基于MRN测量分析经椎板间隙入路内镜下腰椎间盘髓核摘除术的临床意义  

Analysis of clinical significance of lumbar intervertebral disc nucleus pulposus excision by translaminar approach based on MRN measurement

作　　者：王洪伟[1] 李铠湘 王青云[1] 刘晓强[1] 赵湘军[1] 李锐冰 钟章华 谷昌伟 WANG Hong-wei;LI Kai-xiang;WANG Qing-yun;LIU Xiao-qiang;ZHAO Xiang-jun;LI Rui-bing;ZHONG Zhang-hua;GU Chang-wei(Department of Orthopaedic Surgery,Dongguan Donghua Hospital,Dongguan,Guangdong 523110,China)

机构地区：[1]东莞东华医院脊柱外科,广东东莞523110

出　　处：《中国骨与关节损伤杂志》2021年第7期692-695,共4页Chinese Journal of Bone and Joint Injury

基　　金：广东省自然科学基金(2017A030313894)。

摘　　要：目的基于磁共振神经成像(Magnetic resonance neurography,MRN)测量评价经椎板间隙入路内镜下腰椎间盘髓核摘除术治疗腰椎间盘突出症的可行性。方法回顾性分析自2018-01-2019-12纳入的20位健康志愿者,对L_(4)~S_(1)节段相关解剖参数进行MRN测量分析,比较L_(4)、L_(5)神经根与上位椎弓根距离,比较L_(4、5)与L_(5)S_(1)安全三角面积,比较L_(4)、L_(5)、S_(1)神经根与硬膜囊夹角以及L_(4)、L_(5)、S_(1)神经根与硬膜囊边缘距离。结果20例均顺利完成MRN扫描,L_(5)神经根与上位椎弓根距离较L_(4)小,差异有统计学意义(P<0.05)。L_(4、5)与L_(5)S_(1)安全三角面积比较差异无统计学意义(P>0.05)。L_(4)神经根与硬膜囊矢状面夹角与L_(5)比较差异无统计学意义(P>0.05),而S_(1)神经根与硬膜囊矢状面夹角较L_(4)与L_(5)小,差异有统计学意义(P<0.05);L_(4)、L_(5)、S_(1)神经根与硬膜囊边缘的距离比较差异均有统计学意义(P<0.05),L_(5)神经根与硬膜囊边缘的距离大于L_(4),S_(1)神经根与硬膜囊边缘的距离大于L_(4)、L_(5)。结论经椎板间隙入路内镜下腰椎间盘髓核摘除术在下腰椎是安全、可行的,MRN技术可对经椎板间隙入路内镜下腰椎间盘髓核摘除的安全工作区域进行术前评估,对减少神经损伤并发症具有指导意义。Objective Based on magnetic resonance neurography(MRN)measurement to evaluate the feasibility of endoscopic lumbar disc nucleus excision through the interlaminar approach in the treatment of lumbar disc herniation.Methods A retrospective analysis was performed on 20 healthy volunteers from January 2018 to December 2019,MRN measurement and analysis of related anatomical parameters of the L_(4)~S_(1) segment,and comparison of the distance between the nerve roots of L_(4) and L_(5) and the upper pedicle,the safety triangle area was compared between L_(4、5) and L_(5)S_(1),the angle was compared between the nerve roots of L_(4),L_(5),S_(1) and the dural sac,and the distance was compared between the L_(4),L_(5),S_(1) nerve roots and the edge of the dural sac.Results MRN scans were successfully completed in 20 cases.The distance between the exit nerve root of L5 and the upper pedicle was smaller than that of L_(4),and the difference was statistically significant(P<0.05).There was no significant difference in the area of safety triangle between L_(4、5) and L_(5)S_(1)(P>0.05).The angle between the exit nerve root of L_(4) and the sagittal plane of the dural sac was not statistically different from that of L_(5)(P>0.05),while the angle between the exit nerve root of S1 and the sagittal plane of the dural sac was smaller than that of L_(4) and L_(5),and the difference was statistically significant.(P<0.05);the differend in the distance between the L_(4),L_(5),and S_(1),nerve roots and the edge of the dural sac was statistically significant(P<0.05),the distance between the L_(5) nerve root and the edge of the dural sac was greater than that of the L_(4) S_(1) nerve The distance between the root and the edge of the dural sac was greater than L_(4),L_(5).Conclusion The translaminar approach endoscopic lumbar disc nucleus extraction is safe and feasible in the lower lumbar spine.The MRN technology can evaluate the safe working area of the lumbar disc nucleus extraction under the translaminar approach endoscopically,and have

关 键 词：磁共振神经成像 经椎板间隙入路手术 椎间孔镜 腰椎 

分 类 号：R681.5[医药卫生—骨科学]