机构地区:[1]滨州医学院附属医院脊柱外科,山东滨州256603 [2]山东颐养健康集团莱芜中心医院疼痛科,山东济南271103 [3]滨州市人民医院骨关节与运动医学科,山东滨州256600
出 处:《中国矫形外科杂志》2024年第21期1987-1993,共7页Orthopedic Journal of China
基 金:国家重点研发计划资助项目(编号:2017YFC0114002);山东省自然科学基金资助项目(编号:ZR2017LH021);滨州市社会发展科技创新计划项目(编号:2023SHFZ034)。
摘 要:[目的]在三维模型确定与镜下观测一致的骨性标志点,测量辅助单孔分体内镜准确定位并安全减压L_(4)出口神经根的参数。[方法]构建34例L_(4/5)单侧极外侧腰椎间盘突出症患者腰椎CT三维模型,以横突根部下缘与峡部外侧缘的交点(intersection of the lower margin of the transverse process root with the lateral margin of the isthmus,ITPI)为骨性标志点,分别在ITPI所在的矢状面测量相关指标,并进行男女间、健侧与患侧的比较。[结果]L_(4)出口神经根下缘投影于L_(4/5)椎间隙之上,健侧占比(4/34,11.8%)小于患侧占比(18/34,52.9%),投影于L_(4/5)椎间隙之内,健侧占比(30/34,88.2%)大于患侧占比(12/34,35.3%)。分别测量ITPI至L_(4)出口神经根上缘的垂直距离、L_(4)出口神经根下缘的垂直距离、L_(4)出口神经根后缘的前后水平距离、L_(4)下终板的垂直距离、L_(5)上终板的垂直距离、L_(4)椎弓根下缘的垂直距离;ITPI分别至L_(4)下终板最外侧缘的左右水平距离以及其所在矢状面上L_(4)出口神经根上缘的垂直距离、L_(4)出口神经根下缘的垂直距离、L_(4)下终板的垂直距离、L_(5)上终板的垂直距离;ITPI分别至L_(4)椎弓根内侧壁的左右水平距离、硬脊膜外侧缘的左右水平距离,以上指标男女间、健患侧之间差异均无统计学意义(P>0.05)。各测量指标与年龄、BMI均无显著相关性(P>0.05)。[结论]以L_(4)横突根部下缘与峡部外侧缘交点作为骨性标志点,无需向上探查,只需向外、向下磨除部分骨质即可显露并安全减压L_(4)出口神经根。[Objective]In three-dimensional models with the bony landmarks consistent with the endoscopic observation,the parameters related to L_(4) outlet nerve root accurately located and safely decompressed was measured for assistance of one-hole split endoscope.[Methods]On the 3D lumbar models of 34 patients with L_(4/5)unilateral far lateral lumbar disc herniation constructed based on CT,the parameters in the sagittal plane according to the intersection of the lower margin of the L_(4) transverse process root with the lateral margin of the isthmus(ITPI)were measured,including the vertical distance from the ITPI to the upper margin of L_(4) outlet nerve root(UMNR-L_(4)),the vertical distance of the lower margin of L_(4) outlet nerve root(LMNR-L_(4)),the anteroposterior horizontal distance of the posterior margin of L_(4) outlet nerve root(PMNR-L_(4)),the vertical distance of the L_(4) inferior endplate(IEP-L_(4)),the vertical distance of the L_(5) upper endplate(UEP-L_(5)),vertical distance of the pedicle lower margin of L_(4) pedicle(LMP-L_(4)),and so on.The data were compared between two genders and two sides.[Results]In term of the lower margin of L_(4) outlet nerve root projected above the L_(4/5)intervertebral space,the healthy side was smaller than that of the affected side[4/34(11.8%)vs 18/34(52.9%)];while the proportion of healthy side was larger than that of the affected side[30/34(88.2%)vs 12/34(35.3%)]when projected within the L_(4/5)intervertebral space.There were no significant differences between two genders and two sides in terms of the vertical distance between ITPI and the upper edge of L_(4) outlet nerve root,the vertical distance between lower edge of L_(4) outlet nerve root,the horizontal distance between anterior and posterior edge of L_(4) outlet nerve root,the vertical distance between lower end plate of L_(4),the vertical distance between upper end plate of L_(5) and the vertical distance between lower edge of L_(4) pedicle,the left and right horizontal distance of ITPI to the outermost edge of t
关 键 词:极外侧腰椎间盘突出症 出口神经根 单孔分体内镜 三维模型
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