基于磁共振神经显像技术解剖学研究的TLIF操作安全性分析  

Operative safety analysis of transforaminal lumbar interbody fusion in Chinese people based on the anatomical study by magnetic resonance neurography

作　　者：王洪立[1] 杨升达[1] 姜建元[1] 吕飞舟[1] 马晓生[1] 夏新雷[1] 王立勋[1] 

机构地区：[1]上海复旦大学附属华山医院骨科,200040

出　　处：《中华骨科杂志》2013年第2期165-170,共6页Chinese Journal of Orthopaedics

基　　金：2010年国家自然科学基金面上项目（81071438）;2010上海市卫生局课题重点项目;2012年上海市科委医学重点项目（12411951201）

摘　　要：目的通过磁共振神经显像技术（magneticresonanceneurography，MRN）测量腰骶神经根及毗邻结构相关解剖参数，分析腰椎各节段经椎间孔腰椎体问融合术（transforaminallumbarinterbodyfusion，TLIF）的安全性。方法选取12名（男、女各6名）正常健康志愿者，采用3．0T磁共振成像仪行腰骶神经根扫描，通过Osirix软件进行三维成像并测量神经根与上位椎弓根间距，神经根与下位椎弓根间距，神经根与矢状面夹角，上、下相邻椎弓根间距，上、下相邻神经根间距。结果12名志愿者L1-L5神经根通过MRN技术均获得良好显像。L1～L5神经根与上位椎弓根间距、神经根与矢状面夹角呈逐渐变小趋势；而神经根与下位椎弓根间距，上、下相邻椎弓根间距则变化规律不明显。与TLIF术中操作空间密切相关的神经根与下位椎弓根间距男、女分别为（8．99±0．88）mm～（10．72±1．01）mm和（7．76±0．46）mm～（8．54±0．65）mm，大多数受试者各节段均〈10mm，且女性数据明显小于男性。同节段左、右侧的差异无统计学意义。结论根据以上解剖学测量，进行TLIF操作时对上位神经根具有一定骚扰，对某些患者存在一定的损伤风险。Objective To measure the related anatomical parameters of lumbosacral nerve root and adjacent structures by magnetic resonance neurography, and to analyze operative safety of transforaminal lumbar interbody fusion in Chinese people. Methods A total of 12 healthy volunteers, including 6 males and 6 females, underwent magnetic resonance neurography of lumbosacral nerve root using a Siemens 3.0T MRI machine. The Osirix software was used to reconstruct the three-dimensional imaging and measure the following anatomic parameters： 1） the distance between the nerve root and the superior pedicle; 2） the dis- tance between the nerve root and the inferior pedicle; 3） the angle between the nerve root and the sagittal plane; 4） the distance between the superior and inferior nerve roots; 5） the distance between the superior and inferior pedicles. Results L1-L5 nerve roots got a good imaging by magnetic resonance neurography in all 12 volunteers. The distance between the nerve root and the superior pedicle and the angle between the nerve root and the sagittal plane gradually became smaller from L1 to LS. But the variation in the distance between the nerve root and the inferior pedicle and the distance between the superior and inferior pedicles was not obvious. The distance between the nerve root and the inferior pedicles, which was closely related to the op- erating space of TLIF, ranged from （8.99±0.88） mm to （10.72±1.01） mm for males and from （7.76±0.46） mm to （8.54±0.65） mm for females; it was less than 10 mm in each segments in the majority of subjects, and the data of females was significantly smaller than that of males. No significant differences were found in parame- ters between the left and right sides in the same segment. Conclusion Based on the above anatomical study and measurement analysis, we believe that there is some harassment to the upper nerve root in TLIF for Chinese patients, and for some patients there is a certain injury risk.

关 键 词：腰椎 脊柱融合术 脊神经根 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学]