三维CT评估单孔分体内镜治疗L4/5滑脱症椎间融合术的安全性  

Safety of interbody fusion with one-hole split endoscope for L4/5 spondylolisthesis evaluated by threedimensional CT

作　　者：刘昌震 孙宁[1] 朱锴[1] 刘鑫[1] 窦永峰[1] 王建业 毕经纬 朱腾月 孙兆忠[1] Liu Changzhen;Sun Ning;Zhu Kai;Liu Xin;Dou Yongfeng;Wang Jianye;Bi Jingwei;Zhu Tengyue;Sun Zhaozhong(Department of Spine Surgery,Affiliated Hospital of Binzhou Medical College,Binzhou 256603,Shandong Province,China;Department of Orthopedics,Department of Traditional Chinese Medicine,The Sixth Medical Center of PLA General Hospital,Beijing 100048,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 [2]中国人民解放军总医院第六医学中心中医医学部骨伤科,北京市100048

出　　处：《中国组织工程研究》2023年第18期2884-2891,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:新型的单孔分体内镜技术已用于治疗腰椎滑脱症,但尚无该技术安全性、可行性、有效性的文献。目的:通过腰椎CT三维重建,观测骨性标志点与L_(4)、L_(5)神经及椎间隙位置关系,评估单孔分体内镜L_(4/5)滑脱症椎体间融合术的安全性。方法:26例Ⅰ度L_(4/5)滑脱症患者(滑脱组)和26例志愿者(正常组),均行腰椎CT扫描,导入Mimics 17.0软件,测量参数:①测量垂直距离。a,b:L_(5)上终板与L_(5)上关节突冠状位关节面内侧缘交点(N)分别至乳突后缘最高点(R)和L_(5)上关节突尖部(S);c:L_(4)下关节突尖部(X)至N所在矢状面与L_(4)下终板交点(M)。②测量水平距离。d:R至N所在横断面与L_(4)出口神经根下缘交点(N_(1));e:R至M所在横断面与L_(4)出口神经根下缘交点(M_(1));f:N至N所在横断面与神经组织外侧缘交点(N_(2));g:N_(1)至N_(2);h:M_(1)至M_(2);i:N_(2)至M_(1);j:M_(1)至L_(5)上关节突矢状位关节面后缘(R_(1))。③9例患者行单孔分体内镜椎体间植骨融合术,采用腰腿痛目测类比评分、日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)、36条目简明量表(Short-form 36,SF-36)评估疗效。结果与结论:①滑脱组b,c之间差异无显著性意义(P>0.05),表明显露L_(4/5)椎间盘只需去除等量的上、下关节突和/或椎板骨质。②两组d,e差异均有显著性意义(P<0.05),应根据病理变化数据规划手术。③两组f,g,i差异均无显著性意义(P>0.05),表明退行性滑脱未改变行走与出口神经的位置关系,在两者恒定不变的横向工作区置入融合器是安全的。④9例腰椎滑脱症患者末次随访的目测类比评分、JOA、ODI及SF-36评分均较术前、术后6个月明显改善(P<0.05)。⑤安全开窗范围:S向下(11.78±2.34)mm至N、X向上达L_(4)下终板分别显露椎间盘上、下缘;向外开窗至M_(1)不会伤及L_(4)神经;向内减压谨防损伤N及其附近的L_(5)神经。了解新型的单孔分体内�BACKGROUND:A novel one-hole split endoscope technique has been used in the treatment of lumbar spondylolisthesis,but there is no literature on the safety,feasibility and effectiveness of this technique.OBJECTIVE:The relationship between bone markers and L_(4),L_(5)nerves and intervertebral space position is observed by lumbar CT three-dimensional reconstruction to evaluate the safety of intervertebral fusion with one-hole split endoscopic L_(4/5)spondylolisthesis.METHODS:Totally 26 patients with grade I L_(4/5)spondylolisthesis(spondylolisthesis group)and 26 volunteers(normal group)underwent lumbar CT scanning.Data were input into Mimics 17.0 software to measure the following parameters:(1)vertical distance.a,b:The intersection of the medial edge of the articular surface at the coronal position of the upper endplate of L_(5)and the upper articular process of L_(5)(N)to the highest point of the posterior edge of the mastoid process(R)and the tip of the superior articular process of L_(5)(S);c:point of intersection between L_(4)inferior articular process tip(X)and N on sagittal plane and L_(4)inferior endplate(M).(2)Horizontal distance.d:intersection point between R and N and lower edge of L_(4)outlet nerve root(N_(1));e:intersection point of transverse section from R to M with lower edge of L_(4)outlet nerve root(M_(1));f:intersection point of N to N cross section and lateral edge of nerve tissue(N_(2));g:N_(1)to N_(2);h:M_(1)to M_(2);i:N_(2)to M_(1);j:Posterior edge of articular surface(R_(1))in sagittal position of superior articular process from M_(1)to L_(5).(3)Nine patients underwent a one-hole split splinterbody endoscopic interbody fusion with bone grafting.The outcomes were evaluated by visual analogue scale for lumbar and leg pain,Japanese Orthopaedic Association Evaluation score,Oswestry Disability Index,and 36-item Short-Form scale.RESULTS AND CONCLUSION:(1)There was no significant difference between b and c in the spondylolission group(P>0.05),indicating that only equal amounts of upper and lower artic

关 键 词：腰椎滑脱症 单孔分体内镜 椎体间植骨融合术 MIMICS 腰椎CT三维重建 

分 类 号：R459.9[医药卫生—治疗学] R496[医药卫生—临床医学] R318