下腰椎板间隙的影像解剖学测量及其临床意义

Imaging anatomical measurement and clinical significance in minimally invasive surgery of the lower lumbar laminae interval space

目的应用影像解剖学测量腰椎板间隙参数,探讨其临床意义。方法观察145例腰椎间盘突出症患者的腰椎正位片,比较患侧(症状组)与健侧(对照组)椎板间隙形态,根据不同性别分别测量L4/5以及L5/S1节段双侧椎板间隙的高度、宽度和面积;通过腰椎三维CT测量腰椎板间隙的有效直径并进行统计分析。结果在腰椎正位片上健侧L4/5、L5/S1的椎板间隙多呈椭圆形,而患侧的椎板间隙以三角形和扁圆形多见;患侧腰椎板间隙狭窄发生率为68.1%,L4/5节段发生率为65.1%,L5/S1节段71.0%;高度改变的同时伴随宽度的改变;腰椎三维CT测量结果表明,76.5%的患者患侧椎板间隙有效直径小于工作通道直径,其中72.3%位于L4/5节段,80.6%位于L5/S1节段;男性椎板间隙的高度、宽度、面积以及有效直径其均值大于女性,差异具有统计学意义(P<0.05);总体上,L5/S1节段椎板间隙的高度、宽度、面积以及有效直径的均值大于L4/5节段。结论腰椎间盘突出症与椎板间隙的改变存在密切联系,掌握腰椎板间隙的高度、宽度、面积以及有效直径,可指导微创手术方式的选择及术中操作。

Objective To measure the anatomical parameters of lumbar laminae interval space with lower lumbar disc herniation(LDH)by an imaging method and to explore the clinical significance in minimally invasive spinal surgery.Methods One hundred and forty-five anteroposterior X-ray films with single lumbar disc herniation(L4/5 and L5/S1)were enrolled.The morphological characteristics of the lumbar vertabral laminae interval space between affected side(a symptoms group)and healthy side(a control group)were compared.The height,width and the area of the bilateral vertebral laminae interval space in the segments of L4/5 and L5/S1 were measured by X-rays according to the gender.The available diameter of lumbar laminae interval space was measured by lumbar vertebra 3D CT.Then all data were analyzed statistically.Results From the anteroposterior X-ray films of lumbar laminae interval space,the shape of the vertebral laminae interval space in the segments of L4/5 and L5/S1 in the healthy side group was oval,while the shape in the affected side group were in triangle and oblate shapes.The incidence of lumber disc space stenosis in the affected side group was 68.1%in total,including 65.1%happened in L4/5 segment and the incidence of L5/S1 segment was 71%.With the changing in the width of lumbar laminae interval space,the height also changed.The 3D CT result showed that the available diameter of the vertebral laminae interval space in 76.5%of the patients was smaller than the diameter of the working channel.72.3%of which were located in the L4/5 segment,and 80.6%in the L5/S1 segment.The mean height,width and the area as well as available diameter of the lumbar vertebral laminae interval space in male group were higher than those in female group,and the difference was statistically significant(P<0.05).The average height,width and the area as well as the available diameter in segment L5/S1 were larger than those in segment L4/5.Conclusions There was a closed association between lumbar disc herniation and the change of lumbar laminae interval space.With the understanding of the height,width,the area and available diameter of the lumbar vertebral laminae interval space would guide to select the minimally invasive surgical approach and the surgical procedure.