dural是什么意思,dural中文翻译,dural发音、用法及例句

•dural

dural发音

英:['djʊərəl]  美:['djʊrəl]

英:  美:

dural中文意思翻译

adj. 硬脑(脊)膜的

dural常见例句

1 、In 2 cases with spine canal teratoma, heterogeneous signal mass in the dural sac.───椎管内畸胎瘤2例,硬膜囊内不均匀信号团块状占位。

2 、predilection for cystic meningioma and absence of dural attachment are more common.───常分并有囊肿及无硬脑膜接触等特点。

3 、An experimental observation of the histopathological response of the artificial dura as an onlay dural graft and the prevention of peridural fibrosis and adhesion───人工硬膜修补硬脊膜及预防椎管内粘连的实验观察

4 、Objective To explore the angiographic appearances of the hemodynamic change of spinal dural arteriovenous fistulae (SDAVF).───摘要目的探讨硬脊膜动静脉瘘血液动力学改变的血管造影表现。

5 、This paper presents 6 cases with spinal dural arte-riovenous fistula which is a new classification in spinalarteriovenous malformation.───本文报告6例硬脊膜动静脉瘘向脊髓表面静脉引流。

6 、Significance of Endovascular Pressure Determination During Embolization in Patients with Dural Arteriovenous Fistula───供血动脉内压力测定对硬脑膜动静脉瘘栓塞效果的评价

7 、Loosening the spinal conus and repairing the dural matter prevented readhesion and retether.Results Follow-up (0.5-3 years) showed that all of the patients were recovered in different levels.───对有脂肪瘤和皮毛窦应力争切除,松解脊髓圆锥,完整修复硬膜,防止粘连再栓系,随访半年至3年,22例患者术后均有不同程度的好转。

8 、The deep dural layer of the clinoid space is not integral in 15.63?of the 32 CSs.───床突间隙的深层硬膜有15.63?不完整。

9 、1.Basal skull fracture with dural tear at cribriform plate of ethmoid bone and intracerebral cyst filled with air were found during operation.───手术中发现颅底筛骨筛板处有骨折并硬脑膜裂开,及充满气体之大脑囊肿。

10 、Keywords Cavernous sinus Dural arteriovenous fistular Diagnosis Treatment;───海绵窦;硬脑膜动静脉瘘;诊断;治疗;

11 、The treatment options for dural arteriovenous fistula are still controversial now.───对小脑幕动静脉瘘的治疗目前仍存在很多争论。

12 、Post dural puncture headache ( PDPH )───椎管内**后头痛

13 、Keywords Cavernous sinus dural arteriovenous fistula;Superior ophthalmic vein;Transvenous pathway;Embolization;───海绵窦区硬脑膜动静脉瘘;眼上静脉;静脉入路;栓塞术;

14 、Crawford's dural elevator fascia stripper───克劳福德(氏)筋膜剥离器

15 、Keywords Dural arterial-venous fistula;Surgery;───关键词硬脑膜动静脉瘘;手术;

16 、Transverse sinus flow gaps can be observed in as many as 34% of patients with normal MR imaging findings,these gaps should not be mistaken for dural sinus thrombosis.───常规MR表现正常者中有34 %可以发现横窦流动间隙 ,这些流动间隙不应被误诊为静脉窦血栓形成

17 、Key words Cavernous sinus; Dura mater space; Dural fissure; Blood fissure; Clinoid process fissure───关键词海绵窦;硬膜间腔;硬膜间隙;血液间隙;床突间隙

18 、Keywords tentorial dural arteriovenous fistulae venous drainage pathogenesis;───小脑幕脑膜动静脉瘘;静脉引流;形成机制;

19 、Key words: dural tear, degeneratie lumbar surgery, repair, reoperation, complication.───关键词:硬膜囊破裂,退变性腰椎手术,修补,再手术,并发症。

20 、Study on treatment and diagnosis of dural arteriovenous fistulae of the lateral sinus───侧窦型硬脑膜动静脉瘘的诊断及治疗探讨

21 、On midsagittal images, AP dural sac diameter and the upper-endplate angles of L1 and S1 were measured.───在正中矢状位图像上测量了L1和S1水平的硬脊膜囊的前后径和上终板角。

22 、On axial images, dural sac cross-sectional area and anteroposterior (AP) dural sac diameter were measured at the leel of the L3/4, L4/5, and L5/S1 discs.───在轴位图像上,硬脊膜囊的横截面面积和前后径分别在L3/4,L4/5和L5/S1椎间盘高度进行测量。

23 、Keywords Cavernous sinus;Dural arteriovenous fistula;Transvenous pathway;Embolization;───海绵窦;硬脑膜动静脉瘘;静脉入路;栓塞术;

24 、Complicated subarchnoid space bleeding was 30 cases,ventricle bleeding was 5 cases,dural space bleeding was 2 cases.───合并蛛网膜下腔出血30例,脑室内出血5例,硬膜下血肿2例。

25 、This is an MRI scan demonstrating a discreet mass along the lateral convexity and extending from a dural base impinging upon the cerebral hemisphere.───MRI清晰可见右侧一肿块压迫大脑半球。

26 、Etiological factors and treatment of acquired dural arteriovenous fistulae───后天性硬膜动静脉瘘的发病因素和治疗进展

27 、Methods The trend of course and the attributed branches of all venous sinuses in 150 adult dural mater specimens were observed.───方法在150例成人硬脑膜标本上解剖观察各窦的走向及其接受的静脉属支。

28 、Obstructive hydrocephalus due to the compressed midbrain aqueduct by ectatic drainage veins of a dural arteriovenous fistula───天幕区硬脑膜动静脉瘘压迫导水管导致阻塞性脑积水

29 、The largest dural area at the L5/S1 level was in sitting extended.───L5/S1水平最大的硬脊膜区域出现在长时间坐位时。

30 、Howeer, the incidence of headache after unintended dural puncture with larger gauge epidural needles is significantly higher.───但是用硬膜外针穿破硬膜后术后头疼的发生率显著增加。

31 、Uranishi R, Nakase H, Sakaki T. Expresion of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg 1999; 91 ( 11 ): 781 -6───宋振全,赵明光,魏学忠,等.大鼠脑动静脉瘘模型硬脑膜中血管内皮生长因子表达与超微结构变化[J].中国临床康复,2004,8(16):3044-5

32 、DSA analysis and embolization therapy of dural arteriovenous fistulas involving cavernous sinus───海绵窦硬脑膜动静脉瘘的DSA分析与栓塞治疗

33 、Intane 80ED+ two eyepieces;Vixen GP2+ Dural Axis Motor Drive;───定下第二个,9倍定倍瞄,楼主与我联系交易事宜。。。

34 、traumatic dural arteriovenous fistula───外伤性硬脑膜动静脉瘘

35 、sella turcica, diaphragma sellae the dural folds of the pituitary fossa, in which the pituitary gland sits, situated in the sphenoid bone.─── 蝶鞍 鞍膈 蝶鞍的硬脑膜皱襞 也就是脑下垂体部位 位于蝶骨处

36 、Methods 20 patients sustained dural trauma , which were covered with biocolloid (test group) after repairing of dural trauma during operation .───方法20例硬脊膜损伤患者术中硬脊膜修复后覆以生物蛋白胶(实验组),18例修复后不作特殊处理(对照组),术后观察脑脊液漏情况。

37 、At all leels, mean dural sac cross-sectional area in the supine position was significantly smaller than in other postures.───在不同脊椎高度,硬脊膜囊的平均横截面积在仰卧位是显著小于其他体位时。

38 、The LOA sign is possibly related to a tight dural sac, which causes separation between the posterior dural sac and subjacent lamina in the neutral position.───LOA征可能与硬膜囊紧张有关,后者在中位时引起后硬膜囊与邻近椎板之间的分离。

39 、Dural arteriovenous fistula of the cavernous sinus is usually a benign disease and rarely has brainstem edema as its complication.───摘要海绵状窦的硬膜动静脉瘘管通常是一个良性疾病。脑干水肿是其一个很少见的并发症。

40 、dural trace generalized oscilloscope───二踪通用示波器

41 、cerebral dural venous sinus thrombosis───大脑硬脑膜静脉窦血栓形成

42 、endothelioma dural───[医] 硬脑[脊]膜内皮瘤

43 、At postoperative week 6, the patient underwent drainage of a posterior cervical pseudomeningocele and repair of a small dural leak at C2-C3.───术后六周,患儿行后路颈椎假性脑脊膜膨出引流并修补C2-C3小块硬脊膜漏。

44 、Crawford's dural elevator───克劳福德(氏)(硬)脑膜剥离器

45 、Analysis of 23 cases of therapy for dural venous sinus injures using combination of Yunnan Baiyao and EC ear brain glue───云南白药结合EC胶治疗脑静脉窦损伤23例分析

46 、Maternal assessment included an ealuation for benign and serious causes of headache that included preeclampsia, dural puncture, and neurologic lesions.───母体评价包括评价头痛原因的良性或恶性,包括先兆子痫,硬脑膜穿刺和神经损伤。

47 、The dural pressed and displaced was 36 cases. The nerve root pressed,displaced,thicken was 28 cases. The nerve root falled into oblivion and oedema was 16 cases.───椎间盘边缘突出限局性软组织影发现率100%,硬膜囊受压移位36例,神经根受压、移位和增粗28例,有神经根湮没水肿者16例。

48 、Taylor's dural scissors───泰勒(氏)脑膜剪

49 、The clinical features of the case and over 61/2 years results of microsurgical decompression by retracting the arteries with silicon tapes and a dural patch are reported.───报道了案例的临床特点和通过硅制带和硬膜补片收缩动脉的显微外科减压治疗高位脊髓型颈椎病的超过6年半的结果。

50 、Conclusion: Pre-embedding cationic colloidal gold (CCG) labelling technique can reveal the anionic sites on the surface of dural vascular endothelial cells qua ntitatively.───前包埋阳离子胶体金标记技术可特异性地显示硬脑膜血管内皮细胞表面的阴离子场,并可做定量研究。

51 、To investigate clinical feature and therapeutic approach of traumatic dural sinus.───探讨外伤性颅内静脉窦损伤的临床特点及治疗。

52 、double ended dural dissector───双头(硬)脑膜剥离器

53 、Methods Suturing of dural laceration with 2-0 or 3-0 woundless silk thread was performed in twenty-two cases of intracranial venous sinus injuries produced by variant causes.───方法对22例不同原因所致颅内静脉窦损伤病人采用2-0或3-0无创丝线直接缝合静脉窦破裂口,部分病人使用明胶海绵、硬脑膜片或肌肉片加医用耳脑胶进行黏合封闭静脉窦破裂口。

54 、Cavernous sinus dural arteriovenous fistula───海绵窦区硬脑膜动静脉瘘

55 、Keywords Medical biomaterials;Dural substitute;Silk membrane;Compatibility;───医用生物材料;硬脑膜;丝素膜;相容性;

56 、Methods The BMD of 1695 people living in every district of Tianjin were measured using dural energy X-ray absorptiometry(DEXA) .───方法应用双能X线骨密度仪对天津地区1695例人群进行骨密度检测、分析。

57 、MRI can show that the normal flow void of the dural sinus is disappeared, instead of abnormal high or equality intensities.───MRI出现静脉窦正常流空效应消失,代之以异常等或高信号影;

58 、Methods:Clinical materials of 43 p atients who had dural damages during lumbar disc surgery form 1990 to 1998,were retrospectively analyzed.───方法:回顾1990年至1998年间43例腰椎间盘手术致硬脊膜损伤的临床资料。

59 、Objective To explore the DSA features and endovascular treatment technique of dural arteriovenous fistulas involving cavernous sinus.───摘要目的探讨海绵窦硬脑膜动静脉瘘的DSA表现与血管内治疗技术。

60 、Dural repairs were done through an intradural approach via single frontal craniotomy.───从额骨处做开颅术,经硬脑膜内做脑膜修复。

61 、In the double tubular type, the dural theca consists of two independent subtubes within each of which, there is half portion of the spinal cord and a bony, cartilaginous or fibrous septum in between.───双管型特征:硬脊膜为两独立的次管,其内有各自分裂的半脊髓,两硬膜管间隙有骨性、软骨性或纤维性间隔。

62 、The authors present a case of spinal dural arteriovenous fistula with fluctuations in symptoms following embolization.───作者报道了一例硬脊膜动静脉瘘栓塞形成后症状出现反复的病例。

63 、Tentorial dural arteriovenous fistulae are rare clinically.───小脑幕脑膜动静脉瘘临床上比较少见。

64 、CT and MRI of 28 cases with protrusion of lumbar disk in surgical. Findings of bulging and herniation by CT and MRI as well pressed, shift, deformed, calcification, vacuum of dural sac and nerve root.───报道经手术证实的28例腰椎间盘突出患者的CT和MRI所见,观察到腰椎间盘膨隆和间盘疝的CT和MRI表现及其所引起的硬膜囊和神经根受压,移位,变形,钙化,真空征等伴随异常。

65 、The dural area decreased most at the L5/S1 leel due to positional change from standing to supine.───从站立位改为仰卧位时硬脊膜区域的减小以L5/1水平最为显著。

66 、Conclusion The venous sinuses of the dural mater can be classified i...───各组窦均有各自主要的引流区域,且各组窦之间有大量的交通支。

67 、Magnetic resonance imaging and computed tomographic myelography revealed a huge intraspinal extradural meningeal cyst extending from T12 to L3 with cord and dural sac compression.───核磁共振影像检查及电脑断层脊髓摄影显现一巨大脊椎内硬脊膜外脑脊膜囊肿,范围分布自胸椎第十二节至腰椎第三节,造成前侧脊髓及脊膜腔严重的压迫。

68 、zink dural───含锌硬铝

69 、AP dural sac diameter on axial and midsagittal images showed a similar tendency.───前后径在轴位和正中矢状位上呈现相似的变化趋势。

70 、The parameters of anti-protruding properties of dura and its substitutes are introduced on the basis of constant creep solution of the dural deflection under the constant intracranial pressure.───本文根据骨缺损时硬脑膜在脑压作用下的弯曲变形特点,引入抗膨出特性参数:初始变形指数和蠕变指数。

71 、The prolonged hemodia lysis access via subclavian vein can be established with dacron-cuffed dural lumen catheter and accompanied with the effect of high blood flow and low mobidity of complications.───应用带涤纶环双腔导管经锁骨下静脉穿刺 ,可建立长期血液透析通路 ,血流量高 ,并发症少。

72 、The Establishment of Prolonged Hemodialysis Access With Dacron-Cuffed Dural Lumen Catheter───应用带涤纶环双腔导管经锁骨下静脉建立长期血液透析通路

73 、Spinal Cord and Never Roots Conduction Implicated by Laminectomy and Various Materials in Dural Space: An Experimental Study in Rats───不同材料预防硬膜粘连对脊髓电生理的影响

74 、Germany Dural China Sales Centre───德国多丽上海营销中心

75 、Keywords magnetic resonance imaging;central nervous system;spinal cord;dural sac;───关键词磁共振成像;中枢神经系统;脊髓;硬膜囊;

76 、Anterior cranial fossa dural arteriovenous fistula (DAVF) is uncommon.In this report, we present two patients with anterior cranial fossa DAVF.───摘要前颅窝硬脑膜动静脉瘘管是少见的疾病,在本研究报告中,我们提出以外科手术治疗二位病人的经验。

77 、Lagrange's clinic dural hook───拉格朗热(氏)(硬)脑膜钩

78 、Keywords laminectomy;hydroxycamptothecin;mitomycin C;dural mater;adhesion;───椎板切除术;羟基喜树碱;丝裂霉素C;硬膜;粘连;

79 、Diagnosis and treatment of tentorial dural arteriovenous fistulae───小脑幕硬脑膜动静脉瘘的诊断和治疗

80 、Expression of vascular endothelial growth factors and changes of vascular ultrastructure in dura of rat dural arteriovenous fistula model───大鼠脑动静脉瘘模型硬脑膜中血管内皮生长因子表达与超微结构变化

81 、Objective To discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas (SDAVF).───摘要目的增强临床医师对影像不典型硬脊膜动静脉瘘(SDAVF)的认识,并加深对脊髓血管畸形的理解。

82 、We need to separate the cords from the midline dural sacs.─── 我们得把脊髓和中线硬膜囊分开

关键词用英语怎么说

 关键词特指单个媒体在制作使用索引时,所用到的词汇。是图书馆学中的词汇。关键词搜寻是网路搜寻索引主要方法之一,就是希望访问者了解的产品、服务和公司等的具体名称用语。那么你知道吗?下面来学习一下吧。

 关键词的英语说法:

 keyword

 关键词的相关短语:

 误导性关键词 Misleading Words

 关键词过滤 keyword infiltration

 关键词堆积 keyword loading keyword stuffing ; Keywords accumulation

 关键词频率 Keyword Frequency

 关键词检索 Keyword search

 关键词嵌入 Keyword Insertion

 社会化关键词 Social Keywords

 关键词指数 Keyword Effectiveness

 关键词的英语例句:

 1. The key word here is diversify; don't put all your eggs in one basket.

 这里的关键词是多样性;不要在一棵树上吊死。

 2. A *** all dram of whisky may be prescribed by doctors for those over 60 to help them sleep. It is vital though to emphasize that " *** all" is the operative word.

 医生可以建议60岁以上的老人少量地喝点威士忌以改善睡眠,然而至关重要的是必须强调“少量”这个关键词。

 3. The specific epithet variously did or did not repeat a key word from the phrase - name.

 种加词不同程度地重复或不重复同片语名称的某个关键词.

 4. Keywords: geometric nonlinearity, sag effect, equivalent modulus of elasticity, vehicle - bridge interaction.

 关键词: 几何非线性 、 中垂效应 、 等效弹性系数 、 车桥互制.

 5. Keywords: pulsory Education, Marketization of Education, Peer Effects, Efficiency, Equity.

 关键词: 基础教育教育产业化教育市场机制同群效应效率公平.

 6. How many times should my keywords appear on my pages?

 我的关键词应该出现在页面上多少次?

 7. Bhagavan: The word as we move into oneness is effortless effort.

 巴格旺: 进入合一状态的关键词是“无为之为”.

 8. Key words: non - market economy, antidumping, replacing country, market economy status.

 关键词: 非市场 经济反倾销法替代国市场经济地位.

 9. Keywords: Automatic car following, image processing, image matching, translation tracking.

 关键词: 自动跟车 、 影像处理 、 影像匹配 、 车辆位移追踪.

 10. Key words: dural tear, degeneratie lumbar surgery, repair, reoperation, plication.

 关键词: 硬膜囊破裂, 退变性腰椎手术, 修补, 再手术, 并发症.

 11. Also, try optimizing your site with keywords, before the other methods.

 同样的,在使用其他方法之前, 尽量尝试使用关键词来优化你的站点.

 12. Keywords: ahazard potency of debris flow, externality, cost - benefit *** ysis.

 关键词: 土石流特定水土保持区 、 外部性 、 成本效益 分析.

 13. Create and apply negative keywords at the ad group level.

 可以在**组级别新增负关键词,以排除有关的页面.

 14. Keywords: supercritical fluid, consistency test, theoretical model, phase equilibria.

 关键词: 超临界流体 、 一致性测试 、 理论模式 、 相平衡.

 15. Key words: right left visual field, character, graph, reaction time RT .

 关键词: 左右视野, 文字, 图形, 反应时.

腰椎运动单元精细解剖

对于腰腿痛的病因,除椎间盘突出和椎管狭窄外,近年来腰椎管外的解剖结构对腰神经根和腰神经后支的卡压越来越受到学者们的重视。单云官将腰神经走行的全程称为腰神经通道,腰神经通道的任何部分及其内容如发生病变均可产生腰腿痛。腰神经根和腰神经后支受压后最易产生临床症状,现对其走行、分支及腰神经通道周围的解剖结构进行简要综述。

1   腰神经根与腰神经通道

   1.1   腰神经根(lumbar nerve root)

   腰神经根自脊髓发出,穿出硬脊膜囊后,前、后根居于固有的根鞘内,至椎间管外口远侧根鞘续为神经外膜,神经根向前下外斜行。

   1.2   腰神经通道(lumbar nerve root pathway)

   腰神经根经上关节突旁沟、侧隐窝、盘黄间隙至椎间管外口,这段狭窄的骨纤维性通道即腰神经通道。Casey将该通道分为三区。入口区:指神经根离开硬脊膜囊到峡部上缘,前壁为椎体后缘和椎间盘,后壁由上下关节突、关节囊、黄韧带构成。此区最容易产生压迫。中区:位于椎板外侧的峡部和椎弓根下部,此区的神经结构为脊神经节,占空间较大,对轻微刺激较敏感。出口区:指椎间孔(管),上下壁为椎弓根,前壁为椎体上下缘及椎间盘,后方为关节突之外侧。神经根紧沿上一椎弓根的下缘。而郭世绂则把通道分为两段:第一段为神经根管, 通常将腰神经根穿出硬脊膜囊后,行经侧隐窝、盘黄间隙段称腰神经根管。它的前界为椎体后缘,外缘为椎弓根的内侧,内侧缘为硬膜外脂肪及马尾神经囊,后方为小关节面的内侧半及关节突。神经根管内宽外窄、前后略扁,如同小口朝外的漏斗,愈向下愈长,L5神经根管长度几乎为L1神经根管的2倍。第二段为椎间管,它的上界为上一个椎弓根的下缘,前界为椎体上下缘及椎间盘的后外缘,后界为关节突的外侧半,下界为下一个椎弓根的上面。

   周辉等提出腰神经通道腔隙与内容物比例学说,认为腰神经通道腔与腰神经根之间保持一定的空间比例关系。当正常的空间比例关系发生改变,就会使腰神经根在通道的某一部位受到卡压,出现症状。比例关系改变的情况包括:①腰神经根受无菌性炎症及局部充血水肿的影响变粗使得整个通道腔隙相对变窄。②神经通道腔壁狭窄。神经通道腔壁在长期炎性刺激,慢性劳损,或椎间盘突出,黄韧带肥厚,小关节突增生等因素作用下,出现某一部位的骨性或非骨性狭窄,造成腔隙与神经根空间比例缩小,神经根受压。神经根受机械压迫损伤后,可以造成神经内毛细血管通透性增高,导致水肿形成,影响神经根的营养输送,造成瘀血或缺血。Parke等研究认为,静脉瘀血是造成神经根疼痛的一个重要因素,缺血对神经根的传导功能的影响更甚于压力本身。

    椎间管(孔)(Intervertebral foramina)

   腰椎间管为侧隐窝外侧的骨性管道,由四壁二口组成:上壁为上位椎弓根的下缘;下壁为下位椎弓根的上缘,下壁内缘前后走行的嵴线为椎间孔和侧隐窝的分界线;前壁由上位椎体后缘、椎间盘的后缘及下位椎体的后缘三部分组成;后壁为关节突关节和关节囊前的黄韧带。内口朝向侧隐窝,外口朝向脊柱的外侧面。腰椎间管的长度,从上向下依次增长,从L1~L5依次为6.8~11.4mm,而管径自Ll~L5逐渐减小。外口的上下纵径大于前后(横)径,为长圆形。外口与神经根的面积相差悬殊,L1腰神经最细,占居同序数椎间管容积的1/12,L4、L5腰神经最粗,占居同序数椎间管容积的1/5~1/4。腰神经在椎间管内走行的长度约8 mm。在侧隐窝、椎间管内向外下方斜行通过,从L1~S1斜度逐渐增加,神经根与硬膜囊夹角由40°降到22°,因此从L1至L5神经根在椎间管内受压的机会依次增加。腰椎间管有以下解剖特点,①腰神经在管内行程长且斜行,管内纤维组织增生可累及腰神经。②L4、L5腰神经最粗,椎间管的空间范围最小。③脊神经节处粗大,靠近内口处,故内口处为相对的狭窄部位。④后壁黄韧带较厚,可使盘黄间隙变小。⑤椎间盘病变可使椎间管狭窄。腰椎间盘高度≤3 mm时,下腰椎椎间孔狭窄发生率较高。⑥腰椎体后、外侧缘骨质增生,可使椎间管、侧隐窝狭窄。

椎弓根(pedicle of vertebral arch)

   在椎管内段,神经根腹侧和背侧紧邻椎弓根;在椎间孔出口,脊神经节紧邻椎弓根;出椎间孔后,神经根紧贴椎弓根。椎弓根的外侧缘与神经根的内侧缘的最小距离小于5 mm。上位椎弓根与弥漫性椎间盘突出物之间为椎弓根下沟,椎间盘严重退变、缩窄可使上一椎体连同椎弓根下降,加重神经根在此沟内的卡压。

硬脊膜鞘(dural theca)

   硬脊膜鞘即腰神经根鞘[24],由硬脊膜和蛛网膜包绕前、后根和脊神经,可分内、外侧部。内侧部位于侧椎管内,自腰神经前、后根穿过硬脊膜孔处,至脊神经节远侧(合成)脊神经起始段止,分别包绕前根及后根,形成前根鞘及后根鞘。硬脊膜孔是前、后根穿出部位,前、后根鞘起始部硬脊膜较厚,为狭窄好发部位,蛛网膜粘连可累及前、后根。外侧部走行于椎间管内,自前、后根鞘在脊神经节远侧合为一鞘,为腰神经根鞘。出椎间管外口以后逐渐变薄续于神经外膜。硬脊膜续为神经外膜的外口称"袖口"。在"袖口"处也是狭窄的好发部位。

2  腰神经后支及其通道

   腰神经后支较细,在椎间孔处于脊神经节外侧从脊神经发出,向后行经骨纤维孔,在下位椎体横突根部的上缘与上关节突的外侧之间向后下走行,至横突间肌内侧缘,立即分为后内侧支及后外侧支[25],两者都是混合神经,有血管伴行。上腰段后支分支点在椎间孔外1.5 cm处;下腰段后支分支点约在椎间孔外2 cm处。分支处与横突根部的距离以2.9 mm以下者最多,占43.25%[26]。

   2.1  腰神经后支(the posterior ramus of lumbar nerve)主干

   腰神经后支主干长约5~10 mm,以L5最长,平均6.03±1.23 mm,L1最短,平均5.18±1.09 mm。L1~L5后支的直径以1~1.5 mm者最多,占70.00±2.29%[26]。

   2.2  骨纤维孔(osteo-fibrous foramina)

   又称腰神经后支骨纤维孔,位于椎间孔的后外方,开口向后,与椎间孔方向垂直。上界为横突间韧带的镰状缘,下界为下位椎体横突的上缘,内侧界为下位椎骨上关节突的外侧缘,外侧界为横突间韧带的内侧缘。骨纤维孔的体表投影,位于该椎骨棘突外侧,在下述二位点的连线上。上位点在L1腰椎平面后正中线外侧2.3 cm,下位点在L5腰椎平面后正中线外侧3.2 cm。后支过此孔时周围仅有少许脂肪组织,紧贴横突间韧带,神经受压的可能性更大。

   2.3  腰神经后内侧支

   2.3.1  腰神经后内侧支(the medial branch of the lumbar posterior ramus)   L1~L4腰神经后内侧支在下位椎骨横突后面,与来自腰动、静脉后支的血管伴行,向下行于横突及上关节突所形成的沟内,绕过上关节突的外侧缘,进入后内侧支骨纤维管[27]。该支进入骨纤维管后,行程类似"S"形,先行向上外方,翻越骨嵴,转向内下,然后出骨纤维管,沿椎板继续向内下方斜行,重叠分布于关节连线内侧的关节囊、韧带及肌肉。L5后内侧支进入骶骨上关节突、骶翼间沟下行,进入腰神经后内侧支骨纤维管。腰神经后内侧支的直径以0.5~0.9 mm者最多,占(60.00±2.45)%。L2最粗,平均值为0.80±0.20 mm,L1次之,平均值为0.75±0.18 mm,L3以下按序数逐渐变细。

   2.3.2  骨纤维管(osteo-fibrous canal)  腰神经后内侧支骨纤维管位于腰椎上关节突根部的背面,在腰椎乳突与副突间的骨沟内,由外上斜向内下。后内侧支骨纤维管有四个壁,上壁为乳突,下壁为副突,前壁为乳突副突间沟或有腱膜附着,后壁为上关节突副突韧带。

   上关节突副突韧带绝大部分起自于上关节突的外下缘,小部分起自乳突,或称之位乳突副突韧带,该韧带是横突间韧带的内侧部分,有骨化倾向,骨化的结果,在乳突与副突之间出现骨桥,使之成为完全的骨性管。苗华[2]统计显示骨性管约占6.8±1.59%。倪辉[28]对广西壮族男性成人干骨腰椎的研究显示,骨性管发生率为9.44%,且腰椎序数越大,年龄越大,骨性管的出现率越高。

   骨纤维管的入口(外口),即腰神经后内侧支进入骨纤维管部位,根据其外形将它分为圆形、椭圆形或裂隙状三种类型,并指出裂隙形外口约占28.39%,为骨纤维管狭窄区之一。

   骨纤维管是一个近似"拱形"的隧道。从上外到内下有一个转折,即乳突副突间沟骨面向后突起的部分,此处上关节突副突韧带较厚,是骨纤维管一个狭窄区。腰神经后内侧支与伴行的血管在此狭窄区折曲走行,容易遭受挤压,其伴行的血管表面有来自腰交感干的纤维包绕动脉,形成神经丝,也同样会受到挤压引起腰痛。在上关节突副突韧带的内侧缘有骨纤维管的出口,腰神经后内侧支自此离开管道。

   王博[29]所研究骨纤维管的解剖**显示:骨纤维管的中点水平方向上在相应椎体棘突上缘旁开2~3 cm处,下位的椎体节段旁开距离可以相应增大;在纵向上,L1~L3在棘突上缘上方0.5 cm范围以内,L4、L5可在棘突上缘偏下不超过0.5 cm范围内。

2.4  腰神经后外侧支

   腰神经后外侧支(the lateral branch of the lumbar posterior ramus)较粗,L1~L4后外侧支于距横突根上缘约3 mm处由后支发出,与血管伴行走向外下出后支骨纤维孔,沿横突背面向外下斜行,经骶棘肌穿腰背筋膜至皮下,沿途发出肌支和皮支。L1~L3的后外侧支较长,其本干穿过腰背筋膜至皮下,构成臀上皮神经,支配臀上部和外侧部皮肤。L4~L5的后外侧支短而分散,跨髂嵴经臀到骶后,参与形成臀中皮神经。后外侧支的分支主要分布于椎间关节连线以外的结构,如横突间韧带、髂腰韧带、横突间肌、骶棘肌和腰背筋膜等。L1~L5后外侧支的直径以L1为最粗,平均值为1.31±0.20 mm,以后按序数往下逐渐变细。

   腰神经后外侧支的走行并非直出直入,各段之间均有转折角,此角既是神经固定点,又是迂曲回转处。后支全部走行有六个固定点,顺序为出孔点、横突点、入肌点、出筋膜点及入臀点,其中出孔点、横突点和入臀点均较固定,这些部位如遭受损伤或牵拉,可产生局部或牵涉性腰腿痛。后外侧支经横突背面斜向下进入骶棘肌,在过横突时被纤维束固定于横突上,周围未见明显脂肪组织。亦有作者将此部位称为后外侧支骨纤维管[30],认为这个部位是后外侧支易受损伤之处。刘宝国[31]认为臀上皮神经行程过程中相对固定于筋膜鞘及骨纤维管和臀部浅筋膜的神经鞘中,特别是在髂嵴处,极易受损伤。

黄韧带位于脊髓硬膜囊的后外方,相邻两椎弓板之间 ,又称弓间韧带,由弹力纤维构成,薄而坚韧,颜色较黄,故名黄韧带。硬膜外后中部的脂肪位于两侧黄韧带之间,在矢状正中位上黄韧带最薄,呈斜形线状低信号,旁正中层面上呈上宽下尖的三角形,在轴位上,黄韧带与椎板平行,呈“V”字形,构成了矢面及轴面成像。正常黄韧带厚度颈椎小于1 . 5 m m ,胸椎小于2 m m ,腰椎小于4 m m 。肥厚的黄韧带分别呈锯齿形及“V ”样低信号。

1.3  上关节突(superior articular process)

   神经根的走行通道中,上关节突与神经根的关系最为密切。在盘黄间隙神经根位于椎间盘与上关节突、黄韧带之间,在侧隐窝神经根位于上关节突内缘与椎体后缘之间,在椎间孔神经根位于上关节突上缘与上位椎体后缘之间。上关节突肥大、内聚即可在上述部位压迫神经根出现腰腿痛。

   1.4  侧隐窝(lateral recess)

   侧隐窝为腰椎体后侧面的骨性隐窝。其前界为腰椎体后侧面,后界为上关节突前面及椎弓板与椎弓根连接处,外界为椎弓根内侧面,内界入口相当于上关节突前缘平面,向下外续于椎间管。腰神经根走行于侧隐窝内段的长度约4~6 mm[13]。侧隐窝矢径自L1~L5逐渐变小,一般认为侧隐窝的前后径小于2~3 mm,并有临床症状者,可诊断为腰椎侧隐窝狭窄症。

  1.5  盘黄间隙(interspace between intervertebral disc and ligamentum flavum)

   椎间盘与黄韧带之间的空隙,称盘黄间隙[14,15],盘黄间隙参与腰神经根管下部的构成。椎间盘与黄韧带之间的最近距离,L1为4.7 mm,L2为3.4 mm,L3为2.5 mm,L4为1.9 mm,L5为2.5 mm。黄韧带位于相邻两椎弓板之间,向外至下关节突根部,续至横突根部。腰椎黄韧带正常厚度为2.8~4.3 mm,病变时黄韧带增厚可达8~16 mm,可致盘黄间隙狭窄。黄韧带增厚与椎间盘突出均可使盘黄间隙狭窄。