不同体位下腰椎椎板间隙形态变化的测量及其临床意义  

Measurement and clinical significance of morphological changes of lumbar interlaminar space in different positions

作　　者：蒋虎山 曾建成[2] 朱书涛 霍守松 阮昆鹏 JIANG Hu-shan;ZENG Jian-cheng;ZHU Shu-tao;HUO Shou-song;RUAN Kun-peng(Department of Orthopaedics,Huaihe Hospital,Henan University,Kaifeng,Henan,475000,China)

机构地区：[1]河南大学淮河医院骨科,开封475000 [2]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2025年第1期10-15,共6页Chinese Journal of Bone and Joint

摘　　要：目的通过在不同体位下腰椎X线片上对腰椎椎板间隙参数进行测量,得到其绝对值及变化规律,从而为内镜下腰椎后路手术提供理论依据和指导。方法收集我院2022年6月至2023年12月,因L_(4-5)、L_(5)-S_(1)腰椎间盘突出症行经皮内镜下椎板间入路腰椎间盘髓核切除术(percutaneous endoscopic interlaminar discectomy,PEID)的患者共106例。术前常规拍摄腰椎正侧位及功能位X线片,术中拍摄屈曲俯卧位腰椎正侧位X线片,分别测量L_(4-5)和L_(5)-S_(1)椎板间隙的高度及宽度、终板角、腰椎前凸角等。结果术前腰椎正侧位X线片测得L_(4-5)、L_(5)-S_(1)椎板间隙的高度、宽度、终板角分别为(1.50±0.29)cm、(2.35±0.46)cm、(7.57±3.97)°,(1.68±0.29)cm、(3.03±0.52)cm、(10.67±5.38)°;腰椎前凸角为(37.78±15.09)°;术前腰椎功能位X线片上测得L_(4-5)、L_(5)-S_(1)过屈位终板角及腰椎前凸角分别为(2.61±4.28)°、(6.68±4.49)°、(17.84±11.46)°;过伸位终板角及腰椎前凸角分别为(8.76±4.75)°、(12.15±5.38)°、(49.35±13.09)°。术中屈曲俯卧位腰椎正侧位X线片测得L_(4-5)、L_(5)-S_(1)椎板间隙的高度、宽度、终板角分别为(1.70±0.31)cm、(2.40±0.46)cm、(6.55±3.79)°;(1.86±0.33)cm、(3.09±0.64)cm、(9.62±5.17)°;腰椎前凸角为(31.42±12.17)°。比较术前、术中L_(4-5)、L_(5)-S_(1)椎板间隙高度、各终板角及腰椎前凸角变化差异均有统计学意义(P<0.05),且与术前腰椎功能位X线片上终板角及腰椎前凸角的变化呈正相关。结论在不切除骨质的情况下,绝大多数L_(4-5)、L_(5)-S_(1)椎板间隙高度和宽度可以允许7 mm内径的内镜工作导管的置入。Objective By measuring the parameters of lumbar interlaminar space on X-ray films of lumbar spine at different positions,the absolute values and changes were obtained,which provided theoretical basis and guidance for endoscopic posterior lumbar surgery.Methods A total of 106 patients undergoing percutaneous endoscopic interlaminar discectomy(PEID)due to L_(4-5),L_(5)-S_(1) lumbar disc herniation in our hospital from June 2022 to December 2023 were collected.Anteroposterior,lateral and flexion-extension X-rays of the lumbar spine were routinely taken before surgery.Anteroposterior and lateral X-rays of lumbar spine were taken during surgery in prone flexion.The height and width of L_(4-5)and L_(5)-S_(1) interlaminar space,end-plate angle,and lumbar lordosis angle were measured respectively.Results On the preoperative anteroposterior and lateral X-rays of the lumbar spine,the height,width and end-plate angle of L_(4-5),L_(5)-S_(1) interlaminar space were(1.50±0.29)cm,(2.35±0.46)cm,(7.57±3.97)°;(1.68±0.29)cm,(3.03±0.52)cm,(10.67±5.38)°,respectively.And the lumbar lordosis angle was(37.78±15.09)°.The L_(4-5),L_(5)-S_(1) flexion X-rays of the lumbar spine end-plate angle and lumbar lordosis angle were(2.61±4.28)°,(6.68±4.49)°,and(17.84±11.46)°.The end-plate angle and lumbar lordosis angle in extension X-rays of the lumbar spine were(8.76±4.75)°,(12.15±5.38)°and(49.35±13.09)°,respectively.On the intraoperative prone flexion anteroposterior and lateral X-rays of the lumbar spine,the height,width and end-plate angle of L_(4-5),L_(5)-S_(1) interlaminar space were(1.70±0.31)cm,(2.40±0.46)cm and(6.55±3.79)°;(1.86±0.33)cm,(3.09±0.64)cm,(9.62±5.17)°,respectively.And the lumbar lordosis angle was(31.42±12.17)°.The changes of L_(4-5),L_(5)-S_(1) interlaminar height,end-plate angle and lumbar lordosis angle before and during operation were compared,and the differences were statistically significant(P<0.05),which were positively correlated with the changes of end-plate angle and lumbar lordosis ang

关 键 词：X线 椎间盘移位 腰椎 内窥镜检查 

分 类 号：R687.3[医药卫生—骨科学]