基于CT三维重建的髂后上棘上连线在腰椎体表定位中的影像学分析

Imaging analysis upper line of posterior superior iliac spine based on three-dimensional reconstruction of CT in lumbar spine surface localization

目的比较CT三维重建后髂后上棘上连线与髂棘最高点连线(Tuffier’s线)和相应触诊间隙(棘突中点之间)位置的对应关系,探讨髂后上棘上连线在腰椎体表定位中的可行性。方法本研究纳入了在2019年10月—2020年10月于河南省人民医院行腰椎64排CT平扫的患者,男83例,女91例,年龄18~75岁(46.7±15.9岁)。将其CT原始数据导入宝葫芦三维模拟软件进行三维重建。标出两侧髂后上棘上连线(髂后上棘连线上1.5cm)及Tuffier’s线,观察其与相应触诊间隙的相对位置关系。结果174例患者中Tuffier’s线分布在L_(3)~L_(4)触诊间隙18例(10.3%),L_(4)~L_(5)触诊间隙116例(66.7%),L_(5)~S_(1)触诊间隙40例(23.0%)。髂后上棘上连线分布在L_(5)~S_(1)触诊间隙156例(89.7%);S_(1)~S_(2)触诊间隙18例(10.3%)。髂后上棘上连线的位置与L_(5)~S_(1)触诊间隙的一致性高于Tuffier’s线与L_(4)~L_(5)触诊间隙的一致性,差异具有统计学意义(χ^(2)=26.935,P<0.05)。Tuffier’s线的位置与性别之间差异具有统计学意义(P<0.05),随着年龄的增长,Tuffier’s线的位置有向头侧移位的趋势(P<0.05)。髂后上棘上连线的位置与性别之间差异无统计学意义(P>0.05)。随着年龄的增长,髂后上棘上连线的位置有向头侧移位的趋势(P<0.05)。结论髂后上棘上连线和L_(5)~S_(1)触诊间隙相对位置的一致性较Tuffier’s线和L_(4)~L_(5)触诊间隙相对位置的一致性好,髂后上棘上连线在临床应用中有可能成为一种更好的腰椎体表定位方法。

Objective To compare the corresponding relationship between the upper line of posterior superior iliac spine and the highest point line of the iliac spine(Tuffier’s line)and the corresponding palpation space(the middle point of the spinous process)after CT three-dimensional reconstruction.To explore the feasibility of the upper line of posterior superior iliac spine in the localization of the body surface of the lumbar vertebra.Methods This study included patients who underwent 64 CT scan of lumbar vertebrae in Henan people’s Hospital from Oct.2019 to Oct.2020.There were 83 males and 91 females,aged from 18 to 75 years(46.7±15.9 years).These CT data are imported into Baohulu 3 D software for 3 D reconstruction.The bilateral upper line of posterior superior iliac spine(1.5 cm on the line of posterior superior iliac spine)and Tuffier’s line were marked.The relative position relationship between them and the corresponding palpation space was observed.Results Among the 174 patients,Tuffier’s line was distributed in the L_(3)~L_(4)palpation space in 18 cases(10.3%),L_(4)~L_(5)palpation space in 116 cases(66.7%),and L_(5)~S_(1)palpation space in 40 cases(23.0%).The upper line of posterior superior iliac spine was distributed in the L_(5)~S_(1)palpation space in 156 cases(89.7%);S_(1)~S_(2)palpation space in 18 cases(10.3%).The position of the upper line of posterior superior iliac spine is more consistent with the L_(5)~S_(1)palpation space than the Tuffier’s line and the L_(4)~L_(5)palpation space,with significant statistical differences(χ^(2)=26.935,P<0.05).There is a significant statistical difference between the position of Tuffier’s line and gender(P<0.05).With the increase of age,the position of Tuffier’s line tends to shift to the head side(P<0.05).There was no significant difference between the position of the upper line of posterior superior iliac spine and gender(P>0.05).With the increase of age,the position of the upper line of posterior superior iliac spine tends to shift to the head side(P<0.05).Conclusion The consistency between the upper line of posterior superior iliac spine and the relative position of the L_(5)~S_(1)palpation space is better than that of the Tuffier’s line and the relative position of the L_(4)~L_(5)palpation space.The upper line of posterior superior iliac spine may become a better method for positioning the lumbar vertebral body surface in clinical applications.