腰椎滑脱的斜外侧椎间融合术入路影像解剖学评估

Imaging anatomical evaluation of the oblique lateral interbody fusion approach foRlumbaRspondylolisthesis

目的评估腰椎滑脱的斜外侧椎间融合术(OLIF)入路影像解剖学特点。方法将40例门诊腰痛行腰椎MRI检查的患者按照是否存在腰椎滑脱分为腰椎滑脱组(均确诊为L_(4)椎体Ⅰ~Ⅱ度退变性滑脱,20例)和非腰椎滑脱组(20例)。在腰椎MRI的L_(4~5)椎间隙中央层轴位T_(2)加权像上辨识左侧腰大肌、左侧腹主动脉、左侧腰交感干、节段动脉等解剖结构,并分析OLIF入路下相关解剖学参数的关系。结果L_(4)椎体OLIF入路下的左侧腰大肌前缘至腹主动脉的距离、左侧交感干至腹主动脉的距离腰椎滑脱组均明显大于非腰椎滑脱组(P<0.05);L_(4)椎体OLIF入路下的左侧腰大肌前缘至椎间隙前缘的距离、左侧交感干至腹主动脉的距离、节段动脉与相应椎体下缘的距离两组比较差异均无统计学意义(P>0.05)。结论L_(4)椎体Ⅰ~Ⅱ度退变性滑脱患者的OLIF手术操作空间更大,术中发生交感干损伤的风险较小。

Objective To evaluate the imaging anatomical characteristics of oblique lateral interbody fusion(OLIF) approach for lumbar spondylolisthesis.Methods The 40 patients who underwent lumbar MRI examination were divided into lumbar spondylolisthesis group(all patients were diagnosed as L;vertebral Ⅰ~Ⅱ degree degenerative spondylolisthesis, 20 cases) and non-lumbar spondylolisthesis group(20 cases),according to the presence of lumbar spondylolisthesis.The anatomical structures of left psoas major muscle, left abdominal aorta, left lumbar sympathetic trunk and segmental artery were identified by axial T_(2) weighted images of L_(4-5) intervertebral space central layer of lumbar MRI,and the relationship between related anatomical parameters with OLIF approach was analyzed. Results With the L_(4) vertebral OLIF approach, the distance from the anterior edge of the left psoas major muscle to the abdominal aorta and the distance from the left sympathetic trunk to the abdominal aorta were significantly greater in the lumbar spondylolisthesis group than those in the non-lumbar spondylolisthesis group(P<0.05);and there were no significant differences between the two groups in the distance from the anterior edge of the left psoas major muscle to the anterior edge of the intervertebral space, the distance from the left sympathetic trunk to the abdominal aorta, and the distance between the segmental artery and the lower edge of the corresponding vertebrae(P>0.05).Conclusions Patients with Ⅰ~Ⅱ degree degenerative spondylolisthesis of L_(4) vertebrae have more operation space and less risk of sympathetic trunk injury during OLIF operation.