椎间孔镜术相关解剖参数的CT影像测量

Anatomic parameters related to percutaneous endoscopic lumbar discectomy measured on CT images

[目的]在CT影像上测量经皮椎间孔镜椎间盘切除术相关解剖参数。[方法]选取40名志愿者,男女各20名,采集腰椎影像学资料进行数字化处理,测量椎间孔的高度、宽度、椎间隙上下终板水平出口根到上关节突的距离、椎间隙上下终板水平神经根内缘与硬膜囊外缘的距离。[结果]从L3/4到L5S1节段椎间孔的高度和宽度均呈逐步降低趋势,同一节段的左右双侧对比差异无统计学意义(P>0.05),同一侧不同节段椎间孔的高度和宽度差异具有统计学意义(P<0.05)。椎间隙上、下终板水平出口根到上关节突距离从L3/4到L5S1节段逐渐增大。同一节段的左右双侧对比差异无统计学意义(P>0.05),同一侧不同节段椎间隙上、下终板水平出口根到上关节突距离差异具有统计学意义(P<0.05)。椎间隙上下终板水平上神经根內缘与硬膜囊外缘的距离从L3/4到L5S1节段逐渐增大,同一节段的左右双侧对比差异无统计学意义(P>0.05),而同一侧不同节段间隙上下终板水平上神经根內缘与硬膜囊外缘的距离差异具有统计学意义(P<0.05)。[结论]虽然从上到下椎间孔面积逐渐减小,但神经出口根倾斜角度逐渐增大,工作通道可操作范围也逐渐增大。

[Objective] To measure the anatomic parameters related to percutaneous endoscopic lumbar discectomy on CT images.[Methods] A total of 40 healthy volunteers, including 20 males and 20 females, were enrolled into this study. After lumbar CT scanning taken, the image data were digitalized, and then anatomic parameters were measured, including the height and width of the intervertebral foramen, the distance from the superior articular processes surface to the exiting nerve root at the upper and lower end plat level, as well as the distance between the inner edge of the never root and the outer edge of the dural sac at the upper and lower end plat level.[Results] The height and width of intervertebral foramen gradually decreased from L3/4 to L5 S1, with a statistically significant difference among the different levels on the same side (P<0.05), and without statistically significant difference between two sides at the same level (P>0.05). In addition, the distance from the superior articular processes surface to the exiting nerve root at the upper and lower end plat level increased step by step from L3/4 to L5 S1, which was statistically significant among the different levels on the same side (P<0.05), whereas it was not statistically significant between the two sides at the same level (P>0.05). Furthermore, the distance between the inner edge of the never root and the outer edge of the dural sac at the upper and lower end plat level also progressively increased from L3/4 to L5 S1, and there was a significant difference among different levels on the same side (P<0.05), while there was no statistical difference between the two sides at the same level (P>0.05).[Conclusion] Though the area of intervertebral foramen gradually reduces top-down, the inclination nerve outlet root gradually increases. It means that the operating range of working channel gradually increases from L3/4 to L5 S1.