构建腰椎三维模型测量腰椎管减压术区神经组织及骨性结构的位置关系  

Measuring the position relation between nerve tissue and bony structure in lumbar spinal canal decompression area by constructing a three-dimensional model of the lumbar spine

作　　者：王建业 刘鑫[1] 田霖 孙宁[1] 李岳飞 毕经纬 刘昌震 孙兆忠[1] Wang Jianye;Liu Xin;Tian Lin;Sun Ning;Li Yuefei;Bi Jingwei;Liu Changzhen;Sun Zhaozhong(Department of Spine Surgery,Affiliated Hospital of Binzhou Medical College,Binzhou 256603,Shandong Province,China)

机构地区：[1]滨州医学院附属医院脊柱外科,山东省滨州市256603

出　　处：《中国组织工程研究》2023年第4期539-546,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家重点研发计划资助项目(2017YFC0114002),子项目负责人:孙兆忠;山东省自然科学基金资助项目(2R2017LH021),项目负责人:孙兆忠;滨州医学院“临床+X”项目(BY2021LCX17),项目负责人:孙兆忠;滨州医学院科技计划项目(BY2018KJ03),项目负责人:刘鑫。

摘　　要：背景:单侧双通道内镜对侧入路治疗腰椎管狭窄症的文献较少,目前尚无该入路镜下定位、减压范围、各结构毗邻关系等深入分析的资料。目的:通过三维CT重建,观测侧隐窝、椎间孔区域的骨性结构、神经组织、椎间隙、黄韧带附着处及腰椎峡部的位置关系,指导单侧双通道内镜技术在腰椎管狭窄症对侧入路治疗中的合理应用。方法:纳入2019年6月至2021年7月滨州医学院附属医院收治的34例腰椎管狭窄症患者,术前行腰椎CT脊髓造影检查,将影像资料导入Mimics 21.0软件重建腰椎三维CT图像。测量L_(4/5)和L_(5)S_(1)节段相关参数:①腰椎棘突侧方与椎板下缘交点(Q)分别至同序数腰椎对侧椎弓根下缘(a)、下位腰椎对侧椎弓根上缘(b)、同序数腰椎下终板(c)、下位腰椎上终板(d)垂直距离;②上关节突尖部至同序数椎弓根上缘(e)、上位腰椎下终板(f)垂直距离;③腰椎下终板至同序数椎弓根下缘(g)垂直距离;④腰椎上终板至同序数椎弓根上缘垂直距离(h);⑤神经根起点下缘分别至上位腰椎椎弓根下缘(i)、下位腰椎椎弓根上缘(j)垂直距离;⑥经Q(头倾或尾倾)与同序数腰椎对侧椎弓根下缘建立直径3 mm导棒,测量其外展角度(k)。7例患者根据上述测量结果完成单侧双通道内镜对侧入路腰椎管减压术,分别用疼痛目测类比评分、Oswestry功能障碍指数、36条目简明量表综合评估患者情况以验证手术疗效。结果与结论:①Q点、黄韧带上缘可作为镜下重要定位标志;黄韧带上缘压迹线对应的黄韧带上缘可作为内镜下定位标志,以此确定出口神经根、椎间孔上缘及腰椎峡部、下关节突;内镜下经Q点、以垂直于棘突后正中线、无头尾倾方向即可达L_(4/5)对侧椎间孔中1/3水平及L4下终板附近,向下完成椎间盘水平的侧隐窝减压;②L_(5)神经根起点下缘大多投影于对侧L_(4/5)椎间孔下1/3水平,这与L_(4/5)椎�BACKGROUND:There are few articles on the treatment of lumbar spinal stenosis by unilateral two-channel endoscopic contralateral approach,and there is no in-depth analysis of the endoscopic location,decompression scope and adjacent relationship of various structures of this approach.OBJECTIVE:To observe the bony structure,nerve tissue,intervertebral space,attachment of ligamentum flavum and position of lumbar isthmus in lateral recess and foraminal area through three-dimensional CT imaging.METHODS:Totally 34 patients with lumbar spinal stenosis admitted to the Affiliated Hospital of Binzhou Medical College from June 2019 to July 2021 were enrolled.Lumbar CT myelography was performed before surgery,and the images were imported into Mimics 21.0 software to reconstruct lumbar threedimensional CT model.Relevant parameters of L_(4/5) and L_(5)S_(1) segments were measured:(1)The vertical distance from the intersection of the lumbar spinous process and the lower edge of the lamina(Q)to the lower edge of the contralateral same lumbar pedicle(a),the upper edge of the contralateral pedicle of the lower lumbar spine(b),the lower endplate of same lumbar(c),the upper endplate of lower lumbar vertebrae(d);(2)The vertical distance from superior articular process to the upper edge of same lumbar pedicle(e),the lower endplate of upper lumbar vertebrae(f);(3)The vertical distance from the lower endplate of lumbar vertebrae to the lower edge of the contralateral lumbar pedicle(g);(4)The vertical distance from the upper endplate of lumbar vertebrae to the upper edge of the same lumbar pedicle(h);(5)The vertical distance from the lower edge of the nerve root origin to the lower edge of the upper lumbar pedicle(i),the upper edge of the lower lumbar spine pedicle(j);(6)A 3 mm diameter guide rod was established through point Q and the lower edge of the contralateral same lumbar pedicle to measure the abduction angle of guide rod(k).Seven patients underwent unilateral biportal endoscopic lumbar decompression through the contralateral appr

关 键 词：腰椎管狭窄症 单侧双通道内镜技术 三维CT 对侧入路 MIMICS 腰椎管减压 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R445