腰椎椎旁肌间隙至棘突正中线距离的MRI测量及意义

The distance between paraspinal intermuscular cleavage and midline in the lumbar spine and its significance, an MRI study

中文关键词:  多裂肌与最长肌肌间隙  椎旁肌间隙入路  MRI

英文关键词:Multifidus and longissimus muscles  Intermuscular cleavage planes  Paraspinal approach  MRI

中文摘要:

  【摘要】 目的：测量国人腰椎各节段（L1~S1）多裂肌与最长肌间隙至棘突平分线的距离，探讨该距离的分布规律及意义。方法：随机选取2010年1月~2010年12月在我院行腰椎MRI检查的200例腰腿痛患者，其中男性100例，女性100例；在MRI上测量每位患者L1~S1各节段在椎间盘水平多裂肌外缘最凸出一点至棘突平分线的距离，采用频数分析、t检验等统计学方法分析其在不同节段的分布特征，比较不同性别与该距离的相关性。结果：L1/2、 L2/3、L3/4、L4/5、L5/S1椎间盘水平椎旁肌间隙至棘突平分线的距离均呈现正态分布，相同节段男女间多裂肌与最长肌间隙至棘突平分线距离差异无显著性差异（P>0.05），从L1/2~L5/S1椎间盘水平椎旁肌间隙至棘突平分线的平均距离分别为16.17±1.87mm、19.91±2.38mm、24.97±2.96mm、29.85±3.45mm、33.56±3.97mm，各节段平均距离有显著性差异（P＜0.05）。结论：国人腰椎多裂肌与最长肌间隙至棘突平分线距离随着节段的升高逐渐缩小，与患者性别无显著相关性，术前MRI测量可为经椎旁肌间隙手术入路切口的精确定位提供依据。

英文摘要:

  【Abstract】 Objectives: To measure the distances between the midline and the intermuscular planes formed by the multifidus and longissimus muscles at each lumbar level(L1-S1) and discuss the distance distribution in Chinese. Methods: Two hundred patients(100 males and 100 females) suffering from low back pain and with lumbar MRI records were selected randomly in our hospital from January 2010 to December 2010. The distance from the convexest point outside the multifidus muscles to the midline at each level between L1 and S1 was measured in MRI scans. The distance distribution at each level was determined by using the statistical methods(such as frequency analysis, t test). The correlation between sex and the measured outcomes was identified. Results: The statistical result showed normal distribution at each level(L1/2, L2/3, L3/4, L4/5, L5/S1). There was no sex-related statistical significance(P>0.05). Overall mean value between the midline and the paraspinal intermuscular planes at disc level from L1/2 to L5/S1 was 16.17±1.87mm, 19.91±2.38mm, 24.97±2.96mm, 29.85±3.45mm, 33.56±3.97mm, respectively. Mean measurement was significantly different between intermuscular cleavage planes and the midline at each lumbar disc level(P<0.05). Conclusions: The distances between the lumbar intermuscular planes and midline in Chinese gradually decrease from L5/S1 to L1/2. No significant correlations exist between males and females. Preoperative measurements in MRI scans provide valuable reference to determine the precise incision in Wiltse′s paraspinal surgical approach.