单侧双通道脊柱内镜技术对侧入路治疗上腰椎椎间盘突出症的影像学研究及临床应用  

Imaging study and clinical application of unilateral biportal endoscopy technique for upper lumbar disc herniation via contralateral approach

作　　者：王建业 刘鑫[1] 任佳彬[1] 刘彬 李岳飞 刘昌震 耿晓鹏[1] 窦永峰[1] 孙兆忠[1] WANG Jianye;LIU Xin;REN Jiabin;LIU Bin;LI Yuefei;LIU Changzhen;GENG Xiaopeng;DOU Yongfeng;SUN Zhaozhong(Department of Spine Surgery,Affiliated Hospital of Binzhou Medical College,Binzhou Shandong,256600,P.R.China)

机构地区：[1]滨州医学院附属医院脊柱外科,山东滨州256600

出　　处：《中国修复重建外科杂志》2022年第10期1213-1220,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家重点研发计划资助项目(2017YFC0114002);山东省自然科学基金资助项目(ZR2017LH021);滨州医学院“临床+X”项目(BY2021LCX17);滨州医学院科技计划项目(BY2018KJ03)。

摘　　要：目的通过CT三维重建技术,观测上腰椎骨性结构、神经、黄韧带压迹等位置关系,指导单侧双通道脊柱内镜(unilateral biportal endoscopy,UBE)技术对侧入路治疗上腰椎椎间盘突出症(upper lumbar disc herniation,ULDH)。方法以2019年6月—2021年7月收治且符合选择标准的21例ULDH患者作为研究对象,其中男12例,女9例;年龄55~72岁,平均62.1岁。病程1~12年,平均5.7年。病变节段:L_(1、2)1例,L_(2、3)4例,L_(3、4)16例。将患者T_(12)~S_(3)节段CT脊髓造影数据导入Mimics21.0软件行腰椎三维重建,观察上腰椎节段椎体棘突侧方与椎板下缘交点(Q点)、黄韧带上缘压迹线、神经根起点下缘、椎间孔及椎间隙等组织结构毗邻关系。应用Mimics21.0软件建立直径3 mm圆柱体模拟UBE手术路径并测量其外展角(∠b1),以及测量以下腰椎相关指标:L<sub>1、2~L_(3、4)节段Q点至同节段椎体对侧椎弓根下缘、下位椎体对侧椎弓根上缘、同节段椎体下终板、下位椎体上终板的垂直距离(分别记为a1、a2、a3、a4);椎体下终板至同节段椎弓根下缘垂直距离,椎弓根上缘至下位椎体上终板垂直距离(分别记为c1、c2);神经根起点下缘分别至同节段椎弓根上缘、下缘垂直距离(分别记为d1、d2);黄韧带上缘压迹线外侧部与椎弓根内侧缘交点(P点),分别至同节段椎弓根上、下缘垂直距离(分别记为e1、e2);关节突关节间隙、椎体峡部最狭窄处外侧缘分别至硬脊膜外侧缘水平距离(分别记为f1、f2)。研究纳入患者中13例选择UBE对侧入路手术治疗。男8例,女5例;年龄55~71岁,平均63.3岁。病程2~12年,平均6.2年。病变节段:L_(2、3)3例,L_(3、4)10例。记录围术期并发症,影像学复查手术减压情况,采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、简明健康调查量表(SF-36量表)评分评价临床疗效。结果影像学观测显示,各节段a1、a3、a4、e1、e2、f1、f2比较差异均无Objective To investigate the relationships between the bony structures,nerve,and indentations of ligamentum flavum of the upper lumbar spine by using CT three-dimensional reconstruction technique,in order to guide the unilateral biportal endoscopy(UBE)technique via contralateral approach in the treatment of upper lumbar disc herniation(ULDH).Methods Twenty-one ULDH patients who were admitted between June 2019 and July 2021 and met the selection criteria were selected as the research subjects.There were 12 males and 9 females with an average age of62.1 years(range,55-72 years).The disease duration was 1-12 years(mean,5.7 years).There was 1 case of L_(1,2),4 cases of L_(2,3),and 16 cases of L_(3,4).The CT myelography data of T_(12)-S_(3)segment was saved in DICOM format and imported into Mimics21.0 software for three-dimensional reconstruction.The relationship between the intersection(point Q)of spinous process and the inferior margin of lamina,the indentation of superior margin of ligamentum flavum,the inferior margin of nerve root origin,intervertebral space,and foramen were observed.The Mimics21.0 software was used to create a 3-mm-diameter cylinder to simulate the UBE channel and measure its abduction angle(∠b1),as well as measure the following lumbar vertebra-related indicators:in L_(1,2)-L_(3,4)segments,the vertical distance from the point Q to the inferior margin of the contralateral lumbar pedicle of the same lumbar vertebra(a1),the superior margin of the contralateral pedicle of the lower lumbar vertebra(a2),the lower endplate of the same lumbar vertebra(a3),the upper endplate of the lower lumbar vertebra(a4);the vertical distance from the lower endplate of lumbar vertebra to the inferior margin of the lumbar pedicle(c1),the vertical distance from the upper endplate of the lower lumbar vertebra to the superior margin of the lumbar pedicle(c2);the vertical distance from the inferior margin of the nerve root origin to the superior margin(d1)and the inferior margin(d2)of the lumbar pedicle,respectively;the

关 键 词：单侧双通道脊柱内镜技术 对侧入路 上腰椎椎间盘突出症 影像学研究 临床应用 

分 类 号：R687.3[医药卫生—骨科学]