中国人适应性腰椎微创通道:基于CT影像学测量下的解剖数据分析

Minimally invasive channel of the lumbar spine surgery for Chinese:anatomical data based on CT imaging measurements

目的测量正常中国人群中腰椎相关影像学数据,为国人腰椎经皮置钉微创减压手术通道的设计提供解剖学数据。方法回顾性分析2018年至2020年行腰椎CT平扫,既往无腰椎相关疾病的门诊患者88例,其中男40例,女48例,18~38岁,平均(28.6±5.6)岁。于腰椎CT三维重建下测量微创减压手术通道相关参数包括:L1~L5关节突关节宽度、下位上关节突外缘到上位棘突根部的距离、上位椎弓根下缘与下位椎弓根上缘距离、上位椎体下缘至下位椎弓根上缘距离、上位椎弓根上缘至下一椎弓根下缘距离以及上位椎弓根下缘至下一椎弓根下缘距离等。结果关节突关节宽度在L4/5和L5/S1最大,为17.6 mm;下位上关节突外缘到上位棘突根部的距离在L5/S1为最大值24.9 mm;上位椎弓根下缘与下位椎弓根上缘距离在L2/3和L3/4为最大值19.5 mm;上位椎体下缘至下位椎弓根上缘距离在L2/3、L3/4为最大值11.1 mm;上位椎弓根上缘至下位椎弓根下缘距离在L1/2与L2/3为最大值48.5 mm;上位椎弓根下缘至下位椎弓根下缘之间距离在L1/2和L2/3为最大值34.0 mm。结论目前常用于腰椎微创减压手术的固定通道在各参数上缺乏统计学支持,可能会造成不必要的损伤,对中国青年腰椎解剖学参数的统计和研究对设计更加符合中国人的微创手术通道有重要意义。

Objective To measure the imaging data of lumbar spine of Chinses,so as to provide anatomical data for the designing of a minimally invasive decompression surgery channel of lumbar vertebrae.Methods Imaging data of 88 consecutive Chinese without related diseases were evaluated,including 40 male and 48 female.Average age was(28.6±5.6)years.The related parameters measured included the width of facet joint from L1 to L5,distance from lateral edge of superior articular process of the inferior vertebra to the root of superior spinous process of the superior vertebra,distance between the lower edge of pedicle of the superior vertebra and the upper edge of pedicle of the inferior vertebra,distance between lower edge of the interverbal disc and the upper edge of pedicle of the inferior vertebra,distance between the upper edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra and distance between the lower edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra.Results The width of facet joint reached the maximum of 17.6 mm in L4/5 and L5/S1.The distance from the lateral edge of superior articular process of the inferior vertebra to the root of superior spinous process of the superior vertebra reached the maximum of 24.9 mm in L5/S1.The distance between the lower edge of the vertebra of the superior vertebra and the upper edge of pedicle of the inferior vertebra reached the maximum of 19.5 mm in L2/3 and L3/4.The distance between upper edge of the interverbal disc and the upper edge of pedicle of the inferior vertebra reached the maximum of 11.1 mm in L2/3 and L3/4.The distance between the upper edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra reached the maximum of 48.5 mm in L1/2 and L2/3.The distance between the lower edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra reached the maximum of 34.0 mm in L1/2 and L2/3.Conclusion The surgery channel for minimally invasive decompression of lumbar vertebrae for Chinses lacks statistical support in various parameters,which might cause unnecessary damage during surgery.The research of the anatomical parameters of the lumbar spine has great significance for the design of more suitable minimally invasive surgical channels for Chinese.