椎间孔镜工作通道相关解剖参数的三维影像学测量  

Three-dimensional imaging measurement of anatomical parameters related to the working channel of transforaminal endoscope

作　　者：秦豪 钟诚凡[1] 刘伟 罗绍坚[1] 李小川[1] 黄春明[1] QIN Hao;ZHONG Chengfan;LIU Wei;LUO Shaojian;LI Xiaochuan;HUANG Chunming(Department of Orthopedic,Gaozhou People's Hospital,Gaozhou 525200,Guangdong Province,China)

机构地区：[1]高州市人民医院骨科,广东省高州市525200

出　　处：《微创医学》2024年第6期625-630,共6页Journal of Minimally Invasive Medicine

基　　金：茂名市科技计划项目(编号:2020KJZX011)。

摘　　要：目的通过数字医学软件对腰椎椎间孔及毗邻神经进行三维重建,测量三维模型的椎间孔镜工作通道相关参数,从而指导椎间孔镜工作通道的置入,避免神经根损伤。方法将腰椎的MRI“Dicom”数据导入医学三维重建软件Mimics17.0获得腰椎三维模型,测量患者脊柱L3~S1三个节段左右两侧椎间孔镜工作通道相关解剖参数。比较同侧不同椎间隙相关解剖参数的差异及同一椎间隙两侧相关解剖参数的差异。结果L3~S1同一侧不同椎间孔的纵轴和横轴尺寸均呈逐步下降趋势,差异均有统计学意义(均P<0.05);同一节段两侧椎间孔纵轴、横轴尺寸差异无统计学意义(P>0.05)。L3~S1同一侧不同节段神经根到上关节突距离的差异有统计学意义(P<0.05),L3~S1神经根到上关节突的距离自上而下呈逐渐增大的趋势;同一节段两侧神经根到上关节突距离的差异均无统计学意义(均P>0.05)。结论L3~S1神经根到上关节突的距离自上而下呈逐渐增大,L3~L4及L4~L5节段椎间隙下终板水平神经根到上关节突距离小于工作套管直径(7.5 mm),需要磨除部分上关节突方可安全置入椎间孔镜工作套管,否则会导致神经根损伤。Objective Using digital medical software to conduct three-dimensional reconstruction of the lumbar intervertebral foramen and its adjacent nerves,and measure the parameters related to the working channel of the transforaminal endoscope in the three-dimensional model,so as to guide the insertion of the transforaminal endoscope working channel and avoid nerve root injury.Methods The MRI"Dicom"data of the lumbar spine were imported into the medical three dimentional reconstruction software Mimics 17.0 to obtain a three dimentional model of the lumbar spine.And the anatomical parameters related to the working channels of the transforaminal endoscope on both the left and right sides of the three spinal segments(L3—S1)of the patients were measured.The differences between relevant anatomical parameters of different intervertebral spaces on the same side and those of the same intervertebral space on both sides were compared.Results The vertical and horizontal dimensions size of different intervertebral foramina on the same side at the L3—S1 levels showed a gradual decreasing trend,and all the differences were statistically significant(all P<0.05).There was no statistically significant difference in the vertical and horizontal dimensions size of the intervertebral foramina between the two sides of the same spinal segment(P>0.05).There were statistically significant differences in the distances from the nerve roots to the superior articular processes among different segments on the same side at the L3—S1 levels(P<0.05).The distances from the nerve roots to the superior articular processes at the L3—S1 levels showed a gradually increasing trend from top to bottom.There was no statistically significant difference in the distances from the nerve roots to the superior articular processes between the two sides of the same spinal segment(all P>0.05).Conclusion The distances from the L3—S1 nerve roots to the superior articular processes gradually increase from top to bottom.At the level of the inferior endplates of the

关 键 词：椎间孔 解剖 椎间盘切除术 经皮 工作通道 三维重建 神经根 

分 类 号：R687.3[医药卫生—骨科学]