退行性腰椎侧凸极外侧椎体间融合入路腰丛分布的MRI研究  

A MRI study of lumbar plexus in patients with degenerative lumbar scoliosis after extreme lateral interbody fusion

作　　者：何磊[1] 董健文[1] 刘斌[1] 陈瑞强[1] 冯丰[1] 戎利民[1] 

机构地区：[1]中山大学附属第三医院脊柱外科,广州510630

出　　处：《中华医学杂志》2014年第3期178-181,共4页National Medical Journal of China

基　　金：广东省科技计划项目（20118090400078）

摘　　要：目的分析退行性腰椎侧凸病例腰丛分布的MRI影像特点，评价MRI神经显像的应用价值与极外侧椎体间融合（XLIF）手术入路的神经功能安全性。方法2012年7月至2013年2月中山大学附属第三医院脊柱外科对19例退行性腰椎侧凸采用MRI三维快速稳态采集成像序列多平面容积三维重建，左、右侧凸分别为11例、8例，通过L1-2至L4-5各椎间隙中点水平层面轴位图像测量腰丛前缘至手术入路穿刺路径即椎间盘矢状面中心点垂直线（椎间盘矢状面中垂线）的距离，设定正、负值分别表示腰丛前缘位于椎间盘矢状面中垂线后、前方。结果L1-2至L4-5间隙凹侧腰丛前缘距椎间盘矢状面中垂线距离在左侧凸／右侧凸病例依次为（13．7±2．5）mm／（12．9±5．5）mm、（8．3±4．7）mm／（8．5±5．7）mm、（2．7±3．6）mm／（2．5±7．2）mm和（-4．2±3．8）mm／（-3．8±7．1）mm，均较凸侧腰丛分布位置偏后。结论L1．2与12．3间隙两侧、L3_4间隙凹侧腰丛行走于椎间盘矢状面中垂线后方腰大肌内；L34间隙凸侧和IA-5间隙两侧腰丛则移行至椎间盘矢状面中垂线前方，术前MRI腰丛显像对XLIF入路安全性评估有参考价值。Objective To analyze the magnetic resonance neural imaging distribution of lumbar plexus in patients with degenerative lumbar scoliosis and evaluate its value and the safety of extreme lateral interbody fusion （XLIF）. Methods Three-dimensional fast imaging employing steady-state acquisition （3D FIESTA） sequences of lumbar spine were scanned on 19 patients with degenerative lumbar scoliosis, including levoscoliosis （ n = 11 ） and dextroscoliosis （ n = 8 ） . All images were sent to workstation for multiplanar volume reconstruction to analyze the distribution of lumbar plexus from L1-2 to L4-5 level. The axial image distance （ AID ） was measured between anterior edge of lumbar plexus and sagittal central perpendicular line （SCPL）. SCPL was drawn perpendicularly to the sagittal plane of intervertebral disc and passed through its central point. It was actually the pathway of guide wire implanting procedure and the ongoing axis of work channel during XLIF. With respect to SCPL, the distance with a positive value indicated posterior neural tissue whereas a negative value anterior neural tissue. The differences of AID were compared between convex and concave sides and among different cases and levels. Results From L1-2 to IA-5 level, the AID on the concave side in levoseoliosis or dextroscoliosis cases was （ 13.7 ± 2. 5 ） mm/ （12. 9 ±5.5） mm, （8.3 ±4. 7） mm/（8. 5 ±5.7） mm, （2. 7 ±3.6） ram/（2. 5 ±7.2） mm and （ -4. 2 ±3.8） mm/（ -3.8 ±7.1 ） mm respectively. They were located significantly posteriorly to the relevant disc compared to those on the convex side at the same intervertebral space （ P 〈 0. 05 ）. The differences of AID at the same side, concave or convex side, was significant （ P 〈 0. 05 ）. No significant differences of lumbar plexus distribution existed between levoseoliosis and dextroseoliosis cases （ P 〉 0. 05 ）. Conclusion Lumbar plexus passes through psoas posteriorly to SCPL on both side at L1-2, L2-3 level and on the concave sid

关 键 词：脊柱侧凸 脊柱融合术 腰椎 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学]