| Background and Objective Lumbar vertabral lamina is the wide and flat plate structure, lies between the upper and lower articular process and spinous process, in the midline convergence of the bilateral vertabral laminae,it is an important part of the posterior wall of the lumbar spine canal, vertebral body height greater than the vertabral lamina , the vertabral laminae interval space between the upper and lower vertabral laminae, interlaminar connected by the yellow ligament, the structure maintains the integrity and stability of the lumbar spine. Protrusion of lumbar intervertebral disc is the most common and multiple disease in clinical, and material cause of lumbago and scelalgia, mainly occurred in the L4/5, L5/S1. With modern minimally invasive surgical technology and fiber endoscopic development, percutaneous endoscopic lumbar discectomy (PELD) was applied in clinical. Percutaneous endoscopic lumbar discectomy surgical approaches include posterolateral intervertebral foramen means and vertabral laminae interval space means. Frequently-used approach is the intervertebral foramen means, but this approach has limitations, for the L5-S1 intervertebral disc hernia associated with the higher position of the cristae iliaca was difficult. The vertabral laminae interval space approach can not consider the location of the cristae iliaca, and the operation is similar to the open laminectomy, but this approach need to consider the size of the vertebral laminae interval space. Measure morphology of the lower lumbar vertabral laminae interval space in X ray films, providing imaging evidence for the PELD by the vertabral laminae interval space approach.Methods 300 cases of normal lumbar films were recruited. Divided into four groups by sex and age. Male 146 cases,female 154 cases,aged 30-73 years old.30-39 age group 42 cases, male 26 cases and female 16 cases; 40-49 age group 97 cases,male 39 cases, female 58 cases; 50-59 age group 73 cases,male 32 cases and female 41 cases; over 60 age group 88 cases, male 49 cases and female 39 cases.Observe the morphological characteristics of the vertabral laminae interval space in X ray films, measured the lengths of the unilateral vertabral laminae interval space,and the height of the vertabral laminae interval space between 4mm distance of spinous process and 4mm distance of inferior articular process inner margin of L3-4, L4-5, L5-S1. SPSS17.0 statistical software used for data analysis, obtained the average and standard deviation of each group, numeric expressed by x±s.Based on the standard of PELD endoscope diameter, 4mm, 6mm, 7.5mm for the cut-off point to calculate the proportion of the lengths of the unilateral vertabral laminae interval space and the height of specific location in the range.Results Vertabral laminae interval space of L3-4 like heart-shaped gap, and the space of L4-5, L5-S1 like oval shape. Male's height and length of the vertabral laminae interval space were larger than the female; the lower lumbar vertabral laminae interval space increases from top to bottom, L3-4 space is too small, L5-S1 space is too large; The length of unilateral vertabral laminae interval space has not under 4mm, L3-4 gap length 4-6mm range ratio (male 4.1%, female 5.2%) ,6-7.5 mm range ratio (male 15.1%, female 16.9%), over 7.5mm range ratio (male 80.8%, female 77.9% ); L4-5 gap length 4-6mm range (male 0% female 0%) ,6-7.5 mm range (0% male, female 3.2%), over 7.5mm range(male 100%, female 96.8%); L5-S1 gap length over 7.5mm range(male 100%, female 100%).The height of vertabral laminae interval space has not under 4mm, L3-4 space height range of 4-6mm (male 4.1%, female 6.5%) ,6-7.5 mm range (male 25%, female 20.1%), 7.5mm or more (male 70.9% , female 73.4%); L4-5 space height range of 4-6mm (male 2.7%, female 5.2%) ,6-7.5 mm range (male 12.3%, female 14.3%), 7.5mm or more (85% male, 80.5 female %). L5-S1 space height range of 4-6mm (male 0% ,female 0%) ,6-7.5mm range (male 8.2%, female 9.1%), 7.5mm or more (male 91.8%, female 90.9%).Conclusion Most patients with vertabral laminae interval space of L5-S1 can meet the placement of diameter of 7.5mm endoscope; about 4 / 5 patients with the vertabral laminae interval space of L4-5 can meet the placement of diameter of 7.5mm endoscope; about 3 / 4 patients with the vertabral laminae interval space of L3-4 can meet the placement of diameter of 7.5mm endoscope; Measure morphology of the lower lumbar vertabral laminae interval space in X ray films before surgery, to understand the height and length of the ipsilateral vertabral laminae interval space can guide the endoscope of choice and surgery operations of PELD. |
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