经皮腰椎间盘穿刺入路的临床解剖学研究

发布时间：2018-06-20 02:05

本文选题：经皮 + 腰椎间盘　；参考：《第三军医大学》2005年博士论文

【摘要】：目的: 1. 阐明腰椎间盘及其毗邻关系的影像学特征,比较CT 和MRI 的价值和限度。 2. 制作人体脊柱腰段及其周围结构的连续薄层断面解剖图像数据集,说明其形态学特征及规律,比较薄层断面解剖和影像断面解剖的特点。 3. 寻求解决经皮腰椎间盘穿刺中“工作三角”或“安全三角”的确切定义,探明穿刺并发症的解剖学基础。 4. 结合PLDD 临床实践,为选择穿刺入路和提高穿刺水平提供有力的佐证。 5. 建立脊柱腰段的CT 三维重建、三维解剖模型,阐明脊柱腰段及其周围主要结构的立体形态、三维空间位置及其毗邻关系。 6. 构建基于PC 的经皮穿刺椎间盘手术入路可视化模型。材料与方法: 1. 在53 例正常腰椎间盘的CT 图像、40 例正常腰椎间盘的MRI 图像上,对腰椎间盘主要结构及其毗邻关系的影像学特征进行影像学观察和测量。 2. 选取2 例中国数字化可视人体数据,对腰椎间盘主要结构及其毗邻关系的连续断面形态进行解剖学观测,并与上述的CT、MRI 图像对照研究。 3. 选取腰椎间盘突出症患者86 例,经皮腰椎间盘穿刺定位进行激光汽化减压治疗,观察其穿刺成功率和治疗效果。 4. 选择4 例正常脊柱腰段,进行CT 三维重建,对脊柱腰段、腰动脉走行、髂动脉与L5-S1 椎间盘的空间关系进行观测。 5. 选取2 例CVH 数据集脊柱腰段连续断层图像,进行分割和三维重建,观察其空间位置关系。 6. 应用三维重建软件,将脊柱腰段的三维结构可视化并进行穿刺路径虚拟演示。结果: 1. 获得腰椎间盘主要结构及其毗邻关系的影像学特征和相关测量参数,左、右侧之间腰神经长度及宽度、穿刺线到腰神经的距离无显著性差异。CT 对穿刺线的骨性标志点上关节突显示优于MRI,MRI 对软组织密度分辨力较CT 高。
[Abstract]:Objective: 1. To elucidate the imaging features of lumbar intervertebral disc and its adjacent relationship and compare the value and limitation of CT and MRI. 2. The continuous thin sectional anatomical image data set of the lumbar segment of the human spine and its surrounding structure was made to illustrate the morphological characteristics and regularity of the data. The characteristics of thin sectional anatomy and image sectional anatomy were compared. 3. To find a solution to the exact definition of "working triangle" or "safety triangle" in percutaneous lumbar disc puncture, and to find out the anatomical basis of puncture complications. 4. Combined with PLDD clinical practice, it provides strong evidence for selecting puncture approach and improving puncture level. 5. Three-dimensional CT reconstruction and three-dimensional anatomical model of spinal lumbar segment were established to clarify the stereomorphology of spinal lumbar segment and its surrounding main structures, three-dimensional spatial position and its adjacent relationship. A visual model of percutaneous disc surgery based on PC was constructed. Materials and methods: 1. On the CT images of 53 normal lumbar intervertebral discs and 40 normal lumbar intervertebral discs, the imaging features of the main structures and adjacent relations of the lumbar intervertebral discs were observed and measured. 2. The anatomy of the main structures of lumbar intervertebral disc and its contiguous relationship were observed in 2 cases of Chinese digital visible human body data, and the results were compared with the CT MRI images mentioned above. 3. 86 patients with lumbar disc herniation were treated with laser vaporization decompression for percutaneous lumbar disc puncture localization. The success rate and therapeutic effect of laser vaporization were observed. 4. Three dimensional CT reconstruction was performed in 4 cases of normal lumbar spine. The spatial relationship between iliac artery and L5-S1 intervertebral disc was observed. Two consecutive CT images of lumbar spine from CVH data set were selected for segmenting and 3D reconstruction, and the spatial position relationship was observed. 6. 6%. The 3D reconstruction software was used to visualize the three-dimensional structure of the lumbar spine and perform a virtual demonstration of the puncture path. Results: 1. The main structure and adjacent relationship of lumbar intervertebral disc were obtained. The length and width of lumbar nerve between left and right were obtained. There was no significant difference in the distance between puncture line and lumbar nerve. Ct was superior to MRI MRI in the resolution of soft tissue density.
【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2005
【分类号】：R322

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