骨盆后倾俯卧位与俯卧位下L5/S1椎板间隙影像学研究及其临床意义

Radiological study of L5/S1 laminar space on the posterior pelvic prone position and the normal prone position and its clinical significance

目的:在正常俯卧位和骨盆后倾俯卧位对腰5/骶1椎板间隙进行影像学测量,分析其特点,为临床上经皮脊柱内镜术经椎板间隙入路提供指导。方法:选取2017年1月至2018年12月在我院行经皮脊柱内镜治疗的患者52例,按不同的手术体位将其分为两组,俯卧位为常规组,骨盆后倾俯卧位为对照组,每组26例。分别在俯卧位及骨盆后倾俯卧位测量L5/S1单侧椎板间隙的宽度、棘突旁向外4 mm与同侧下关节突内缘向内4 mm之间的椎板间隙高度。比较分析两组患者内镜置入时间、手术操作时间。结果:在52例腰椎正位片中,骨盆后倾俯卧位与俯卧位相比L5/S1椎板间隙高度明显增加,差异具有统计学意义(P<0.05),两组单侧椎板间隙的宽度无明显变化(P>0.05)。对照组内镜置入时间、手术操作时间较常规组明显缩短(P<0.05)。结论:骨盆后倾俯卧位时可减少腰骶角角度,抵消腰椎前凸,使椎板间隙高度增加,为PEID(经椎板间隙入路脊柱内镜下椎间盘切除术)术前通道安放、术中操作提供帮助,该体位易摆放,易在基层医院推广开展。

Objective:To investigate the radiological measurements and features of the L5/S1 laminar space in the normal prone position and the posterior pelvic prone position,and to provide guidance for the translaminar approach for percutaneous spinal endoscopy in clinical practice.Methods:A total of 52 patients who underwent percutaneous spinal endoscopy in our hospital from January 2017 to December 2018 were enrolled According to the body position during surgery,they were divided into conventional group with the normal prone position and control group with the posterior pelvic prone position,with 26 patients in each group.Radiological examination was performed to measure the width of the L5/S1 unilateral laminar space and the height of the laminar space between 4 mm outward from the spinous process and 4 mm inward from the inner edge of the ipsilateral inferior articular process in the normal prone position and the posterior pelvic prone position.The two groups were compared in terms of time of endoscopic placement and of operation.Results:In the anteroposterior lumbar spine radiographs for the 52 patients,the height of the L5/S1 laminar space in the posterior pelvic prone position was significantly higher than that in the prone position(P<0.05),and there was no significant change in the width of the unilateral laminar space in the two groups(P>0.05).Compared with the conventional group,the control group had significantly shorter time of endoscopic placement and time of operation(P<0.05).Conclusion:The lumbosacral angle can be reduced in the posterior pelvic prone position,which can offset lumbar lordosis,increase the height of the laminar space,and provide help for preoperative placement of PEID(percutaneous endoscopic interlaminar discectomy)channel and intraoperative operation.The posture is easy to place and can be easily promoted in primary hospitals.