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观测24具成人防腐尸体L_5～S_1椎间盘的上、中、下部断面标本和解剖8具尸体标本的L_5～S_1椎间盘毗邻结构,证实L_5～S_1椎间盘存在三个可供穿刺的部位:前区、侧区、后外侧区.穿刺L_5～S_1椎间盘宜首选后外侧区.该区位于椎关节突和L_5脊神经前支之间,仅见于椎间盘的中下部断面,间隙宽度分别为6.7mm和9.9mm.穿刺针从髂后上棘外上方3.5～4.0cm处进针,在X线的指引下,针尖穿入由第5腰椎横突(上),椎骨关节突(内侧),骶骨翼(下)、髂骨翼(外侧)围成的骨孔(此时穿刺针与矢状面夹角为50～55°,前倾角度为15～25°),一般都能到达椎间盘中心.侧区是椎间盘侧面的“(?)”形神经、血管间隙,在椎间盘上部断面间隙宽10.3mm.穿刺途径有髂骨翼阻挡,直针穿刺需用骨钻钻孔.由于该区面积小,位置深,要使穿刺针准确进入“(?)”区内,操作难度大,有刺伤神经和刺破大血管的危险,穿刺时需同时作髂总静脉造影.侧区穿刺以与矢状面97.5°夹角进针,有可能穿经腹膜腔和损伤右侧的盲肠.前区为左、右髂血管之间的椎间盘显露区,血管间距达35.8mm,面积大,穿刺安全,但需经过腹膜腔,操作时需腹腔镜引导.
The upper, middle and lower sections of 24 L-5 ~ S 1 intervertebral discs of adult anticorrosive corpses and the adjacent structures of L_5 ~ S 1 intervertebral disc of 8 corpse specimens were observed. There were three sites for L_5 ~ And the posterolateral region.The puncture L_5 ~ S_1 intervertebral disc should be the preferred posterolateral region.It is located between the vertebral articular process and the anterior branch of the L_5 spinal nerve, only found in the middle and lower section of the intervertebral disc, the width of the gap is 6.7mm and 9.9mm respectively. Needle from the top of the posterior superior iliac spine 3.5 ~ 4.0cm outside the needle, under the guidance of the X-ray, the needle penetrated by the fifth lumbar transverse process (on), vertebral articular process (medial), sacral wing Bone (the lateral) of the bone (the angle between the puncture needle and the sagittal plane is 50 ~ 55 ° and the anteversion angle is 15 ~ 25 °) usually reach the center of the disc. The lateral area is the side of the disc “(?)” Shape nerve, vascular space, 10.3mm wide in the upper part of the intervertebral disc space. There are iliac wing puncture approach blocking, needle puncture bone drilling .Because the area is small, deep, to make the puncture Accurate access to the “(?)” Area, the operation is difficult, there is the risk of stabbing the nerves and punctures the blood vessels, need to puncture When the iliac vein for angiography.The lateral puncture to the sagittal plane 97.5 ° angle into the needle, it is possible to wear through the peritoneal cavity and damage the right cecum.The anterior region for the left and right iliac vessels between the disc exposure area, Vascular spacing up to 35.8mm, large area, puncture safety, but need to go through the peritoneal cavity, the operation required laparoscopic guidance.