多层螺旋CT辅助设计腰5骶1椎间盘侧后方穿刺路径

Multislice spiral CT in the posterolateral puncture approach to the fifth lumbar and first sacral disc

目的探讨利用多层螺旋CT(MSCT)的多平面重组成像(MPR)技术和空间成像(InSpace)功能辅助设计腰5骶1(L5S1)椎间盘侧后方穿刺路径的可行性,并分析影响穿刺的主要因素。方法对81例临床拟诊腰椎间盘突出症患者按常规扫描,B31Smediumsmooth+2.0mm层厚重建,利用MPR和InSpace观察,测量所需数据并进行统计学分析。结果①共55例(67.9%)适合直接穿刺,穿刺参数:穿刺高度(3.80±1.19)cm,距后正中线距离(9.00±1.69)cm,进针深度(11.99±1.62)cm,与水平夹角(42.71±7.88)°,与尾侧夹角(26.22±7.61)°。②不适合直接穿刺患者的影像学资料显示因髂嵴阻碍穿刺5例;15例患者伴有不同程度的椎体及关节突关节的增生其中因关节突关节阻碍8例,因椎间隙狭窄7例;穿刺至椎间盘但未位于椎间盘中央区6例。结论多层螺旋CT可协助确定L5S1椎间盘侧后方直接穿刺的可能性并精确定位穿刺点及确定穿刺参数;影响L5S1椎间盘穿刺的原因是多因素的,髂嵴高度并非唯一因素。

Objective To evaluate the feasibility of multiplanar reconstruction （MPR） and Inspace of Multislice spiral CT in the posterolateral puncture approach to the Fifth lumbar and First sacral disc and the blockage factors of it. Methods MSCT scanning was performed in 81 patients considered lumbar disc herniation and whole visual field was reconstructed with B31S medium smooth^＋ 2.0 mm. The date was measured in MPR and analyzed with statistics. Results （1）The posterolateral puncture approach the L5 S1 disc could be availale in fifty five cases. The puncture parameters were： height （3.80±1.19） cm, the distance toposterior median line （9.00±1.69） cm, the depth （11.99±1.62） cm, the include angle to level （42.71±7.88）°, and the include angle to cauda （26.22±7.61）°. （2） For those posterolateral puncture approach the L5S1 disc not available, 5 cases were blocked with iliac crest, 8 cases blocked with zygapophysial joints, 7 cases with vertebral interspace straitness, and 6 cases failed to arrived the center of disc. Conclusion MSCT can be used to estimate the feasibility for posterolateral puncture approach to L5 S1 disc and to assess the puncture location and parameters accurately. There are some factors affecting the posterolateral puncture approach to L5 S1 disc, the iliae crest is not the only factor.