Clinical anatomic study of acupotomy lysis in lumbar ligamentum flavum of human
ZHU Xinyue1,2 LIU Zixiang1,2 GU Peiliang3 ZHANG Weiguang3 LI Shiliang1
1.Department of Acupuncture, China-Japan Friendship Hospital, Beijing 100029, China;
2.Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100032, China;
3.Department of Human Anatomy, School of Basic Medical Sciences, Peking University, Beijing 100191, China
Abstract：Objective To explore the anatomical path of acupotomy for lumbar ligamentum flavum (LF) and provide a safer and reliable minimally invasive treatment of Chinese medicine for lumbar disc herniation (LDH) and lumbar spinal stenosis (LSCS). Methods Ten cadavers including 4 females and 6 males with age from 60 to 90 years old [(70.50±14.17) years old in an average] without formalin fixation were selected. The specimens were derived from the Donor Center of School of Basic Medical Sciences, Peking University from September 2016 to January 2018. According to the body surface of the human anatomy, the first approach was to insert the needle from the facet joint to the spinous process in the direction of the vertical axis of the vertical body. The second direction was parallel to the longitudinal direction of the human body from the side of the spinous process and a transverse direction from the tail side to the head. Those methods loosened L3/L4, L4/L5, L5/S1 three segments of ligamentum flavum. The angle for acupotomy and the depth of needle penetration, the distance between the puncture point and spinous process, and the distance between the puncture point and cornua sacralia on cadavers were measured. The resulting data was processed and analyzed. Results After dissection, no obvious blood vessels and nerves were observed in the paracentesis path, and the spinal dural membrane was intact. There was no significant difference between the left and right measurement data (P ＞ 0.05). The penetration depth of the vertical longitudinal axis approach was less than the depth of the parallel longitudinal axis approach (P ＜ 0.01). The distance between the puncture point and cornua sacralia for the vertical longitudinal axis was greater than that of the parallel longitudinal axis (P ＜ 0.01). Vertical and parallel longitudinal axis measuremented of L3/L4, L4/L5, and L5/S1 showed no significant difference in needle insertion angle, needle depth, and spinous process distance for the three segments (P ＞ 0.05). Conclusion The vertical longitudinal axis approach of loosening the ligamentum flavum by the needle knife is better than the parallel longitudinal axis approach. Before clinical treatment, reference can be made to the measurement results obtained in this study to obtain a more accurate insertion point for lumbar ligamentous ligament release.
2018, Vol. 15 
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