影像三维重建安全辅助单孔分体内镜治疗L_(5)/S_(1)极外侧腰椎间盘突出症  

Three-dimensional image reconstruction can safely assist one-hole split endoscope in treatment of L_(5)/S_(1) far lateral lumbar disc herniation

作　　者：冯志萌 孙宁[1] 孙兆忠[1] 李岳飞 刘昌震 李洒 Feng Zhimeng;Sun Ning;Sun Zhaozhong;Li Yuefei;Liu Changzhen;Li Sa(Department of Spinal Surgery,Binzhou Medical University Hospital,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》2025年第9期1876-1882,共7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(ZR2017LH021),项目负责人:孙兆忠;滨州市社会发展科技创新计划(2023SHFZ034),项目负责人:孙兆忠。

摘　　要：背景:单孔分体内镜作为一种新型的内镜技术,适用于治疗极外侧腰椎间盘突出症。但目前国内外针对L_(5)/S_(1)这一发病率极低的极外侧腰椎间盘突出症的研究资料甚少,尚无详尽描述单孔分体内镜治疗L_(5)/S_(1)极外侧腰椎间盘突出症的影像解剖学资料。目的:通过影像三维重建确定骨性标志点,并以该标志点准确定位L_(5)出口神经根、L_(5)/S_(1)椎间隙及其他结构之间的位置关系,辅助单孔分体内镜经后外侧入路实现对L_(5)出口神经根的减压,治疗L_(5)/S_(1)极外侧腰椎间盘突出症。方法:选择符合纳入标准的29例L_(5)/S_(1)单侧极外侧腰椎间盘突出症患者,其中男12例,女17例;年龄48-74岁。将患者的腰椎CT数据资料导入Mimics 21.0软件中重建腰椎三维模型。测量L_(5)/S_(1)相关参数:①在横突根部下缘与峡部外侧缘的交点(H)所在矢状面上测量:H分别至L_(5)出口神经根上缘、下缘的垂直距离(a1,a2);H分别至L_(5)下终板、S1上终板的垂直距离(b1,b2);H至L_(5)椎弓根下缘的垂直距离(c);②H至L_(5)椎弓根内侧壁所在矢状面的左右水平距离(d);③H至硬脊膜外侧缘所在矢状面的左右水平距离(e);④H至L_(5)下终板最外侧缘所在矢状面的左右水平距离(f);⑤在L_(5)下终板最外侧缘所在矢状面上测量:H所在横断面分别至L_(5)出口神经根上缘、下缘的垂直距离(g1,g2);H所在横断面分别至L_(5)下终板、S1上终板的垂直距离(h1,h2);⑥H至L_(5)出口神经根最后缘所在冠状面的前后水平距离(i);⑦骶骨翼后缘最高点至L_(5)下终板最后缘所在冠状面的前后水平距离(j)。结果与结论:①男女之间各相关测量参数相比差异无显著性意义(P>0.05);②a1,a2,b1,b2,c,d,e,f,h1,h2,g1,g2,i,j患侧与健侧相比差异无显著性意义(P>0.05);③观测发现,a1与c之间相比差异无显著性意义(P>0.05),表明椎弓根下缘即为L_(5)出口神经根上缘,L_(5)出口神经根紧贴�BACKGROUND:One-hole split endoscope as a new type of endoscopic technique is suitable for the treatment of far lateral lumbar disc disease.However,there are few research data on L_(5)/S_(1),which has a very low incidence of far lateral lumbar disc herniation at home and abroad,and there is no detailed image anatomical data describing the one-hole split endoscope treatment of L_(5)/S_(1) far lateral lumbar disc herniation.OBJECTIVE:Through the three-dimensional image reconstruction,the bony landmarks were determined to accurately locate the positional relationship between the L_(5) outlet nerve root,the L_(5)/S_(1) intervertebral space and other structures.One-hole split endoscope via posterolateral approach was used to accurately,safely and effectively decompress the L_(5) outlet nerve root and treat the L_(5)/S_(1) far lateral lumbar disc herniation.METHODS:Twenty-nine patients with L_(5)/S_(1) unilateral far lateral lumbar disc herniation who met the inclusion and exclusion criteria were selected,including 12 males and 17 females at the age of 48-74 years.The lumbar CT data of the patients were imported into Mimics 21.0 software to reconstruct the three-dimensional lumbar model.Measurement of L_(5)/S_(1) related parameters:(1)Measurement on the sagittal plane at the intersection(H)of the lower edge of the transverse process and the lateral edge of the isthmus:The vertical distance between H and the upper and lower edges of L_(5) outlet nerve root(a1,a2);the vertical distance between H and the lower endplate of L_(5) and the upper endplate of S_(1)(b1,b2);vertical distance from the lower edge of the pedicle from H to L_(5)(c).(2)Horizontal distance between the left and right sides of the sagittal surface where the medial wall of the pedicle was located from H to L_(5)(d).(3)The horizontal distance from H to the left and right side of the sagittal plane where the lateral margin of the dura was located(e).(4)Horizontal distance(f)between the left and right sides of the sagittal plane at the outermost edge of the l

关 键 词：极外侧腰椎间盘突出症 单孔分体内镜 影像三维重建 骨性标志 数字化软件 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681.5