腰椎间盘突出症相关侵入类治疗体位下后侧安全入路临床研究

Clinical study on the posterior safety approach for invasive treatment of patients with lumbar disc herniation

目的:探讨腰椎间盘突出症相关侵入类治疗体位(俯卧位)下的后侧安全入路。方法:选择成年腰椎间盘突出症患者22例,用3.0T MRI对其腰椎(L_1-S_1)进行扫描,分别测量双侧上位腰椎下关节突外缘和下位腰椎上关节突外缘至后正中线的水平间距、双侧腰椎关节突关节后缘至腰背侧皮肤的最近距离,统计其差异。结果:侵入类治疗体表入路安全区间为距离后正中线:L_(1-2)为10.83～17.5 mm、L_(2-3)为13.03～19.17 mm、L_(3-4)为15.72～21.20 mm、L_(4-5)为19.47～25.55 mm、L_5-S_1为24.69～29.04 mm;侵入类治疗体内活动安全区间:L_(1-2)为7.03～7.93 mm、L_(2-3)为6.80～8.10 mm、L_(3-4)为6.57～7.66 mm、L_(4-5)为7.63～8.63 mm、L_5-S_1为6.13～7.27 mm,侵入类治疗的体内进针深度安全区间:L_(1-2)为37.19～39.85 mm、L_(2-3)为38.64～41.45 mm、L_(3-4)为40.23～43.60 mm、L_(4-5)为43.07～46.57 mm、L_5-S_1为45.24～49.00mm。结论:侵入类治疗的进针点、体内活动范围、进针深度,以平行矢状面和垂直冠状面进针较为安全,且应结合腰椎MRI,确保治疗的个体性、精确性、安全性。

Objective:To investigate the posterior safety approach in patients with lumbar intervertebral disc protrusion associated with invasive treatment(prone position).Methods: Twenty-two adult volunteers were selected and their lumbar vertebrae(L1-S1) were scanned with 3.0 T MRI. The horizontal distance between the Upper lumbar subtotal articular process and the lower lumbar superior articular process to the posterior median line was measured. The closest distance from the posterior edge of the lateral lumbar facet joint to the skin on the lower back was counted. And count the differences.Results:The safety interval of the invasive treatment surface is the distance from the midline: L1-2:10.83-17.5 mm,L2-3:13.03-19.17 mm,L3-4:15.72-21.20 mm,L4-5:19.47-25.55 mm,L5-S1:24.69-29.04 mm. Invasive treatment of in vivo activity safety interval: L1-2:7.03-7.93 mm,L2-3:6.80-8.10 mm,L3-4:6.57-7.66 mm,L4-5:7.63-8.63 mm,L5-S1:6.13-7.27 mm. Needle depth safety interval for invasivetreatment:L1-2:37.19-39.85 mm,L2-3:38.64-41.45 mm,L3-4:40.23-43.60 mm,L4-5:43.07-46.57 mm,L5-S1:45.24-49.00 mm.Conclusion: The needle insertion point, the range of motion in the body, and the depth of the needle in the invasive treatment are safer in the parallel sagittal plane and the vertical coronal plane, and should be combined with lumbar MRI to ensure the individuality, accuracy and safety of the treatment.