Xu Rui-Sheng, Wu Jie-Shi, Lu Hai-Dan, Zhu Hao-Gang, Li Xia, Dong Jian, Yuan Feng-Lai
Department of Orthopaedics, The Third Affiliated Hospital of Nantong University, Wuxi, China.
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Orthop Surg. 2017 May;9(2):237-240. doi: 10.1111/os.12325. Epub 2017 May 30.
To observe the morphology character of the anterior epidural space at the L disc level and to provide an anatomical basis for safely and accurately performing a percutaneous endoscopic lumbar discectomy (PELD). Fifty-five cases with L S lumbar disc herniation were included in this study, and cases with L disease were excluded. When the puncture needle reached the epidural space at the L S level, iohexol was injected at the pressure of 50 cm H O during the PELD, then C-Arm fluoroscopy was used to obtain standard lumbar frontal and lateral images. The widths of epidural space at the level of the L lower endplate, the L upper endplate, as well as the middle point of the L disc were measured from the lumbar lateral X-ray film. Epidural space at the L disc plane performs like a trapezium chart with a short side at the head end and a long side at the tail end in the lumbar lateral X-ray radiograph, while the average widths of epidural space were 10.2 ± 2.5, 12.3 ± 2.3, and 13.8 ± 2.6 mm at the upper, middle, and lower level of the L disc. Understanding the morphological characteristics of epidural space will contribute to improving the safety of the tranforaminal percutaneous endoscopy technique.
观察L椎间盘水平硬膜外前间隙的形态特征，为安全、准确地实施经皮内镜下腰椎间盘切除术（PELD）提供解剖学依据。本研究纳入55例L₅S₁腰椎间盘突出症患者，排除L₅疾病患者。在PELD过程中，当穿刺针到达L₅S₁水平硬膜外间隙时，以50 cm H₂O的压力注入碘海醇，然后使用C形臂荧光透视获取标准的腰椎正位和侧位图像。从腰椎侧位X线片测量L₅下端板、L₅上端板以及L₅S₁椎间盘中点水平的硬膜外间隙宽度。在腰椎侧位X线片中，L₅S₁椎间盘平面的硬膜外间隙呈头端短边、尾端长边的梯形，而L₅S₁椎间盘上、中、下水平硬膜外间隙的平均宽度分别为10.2±2.5、12.3±2.3和13.8±2.6 mm。了解硬膜外间隙的形态特征将有助于提高经椎间孔入路经皮内镜技术的安全性。
