经皮椎间孔镜手术入路相关影像学研究

发布时间：2018-05-14 19:52

本文选题：内镜 + 磁共振成像　；参考：《济宁医学院》2017年硕士论文

【摘要】：目的:通过磁共振成像(Magnetic Resonance Imaging,MRI)测量正常成年人与腰椎间盘突出症(Lumbar Intervertebral Disc Herniation,LDH)患者的腰4(L4)神经根与腰5(L5)上关节突尖部之间的距离,探讨经皮椎间孔入路椎间孔镜下手术(Percutaneous Endoscopic Lumbar Discectomy,PELD)治疗L4/5椎间盘突出的安全性,为临床应用PELD提供准确的影像学参考数据。方法:收集2016年6月至2016年12月于我院MRI室行腰椎MRI检查患者共68例。将患者按照有无L4/5间盘突出分为突出组和正常组。患者年龄在20-40岁范围内,腰椎MRI图像无异常侧凸及后凸,横断面图像平行于上下终板。使用PACS(Picture Archiving and Communication Systems)系统软件测量,首先测量腰4/5终板间隙高度,然后使用标记笔在电子计算机屏幕上标记L5上关节突尖部,测量下终板、椎间隙中间层面、上终板层面神经根与标记点之间的距离,记录数据。根据勾股定理计算标记点与神经根之间距离,并用SPSS17.0软件进行统计学分析。结果:终板间隙高度正常组均值为8.66?0.65mm,椎间盘突出组均值为5.91mm?0.40mm,差异有统计学意义(p0.05)。正常组标记点与下终板层面神经根距离左侧4.29±1.36mm,右侧4.45±1.57mm;椎间隙中间层面左侧7.03±1.41mm,右侧7.15±1.41mm;上终板层面左侧11.48±1.16mm,右侧11.42±1.27mm。突出组标记点与下终板层面神经根距离症状侧4.58±1.98mm,无症状侧4.72±1.80mm;中间层面症状侧7.35±1.72mm,无症状侧7.18±1.77mm;上终板层面症状侧12.07±2.06mm,无症状侧11.72±2.10mm,以上差异均无统计学意义(p0.05)。结论:1、腰椎间盘突出可导致椎间隙高度降低,但腰4/5椎间盘突出不会造成神经根明显移位。2、年龄在20-40岁L4/5椎间盘1区和2区突出患者中,上关节突尖部与神经根之间距离大于工作通道半径,可以尝试沿上关节突尖部滑入椎管内,另外,行椎间孔成型时亦不会损伤出口根。
[Abstract]:Objective: to measure the distance between the L4 nerve root of normal adults and the Lumbar Intervertebral Disc herniation of lumbar intervertebral disc herniation (L5) by magnetic Resonance imaging (MRI). To investigate the safety of percutaneous transhepatic Endoscopic Lumbar discectomytomy (PELDD) in the treatment of L4 / 5 disc herniation, and to provide accurate imaging data for clinical application of PELD. Methods: from June 2016 to December 2016, 68 patients underwent lumbar MRI examination in our MRI room. Patients were divided into protrusion group and normal group according to L 4 / 5 disc herniation. In the age range of 20-40 years, MRI images of lumbar vertebrae showed no abnormal scoliosis and kyphosis, and the cross-sectional images were parallel to the upper and lower endplates. PACS(Picture Archiving and Communication Systems) software was used to measure the height of the lumbar 4 / 5 endplate gap, and then the upper articular process tip of L5 was marked on the computer screen with a marker pen, and the lower end plate and intervertebral space were measured. The distance between the nerve root and the labeled point in the upper endplate was recorded. The distance between marker points and nerve roots was calculated according to Pythagorean theorem, and the statistical analysis was carried out with SPSS17.0 software. Results: the mean value of intervertebral disc herniation was 5.91 mm 0.40 mm in the normal group and 0.65 mm in the disc herniation group. The difference was statistically significant (P 0.05). In the normal group, the distance between the labeled point and the nerve root of the inferior endplate was 4.29 卤1.36 mm on the left side and 4.45 卤1.57 mm on the right side, 7.03 卤1.41 mm on the left side and 7.15 卤1.41 mm on the middle layer of the intervertebral space, and 11.48 卤1.16 mm on the upper end plate and 11.42 卤1.27 mm on the right side. In the protruding group, the distance between the marked point and the nerve root in the inferior endplate was 4.58 卤1.98 mm and 4.72 卤1.80 mm in the asymptomatic side, 7.35 卤1.72 mm and 7.18 卤1.77 mm in the medial side, 12.07 卤2.06 mm and 11.72 卤2.10 mm in the upper end plate, respectively. Conclusions 1, lumbar disc herniation may lead to the reduction of intervertebral space height, but lumbar 4 / 5 disc herniation does not cause obvious displacement of nerve root. The distance between the superior articular process tip and the nerve root is larger than the working channel radius, so we can try to slide into the spinal canal along the superior articular process tip. In addition, the outlet root will not be damaged when the intervertebral foramen is formed.
【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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