内镜辅助下经椎间孔腰椎减压融合术治疗合并严重肺功能不全腰椎管狭窄症1例[J].中国骨与关节损伤杂志，2019,34(9):1005-1006.
24丁一，海涌，杨晋才，等.经皮内窥镜辅助下经椎间孔腰椎减压融合术治疗单节段腰椎管狭窄症对多裂肌的影响[J].中国脊柱脊髓杂志，2019,29(9):822-827.
25 Wu J,Liu H,Ao S,et al.Percutaneous endoscopic lumbar interbody fusion:technical note and preliminary clinical experience with 2-year follow-up[J].Bio Med Res Int,2018,2018:1-8.
26 Nagahama K,Ito M,Abe Y,et al.Early clinical results of percutaneous endoscopic transforaminal lumbar interbody fusion:A new modified technique for treating degenerative lumbar spondylolisthesis[J].Spine Surg Related Res,2019,3(4):327-334.
27吴李勇，王越，凌广烽，等.通道下经椎间孔腰椎椎体间融合术后融合器移位原因分析[J].颈腰痛杂志，2015,36(6):482-485.
28 Sang-ho L,Yener EH,Junseok B.Percutaneous transforaminal endoscopic lumbar interbody fusion:Clinical and radiological results of mean 46-month follow-up[J].Bio Med Res Int,2017,2017:3731983.
29 Stickley C,Philipp T,Wang E,et al.Expandable cages increase the risk of intraoperative subsidence but do not improve perioperative outcomes in single level transforaminal lumbar interbody fusion-Science Direct[J].Spine J,2020,21(1):37-44.
30 Nakamura S,Taguchi M.Full percutaneous lumbar interbody fusion[J].J Neurol Surg A Cent Eur Neurosurg,2017,78(6):601-606.
31尹鹏，海涌，杨晋才，等.经皮内镜下经椎间孔与传统后入路椎间融合术治疗伴有腰椎不稳的腰椎管狭窄症的疗效对比[J].中国脊柱脊髓杂志，2021,31(3):213-221.
基本信息:
DOI：10.13210/j.cnki.jhmu.20220314.001
中图分类号:R687.3
引用信息:
[1]彭秋宇,陈焕雄,钟贞浩,等.Kambin三角及改良四角的解剖及临床应用的研究[J].海南医学院学报,2022,28(15):1147-1152+1161.DOI:10.13210/j.cnki.jhmu.20220314.001.
基金信息:
海南省自然科学基金资助项目（819QN365）; 国家自然科学基金资助项目（81902270）~~
2022-03-16
2022-03-16
2022-03-16