Anatomic study of ultrasound-guided acupotomy release of rabbits lumbar ligamentum flavum
ZHAO Yu1 GUO Shuang1 CHEN Can1 CHEN Yiren1 DU Mengfan1 NIU Susheng2 LIU Jing3 ZHANG Yan1
1.School of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fujian Province, Fuzhou 350122, China;
2.Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fujian Province, Fuzhou 350122, China;
3.the First Department of Bone Traumatology, Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fujian Province, Fuzhou 350004, China
Abstract：Objective To explore the approach of acupotomy release rabbit lumbar ligamentum flavum under ultrasound guidance, according to the anatomical structure of the rabbit lumbar spine and the shape of the ligamentum flavum. Methods The height of spinous process, mastoid process, length, and width of lamina space of L5, L6, and L7 vertebrae in six male New Zealand rabbits aged three months were measured; the six 3-month-old male New Zealand rabbits were measured with the ultrasound probe vertical. The lateral axis of the posterior midline was placed, and the angle between the spinous process and the mastoid process was measured under ultrasound. The longitudinal axis of the ultrasonic probe was placed beside the spinous process to release the ligamentum flavum on both sides of L4/5, L5/6, and L6/7 segments in a plane way the acupotomy insertion depth, insertion angle, the vertical distance from the insertion point to the posterior midline and the vertical distance from the horizontal line of the sacral angle were measured, after the measurement, the data was analyzed and the anatomical structure of acupotomy path was observed. Results There was no significant difference in mastoid hight and spinous process height among L5, L6, and L7 vertebrae (P＞0.05). The length and width of the L5-L7 intervertebral space gradually increased, and the middle part of the yellow ligament was thicker, followed by the medial part, and the lateral part was thinner. There was no significant difference in the angle between spinous process and mastoid process on both sides of L5, L6 and L7 vertebrae measured by ultrasonic transverse axis (P＞0.05). After the longitudinal approach of the needle knife arrived at the yellow ligament under ultrasound guidance, there was no statistical significance in the vertical distance between the insertion points of the left and right sides of the L4/5, L5/6 and L6/7 segments measured after needle retention, the insertion depth of the needle knife, the angle between the needle knife and the horizontal line, namely the insertion angle of the needle knife (P＞0.05). The vertical distance of the horizontal line of the sacral angle at the left and right needle insertion points of L6/7 was shorter than L4/5 and L5/6, and the vertical distance of the horizontal line of the sacral angle at the left and right needle insertion points of L5/6 was shorter than L4/5, the differences were statistically significant (P＜0.05). No obvious blood vessels and nerves were observed in the puncture path, and the dura was intact. Conclusion It is a safe approach to release the rabbit ligamentum flavum with acupotomy when the ultrasound probe is placed parallel to the longitudinal axis. The needle insertion angle should be adjusted according to the anatomical differences of L4/5, L5/6, and L6/7 segments.
[1] Sakai Y，Ito S，Hida T，et al. Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum [J]. J Orthop Sci，2017，22（1）：27-33.
[2] Munns JJ，Lee JY，EspinozaOrías AA，et al. Ligamentum flavum hypertrophy in asymptomatic and chronic low back pain subjects [J]. PLoS One，2015，10（5）：e0128321.
[3] 何星.小针刀疗法治疗腰椎间盘突出症的临床效果观察[J].中医临床研究，2016，8（8）：27-28.
[4] 叶肖琳，黄雪莲，叶新苗.小针刀对腰椎间盘突出症治疗效果的Meta分析[J].中华中医药杂志，2016，31（7）：2784-2788.
[5] 杨福彪，王超.针刀松解黄韧带联合温针灸治疗老年腰椎管狭窄随机平行对照研究[J].中医药信息，2016，33（4）：99-101.
[6] 龚重九，张天民.针刀松解黄韧带治疗腰椎间盘突出症的临床研究[J].针灸临床杂志，2015，31（9）：34-36.
[7] 林秀华，刘存斌，耿凯，等.超声引导下针刀松解黄韧带治疗腰椎间盘突出症的临床效果[J].中国医药导报，2022，19（9）：157-160.
[8] 朱新月.超声引导下针刀松解黄韧带的临床解剖学研究[D].北京：北京中医药大学，2018.
[9] Altinkaya N，Yildirim T，Demir S，et al. Factors associated with the thickness of the ligamentum flavum： is ligamentum flavum thickening due to hypertrophy or buckling [J]. Spine（Phila Pa 1976），2011，36（16）： E1093-E1097.
[10] Hashizume H，Yoshida M. Spinalstenosis [J]. J Spinal Disord Tech，2014，72（10）：1768-1772.
[11] Reina MA，Lirk P，Puigdellivol-Sanchez A，et al. Human lumbar ligamentum flavum anatomy for epidural anesthesia：reviewing a 3D MR-based interactive model and postmortem samples [J]. Anesth Analg, 2016，122（3）：903-907.
[12] Abbas J，Hamoud K，Masharawi YM，et al. Ligamentum flavum thickness in normal and stenotic lumbar spines [J]. Spine（Phila Pa 1976），2010，35（12）：1225-1230.
[13] Altun I, Yuksel KZ. Histopathological analysis of ligamentum flavum in lumbar spinal stenosis and disc herniation [J]. Asian Spine J，2017，11（1）：71-74.
[14] Yoshiiwa T，Miyazaki M，Kawano M，et al. Analysis of the relationship between hypertrophy of the ligamentum flavum and lumbar segmental motion with aging process [J]. Asian Spine J，2016，10（3）：528-535.
[15] Sairyo K，Biyani A，Goel V，et al. Pathomechanism of ligamentum flavum hypertrophy：a multidisciplinary investigation based on clinical，biomechanical，histologic，and biologic assessments [J]. Spine （Phliapa 1976），2005，30（23）： 2649 -2656.
[16] Park JB，Chang H，Lee JK. Quantitative analysis of transforming growth factor-beta 1 in ligamentum flavum of lumbar spinal stenosis and disc herniation [J]. Spine （Phliapa 1976）， 2001，26（21）：E492-E495.
[17] Sairyo K，Biyani A，Goel VK，et al. Lumbar ligamentum flavum hypertrophy is due to accumulation of inflammation-related scar tissue [J]. Spine （Phliapa 1976），2007，32（11）：E340- E347.
[18] Hayashi K，Suzuki A，Abdullah Ahmadi S，et al. Mechanical stress induces elastic fibre disruption and cartilage matrix increase in ligamentum flavum [J]. Sci Rep，2017，7（1）： 13092.
[19] Wang B，Gao C，Zhang P，et al. The increased motion of lumbar induces ligamentum flavum hypertrophy in a rat model [J]. BMC Musculoskelet Disord，2021，22（1）：334.
[20] 谭芳，谭江威，王春晓，等.微创手术在退行性腰椎管狭窄症中的应用进展[J].医学综述，2021，27（5）：967-972.
[21] 朱延兵，郑卫东，李亮，等.后路椎间盘镜治疗老年性腰椎管狭窄症[J].中国老年学杂志，2011，31（24）：4901-4902.
[22] 马运芳，华国昌.针刀松解黄韧带对腰椎管狭窄症的效果观察[J].中医临床研究，2011，3（22）：78-79.
[23] Hayashi K，Suzuki A，Terai H，et al. Fibroblast Growth Factor 9 Is Upregulated Upon Intervertebral Mechanical Stress- Induced Ligamentum Flavum Hypertrophy in a Rabbit Model [J]. Spine（Phila Pa 1976），2019，44（20）：E1172- E1180.
[24] 郑振雨.CRLF1激活ERK1/2信号通路调控TGF-β1介导的黄韧带肥厚的机制研究[D].广州：南方医科大学，2020.
[25] Zheng ZY，Li P，Ao X，et al. Characterization of a Novel Model of Lumbar Ligamentum Flavum Hypertrophy in Bipedal Standing Mice[J]. Orthop Surg，2021，13（8）：2457- 2467.
[26] 任海涛.针刀切割黄韧带治疗黄韧带肥厚型腰椎管狭窄症的解剖学基础及临床应用[D].武汉：湖北中医药大学，2016.
京公网安备 11010502046598号