不同体位下腰椎椎间孔外口解剖学及影像学研究

Anatomy and imaging study of lumbar intervertebral foramina in different body positions

目的:比较正常人尸体L3-S1节段椎间孔外口相关解剖参数和正常人俯卧位和侧卧位L3-S1节段MRI影像椎间孔相关解剖参数。方法:测量6具正常人尸体标本L3-S1节段椎间孔纵径、横径,与2019年1月—2020年1月随机选取的20名健康志愿者腰椎磁共振影像俯卧位和侧卧位同侧椎间孔的纵径、横径进行对比。结果:尸体标本和磁共振影像上俯卧位从L3/4到L5/S1节段椎间孔的高度和宽度均呈逐步降低趋势。解剖学测量和影像学测量无显著差异(P>0.05),正常人侧卧位从L3/4到L5/S1节段椎间孔的纵径和横径逐步降低,侧卧位和俯卧位凸侧不同节段椎间孔的纵径和横径对比差异具有统计学意义(P<0.05),侧卧位凸侧影像学测量和解剖测量差异有统计学意义(P<0.05)。结论:侧卧位时相应节段椎间孔面积较俯卧位相对较大,椎间孔镜下手术安全性可能更好,但由于镜下操作的镜像关系,具体操作应视手术者习惯选择。

Objective To compare the anatomical parameters related to the external foramina of the L3-S1 segment in normal cadavers with those of the L3-S1 segment in the prone and lateral decubitus of normal subjects in MRI images.Methods The height and width of the foramen in L3-S1 segment were measured from 6 normal cadavers.The height and width of the ipsilateral foramina in the prone and lateral decubitus positions were measured and compared in 20 randomly selected volunteers from January 2019 to January 2020.Results The height and width of the foramina in the prone position from L3/4 to L5/S1 were gradually decreased in cadaver specimens and MRI images.There was no significant difference between the anatomical measurement and imaging measurement(P>0.05).The height and width of the foramina in the lateral decubitus from L3/4 to L5/S1 showed a gradual decrease trend in normal people.The difference of the height and width of the foramina in different segments on the same side between the lateral decubitus and the prone position was statistically significant(P<0.05).The difference between the imaging measurement and anatomical measurement in lateral decubitus position was statistically significant(P<0.05).Conclusion The foraminal area of the corresponding segment in the lateral decubitus position is relatively larger than that in the prone position,and the safety of foraminal surgery may be better.However,due to the mirror image of the operation under the microscope,the specific operation should be selected according to the habits of the operator.