经腹穿刺腰_5骶_1椎间盘髓核摘除术的影像解剖研究  

Imaging anatomy study of transabdominal L_5/S_1 lumbar discectomy

作　　者：姜文进[1] 生琦瑞[1] 孙博琳[1] 程雪玲[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院介入放射科,山东烟台264000

出　　处：《医学影像学杂志》2010年第12期1875-1878,共4页Journal of Medical Imaging

摘　　要：目的:为经腹穿刺腰椎间盘髓核摘除术提供影像学解剖依据和术前分型方法,提高手术安全性。方法:选取15例CT血管造影(CTA)影像资料,应用容积重建(VR)显示骶正中动脉,对比观察骶正中动脉与肠系膜动脉分支。选取27例患者下腹部压迫前后CT图像,测量L5/S1腰椎间盘前髂血管间隙。随机选取2009年9月～11月200例腰椎MRI检查影像学资料,测量L5/S1腰椎间盘前髂血管间隙,并根据血管间隙占椎间盘宽度的比例进行分型。结果:骶正中血管位于腹膜后紧贴椎体或椎间盘下行,通过血管直径及位置可与肠系膜血管分支区分。L5/S1椎间盘前方髂血管间隙宽度为(33.26±11.21)mm,安全型占69.0%(138/200),相对安全型占19.0%(38/200),阻挡型占12.0%(24/200)。经腹压迫前后髂血管间隙宽度的变化有明显统计学意义(P<0.01)。结论:L5/S1椎间盘前髂血管间存在安全穿刺间隙,压腹后明显增宽,术前根据MRI或CT定位,可以避开骶正中血管及髂血管。Objective:To provide anatomical basis for imaging and preoperative classification method in transabdominal lumbar discectomy(TALD) so as to improve surgical safety.Methods:The image data of 15 patients underwent CT angiography(CTA) examination were reconstructed for the median sacral artery(MSA) by volume rendering(VR) to comparatively observe the MSA and mesenteric vessel branch.27 patients underwent abdominal CT before and after abdominal compression,while,vascular space in front of lumbosacral disc was also observed and measured.200 patients were randomly selected with lumbar MRI from September to November 2009.The vascular space in front of lumbosacral disc was measured and classified according to the ratio of the vascular space distance to the width of their posterior discs.Results:MSA in the retroperitoneal space went down close to the disc or vertebral body,and we can distinguish MSA and mesenteric vessel branch according to the blood vessel diameter and their position.At the level of lumbosacral disc,the inter-vascular space was(33.26±11.21) mm,of which 69.0%(138/200) was safety type,19.0%(38/200) was the relative safety type,and 12.0%(24/200) was block type.After the abdominal pressure,the change of the inter-vascular space was significant(P <0.01).Conclusion:There is safe puncture space at the level of lumbosacral disc,the space can be significantly widened after abdominal compression.We can avoid the MSA injury by preoperative MRI or CT localization.

关 键 词：经腹穿刺 腰椎 椎间盘切除术 分型 安全性 

分 类 号：R8[医药卫生—临床医学] R445