对腰大池持续脑脊液引流穿刺点的MRI分析

MRI analysis of puncture point of continued lumbar cerebrospinal fluid drainage

目的为探讨持续腰大池脑脊液引流（Continued lumbar cerebrospinal fluid drainage，CLCFD）穿刺点的解剖学依据和提高引流效果。方法选择64例行腰椎MRI检查的成年人，正中矢状面扫描进行穿刺点解剖学测量分析，即从L3-4和L4-5椎间盘的中点做一与椎管垂直的直线，命名为H1和H2线；该线与椎管前后径交点的中点即为两椎间隙的测量点（A点为L3-4，B点为L4-5）。分别测量A、B点到脊髓圆锥和硬膜囊终点的直线距离，H1和H2线与皮肤的交点S1和S1到蛛网膜下腔的距离。结果S1和S1到蛛网膜下腔的距离分别为（51．3±7．4）mm，（53．3±8．4）mm。A、B点到脊髓圆锥的距离分别为（90．1±16．4）mm，（121．9±17．3）mm；A、B点到硬膜囊终点的直线距离分别为（91．1±14．4）mm，（61．6±13．0）mm。比较A、B点到脊髓圆锥的距离及B点到脊髓圆锥和硬膜囊终点直线距离的差异有统计学意义。结论首选L4-5间隙穿刺头向置管；若选择L3-4间隙穿刺，头向和尾向置管都可行，但头向置管有利于引流。

Objective To explore for anatomic basis and improve drainage effects on CLCFD. Methods The MR machine of Siemens Trio Tim 3.0 T was used to scan the normal spinal canal of 64 adult subjects. The datum was measured in the median sagittal section of the lumbar vertebral column. Through midpoint of lumbar L3-L4 and L4-L5 vertebral disc＇ s, we painted vertical lines of vertebra, named H1 and H2 lines. The vertical line cross vertebral column at two points. The midpoint of two points is measured point（ A is L3-L4, B is L4-L5 ）. We measured distance from the junction of H1 or H2 lines and skin S1 or S1 to subarachnoid space,distance from A or B to the ending of spinal and dural pocket. Results The distance from S1 or S1 to subarachnoid space was （51.3±7.4）mm, （53.3 ± 8.4） mm. A, B point to the ending of spinal were （90. 1 ± 16.4） mm, （ 121.9 ± 17.3）mm. A,B point to the ending of dural pocket was（91.1 ±14.4） mm, （61.6 ± 13.0） mm. The distance from A, B point to the ending of spinal and B point to the ending of spinal and dural pocket were statisticalIy significance（P 〈 0. 01）. Conclusion Select lumbar L4-L5 puncture and cephalad implant catheter at first. It is possible to implant catheter cephalad or canda if select lumbar L3-L4 puncture, but cephalad implant catheter is beneficial to the cerebrospinal fluid drainage.