基于腹部CT血管成像评价斜外侧腰椎椎间融合术手术通道的解剖学研究

Anatomical study of surgical corridor for oblique lateral interbody fusion based on abdominal computed tomography angiography

目的探讨性别、年龄、皮脂厚度及主动脉分叉位置对斜外侧腰椎椎间融合术(OLIF)手术通道大小的影响。方法回顾性分析2021年10月至2022年2月在嘉兴市第一医院接受腹部CT血管成像技术检查的100例患者的影像学资料。测量OLIF手术通道大小,比较不同节段、性别、年龄、皮脂厚度、腹主动脉分叉位置下的手术通道大小差异,以及腰椎节段动脉走形对OLIF手术的影响。结果不同节段手术通道大小的比较差异有统计学意义(P<0.01),其中L_(4~5)节段手术通道小于L_(1~2)、L_(2~3)、L_(3~4)节段(均P<0.01)。不同性别各节段手术通道大小比较差异均无统计学意义(均P>0.05)。皮脂厚度与L_(4~5)节段手术通道大小呈负相关(r=-0.332,P<0.01)。不同腹主动脉分叉位置患者L_(4~5)节段手术通道大小比较差异有统计学意义(P<0.05)。L_(1)、L_(5)节段动脉前1/3处至椎体下终板的距离与管状撑开器半径10 mm比较差异均无统计学意义(均P>0.05),L2~4各节段动脉前1/3处至椎体下终板的距离与管状撑开器半径10 mm比较差异均有统计学意义(均P<0.01)。结论L_(4~5)节段OLIF手术通道小于L_(1)~4节段,且手术通道大小受腹主动脉分叉位置及皮脂厚度影响,此外,当行L_(1~2)及L_(4~5)节段OLIF手术时,需警惕L_(1)和L_(5)节段血管损伤风险。

Objective To explore the anatomical structure of a surgical corridor for oblique lateral interbody fusion(OLIF)based on abdominal computed tomography angiography(CTA).Methods The imaging findings of 100 patients who underwent abdominal CTA in Jiaxing First Municipal Hospital from October 2021 to February 2022 were retrospectively reviewed.The size of the OLIF surgical corridor(the distance between the left margin of the abdominal aorta or the left common iliac artery and the anteromedial margin of the psoas major muscle on the axial midpoint image of the L_(1-5) disc)was measured;the position of the bifurcation of the abdominal aorta,the course of the lumbar segmental arteries and the structural relationship between the disc and the vertebral body were observed.The differences in corridor size under different level,gender,age,sebum thickness,and abdominal aortic bifurcation positions,as well as the influence of lumbar segmental artery alignment on OLIF surgery were investigated.Results The surgical access size of L_(4-5) segment was significantly smaller than that of L_(1-2),L_(2-3),and L_(3-4) segments(all P<0.01),while there were no significant differences in surgical access size between males and females(all P>0.05).The sebaceous thickness was negatively correlated with L_(4-5) segment surgical access size(r=-0.332,P<0.01).There was significant difference in the size of surgical access at L_(4-5) segment among patients with different abdominal aortic bifurcation location(all P<0.05).The distance from the anterior 1/3 of the artery to the inferior endplate of the vertebral body in each segment of L_(1) and L_(5) was not significantly different to the radius of the canal spreader of 10 mm(both P>0.05);while that of L2-4 was significantly different to the radius of the canal spreader of 10 mm(all P<0.01).Conclusion L_(4-5) segment OLIF surgical access is smaller than L_(1-4) segment,and the access size is influenced by the location of the abdominal aortic bifurcation and sebaceous thickness.In addition,when performing L_(1-2) and L_(4-5) segment OLIF surgery,the risk of vascular injury to L_(1) and L_(5) segments needs to be alerted.