微创斜向腰椎椎体间融合术手术入路的影像学相关研究

Radiographic study of operative approach in minimally invasive oblique lumber interbody fusion

中文关键词:  微创斜向腰椎椎体间融合术  影像学  血管  腰大肌

英文关键词:Minimally invasive oblique lumber interbody fusion  Radiography  Vessel  Psoas major

中文摘要:

  【摘要】 目的：分析L1/2～L4/5各椎间隙之间血管和腰大肌关系，了解微创斜向腰椎椎体间融合术手术入路的影像学特点。方法：选取2013年11月～2015年9月收治的113例腰椎疾病患者，12例因MRI、X线片技术上问题造成的影像显示不清或者腰椎/腹膜后手术史影响正常解剖被排除，最后对101例患者的MRI及X线片进行数据测量，男46例，女55例，年龄51～68岁，平均59.0±4.4岁。在MRI上测量L1/2～L4/5各椎间隙平面血管和腰大肌间的距离；在侧位X线片上测量L5上终板中点与左侧髂棘的垂直距离，高于髂棘为正值，低于髂棘为负值。结果：L1/2～L4/5椎间隙平面血管和腰大肌间的平均距离左侧分别为20.7±5.63mm、20.1±6.97mm、19.5±6.20mm、15.7±7.86mm，右侧分别为15.3±6.29mm、8.8±4.32mm、7.1±4.34mm、4.8±3.69mm；左侧均大于右侧，差异有统计学意义（P<0.01），由L1/2～L4/5血管和腰大肌间的平均距离呈下降趋势；左侧L4/5椎间隙平面血管和腰大肌平均距离小于其他节段平均距离，差异有统计学意义（P<0.01），其中有9例血管与腰大肌间隙距离小于5mm，2例血管与腰大肌之间无间隙；在X线片上L5上终板中点与左侧髂棘的垂直距离为-33~19.6mm，平均-7.0±14.2mm，其中30%髂嵴高于L5上终板中点。结论：MRI可作为微创斜向腰椎椎体间融合术手术入路的术前评估手段，节段越高，血管与腰大肌间隙距离越大，而且左侧血管肌肉间隙大于右侧，适合采用微创斜向腰椎椎体间融合术。

英文摘要:

  【Abstract】 Objectives: To analyze the relationship between the vessel and psoas major of L1/2-L4/5 levels, and to investigate the radiographic characteristics of the operative approach in minimally invasive oblique lumber interbody fusion. Methods: 113 cases were selected from the inpatients who had the lumbar MRI and anteroposterior(AP) lumbar film between November 2013 and September 2015. 12 cases were excluded due to the unclear imaging or other abdominal surgery history. Finally 101 cases were chosen, among whom there were 46 males and 55 females, aging from 51 to 68 years(average, 59.0±4.4 years). The distances between the vessel and psoas major of L1/2-L4/5 levels were measured on MRI, and the vertical distances between the upper end plate midpoint of L5 and left iliac crest were measured in the anteroposterior(AP) lumbar film. Results: The distances between the vessel and psoas major of L1/2-L4/5 levels were 20.7±5.63mm, 20.1±6.97mm, 19.5±6.20mm, 15.7±7.86mm respectively on the left side, and 15.3±6.29mm, 8.8±4.32mm, 7.1±4.34mm, 4.8±3.69mm respectively on the right side. The distance of left side at each level was significantly longer than that of right side(P<0.01), respectively. The distance decreased from level L1/2 to L4/5. The distance of L4/5 level was significantly shorter than that of other levels on left side(P<0.01), there were 9 subjects less than 5mm, and 2 of them had no gap between the vessel and psoas major. The vertical distances between the upper end plate midpoint of L5 and left iliac crest ranged from -33 to 19.6mm(average, -7.0±14.2mm), 30% of which had higher iliac crest than the upper end plate midpoint of L5. Conclusions: MRI is an effective way to access the operative approach in the minimally invasive oblique lumber interbody fusion preoperatively. There may be more benefit from the higher lever by using the minimally invasive oblique lumber interbody fusion. The distance between the left vessel and psoas major is longer than the right side, as a result, the left side is recommended as the surgical approach.