微创斜向腰椎椎体间融合术手术入路的影像学相关研究

发布时间：2018-02-06 04:27

本文关键词： 微创斜向腰椎椎体间融合术影像学血管腰大肌　出处：《中国脊柱脊髓杂志》2016年08期 　论文类型：期刊论文

【摘要】：目的 :分析L1/2~L4/5各椎间隙之间血管和腰大肌关系,了解微创斜向腰椎椎体间融合术手术入路的影像学特点。方法:选取2013年11月~2015年9月收治的113例腰椎疾病患者,12例因MRI、X线片技术上问题造成的影像显示不清或者腰椎/腹膜后手术史影响正常解剖被排除,最后对101例患者的MRI及X线片进行数据测量,男46例,女55例,年龄51~68岁,平均59.0±4.4岁。在MRI上测量L1/2~L4/5各椎间隙平面血管和腰大肌间的距离;在侧位X线片上测量L5上终板中点与左侧髂棘的垂直距离,高于髂棘为正值,低于髂棘为负值。结果:L1/2~L4/5椎间隙平面血管和腰大肌间的平均距离左侧分别为20.7±5.63mm、20.1±6.97mm、19.5±6.20mm、15.7±7.86mm,右侧分别为15.3±6.29mm、8.8±4.32mm、7.1±4.34mm、4.8±3.69mm;左侧均大于右侧,差异有统计学意义(P0.01),由L1/2~L4/5血管和腰大肌间的平均距离呈下降趋势;左侧L4/5椎间隙平面血管和腰大肌平均距离小于其他节段平均距离,差异有统计学意义(P0.01),其中有9例血管与腰大肌间隙距离小于5mm,2例血管与腰大肌之间无间隙;在X线片上L5上终板中点与左侧髂棘的垂直距离为-33~19.6mm,平均-7.0±14.2mm,其中30%髂嵴高于L5上终板中点。结论 :MRI可作为微创斜向腰椎椎体间融合术手术入路的术前评估手段,节段越高,血管与腰大肌间隙距离越大,而且左侧血管肌肉间隙大于右侧,适合采用微创斜向腰椎椎体间融合术。
[Abstract]:Objective: to analyze the relationship between blood vessels and psoas major muscle between L 1 / 2 and L 4 / 5 intervertebral spaces. Objective: to investigate the imaging features of minimally invasive oblique lumbar interbody fusion. Methods: from November 2013 to September 2015, 12 patients with lumbar vertebra disease were treated with MRI. The X-ray images were not clear or the history of lumbar / retroperitoneal surgery was excluded. Finally, the data of MRI and X-ray films were measured in 101 patients (46 males). 55 female patients, aged 51 to 68 years (mean 59.0 卤4.4 years), were measured on MRI for the distance between the intervertebral vessels and the psoas major muscles in the intervertebral space of L 1 / 2 and L 4 / 5; The vertical distance between the midpoint of the upper end plate of L5 and the left iliac spine was measured on the lateral radiographs, which was higher than that of the iliac spine. Results the average distance between the intervertebral space and the psoas major muscle was 20.7 卤5.63mm / 20.1 卤6.97mm, respectively. 19.5 卤6.20mm, 15.7 卤7.86mm, 15.3 卤6.29mm, 8.8 卤4.32mm, 7.1 卤4.34mm, respectively. 4.8 卤3.69mm; The difference between left side and right side was statistically significant (P 0.01). The average distance between L 1 / 2 L 4 / 5 blood vessels and psoas major muscle showed a decreasing trend. The average distance between the left L4 / 5 intervertebral space and the psoas major muscle was less than that of the other segments, and the difference was statistically significant (P 0.01). In 9 cases, the distance between the blood vessels and the psoas major muscle space was less than 5 mm. There was no space between the blood vessel and the psoas major muscle in 2 cases. The vertical distance between the midpoint of the upper end plate of L5 and the left iliac spine on the X ray film was -33 ~ 19.6mm, with an average of -7.0 卤14.2mm. Conclusion 30% iliac crest is higher than the midpoint of L5 superior endplate. Conclusion the microinvasive approach to oblique lumbar interbody fusion can be used in preoperative evaluation. The higher the level of the iliac crest is, the greater the distance between the blood vessel and the psoas major muscle is. Moreover, the left vascular muscle space is larger than that of the right, which is suitable for minimally invasive oblique lumbar interbody fusion.
【作者单位】：广东省人民医院广东省医学科学院骨科;
【分类号】：R687.3

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