腰椎棘突间区的影像解剖学研究及其临床意义

Radiologic Anatomy of Interspinal Regions of Lumbar Vertebrae and Its Clinical Significance

目的：探讨三维CT重建腰椎棘突间区的方法及其临床意义。方法：GE light speed 16 pro螺旋CT扫描患者46人，扫描条件为层厚0．625mm，层距0．3mm，在图像工作站中ADW4．2软件采用容积再现及多平面重建技术重建T12至S1段脊柱三维图像，对图像进行整倍数放大，并使用图像工作站（Advantage Workstation）软件中的测量工具，对棘突间距，棘突顶距，棘突中央高度，相邻棘突上下缘及中央厚度进行测量，测量过程中可以对腰椎三维图像任意角度旋转，选择最佳测量图像，对测量的图像数据进行正态性检验、t检验。结果：腰椎棘突间距从上到下（L1～5）逐渐减小，L1～2为8．26mm，L4～5，为5．66mm。棘突顶距棘突中央高度中段大于上段和下段，T12～L1的棘突顶距为54．91mm，至L2～3，增大为59．35mm，L4～5减小为47．13mm。L3的棘突高度最大，为21．56mm，上一棘突下缘大于相邻下一棘突上缘厚度。女性棘突较男性棘突短薄矮（P〈0．05～P〈0．01）。结论：本研究可模拟生理状态下腰椎棘突间区解剖，所测指标呈正态分布，能够反映国人腰椎棘突间区解剖，为腰椎棘突间内固定器的设计和临床的应用及计算机导航手术系统的应用提供解剖学基础。

Objective：To investigate the technique and clinical significance of three-dimension CT （3D） reconstruction in interspinal region of lumbar spine. Methods：GE light speed 16 pro CT scanned 46 patients. ADW4.2 software was used to reconstruct the lumbar spine （T12～S1 ） by Volume rendering （VR） and multiple planar reformatting （ MPR ）. The 3-D image was amplified. The measurement tools in software were used to measure the following parameters of lumBar vertebrae from T12 to S1 ： the distance between two adjacent spinous processes （DB）, the distance across two adjacent spinous processes （DA）, the height of spinous processes（ H）, the thickness of the central part spinous processes（TC） , the thickness of the inferior margin of the upper spinous process（ TI） and that of the superior margin of the lower（TS） for the two adjacent spinous processes. During the measurement, the 3-D image could be rotated freely until the proper image was found. All the data obtained were analyzed with SPSS 10.0 statistical software for test of normality and t test. Results： The DB decreased successively from the superior to the inferior of lumbar vertebae. DBL1-2 was 8.26 mm and DBL5-S1 was 5.66 mm. The DA and H increased from the superior to the middle, and then decreased from the middle to the inferior lumbar vertebrae. DA T12 - L1 was 54.91 mm and DA L2-3 was 59.35 mm. Then DA L4-5 decreased to 47.13mm. HL3 was the biggest,which was 21.56 mm. For two adjacent vertebrae, the TI was thicker than TS. The spinous processes of the female were shorter, thinner and lower than that of the male （ P 〈0.05 to P 〈0. 01 ）. Conclusions：The 3-D image obtained in our study can simulate anatomy of the interspinal region of lumbar spine. All the data obtained for the measured parameters are normally distributed, which can show the anatomy of the interspinal region of Chinese men lumbar vertebrae and supply anatomical basis for the design and clinical application of interspinous device and computer assisted surgery for lumbar spine.