国人直肠后间隙入路轴向行腰骶椎融合的影像学与解剖学测量

The anatomical and radiographic measurement in Chinese for the axial lumbosacral interbody fusion via retrorectal approach

中文关键词:  椎间植骨融合  直肠后间隙  骶骨进入点  影像学  解剖学

英文关键词:Interbody fusion  Retrorectal space  Entry point of sacrum  Radiology  Anatomy

中文摘要:

  【摘要】 目的：探讨国人直肠后间隙入路轴向行腰骶椎融合术的可行性。方法：选取国人正常成人（男40例、女40例）腰骶椎侧位X线片共８0张，通过对腰骶椎侧位X线片L5椎体下缘及S1椎体前缘的测量确定骶骨进入点的位置，计算S1椎体上缘至骶骨进入点与骶骨前缘距离的百分比。选取成人（男40例、女40例）骨盆CT片共８0张，排除骶骨骨折及盆腔占位性病变，测量骨盆CT（S3、S4平面）骶椎正中前缘到直肠后缘的距离，即建立工作管道矢状面的安全距离。选取40块经防腐处理的干燥成人骶骨标本，排除骨折与占位性病变，游标卡尺测量骶骨横线水平骶前孔内侧缘间距，即建立工作管道冠状面的安全距离。2具经甲醛防腐固定处理的成人男女尸体标本各一具，参照国外AxiaLIF手术方式，建立最大直径为1.2cm的工作管道；工作管道建成后解剖尸体标本，暴露腰骶椎区域及直肠后间隙，观察工作通道周围毗邻解剖结构损伤情况。结果：国人男性腰骶椎侧位片S1椎体前缘进针点位置为（71.6±14.8）%，女性进针点位置为（66.9±18.6）%；CT片测量：国人男性骨盆S3与S4平面直肠后间隙间距为9.9±4.7mm、9.7±4.6mm，女性骨盆 S3与S4平面直肠后间隙间距为6.0±2.6mm、5.9±2.4mm，男性直肠后间隙大于女性（P＜0.05）；骶骨标本骶前孔内侧缘间距（TS1、TS2、TS3、TS4）分别为3.1±0.3mm、2.9±0.2mm、2.7±0.2mm、2.6±0.2mm，不同骶前孔内侧缘间距比较有显著性差异（P＜0.05）；尸体标本模拟手术顺利，可顺利建立直径1.2cm工作管道，工作通道周围毗邻解剖结构无损伤，男女性尸体标本骶骨进入点水平最靠近中线的左右髂血管间的距离分别为5.0cm、5.6cm。结论：国人应用直肠后间隙入路轴向行腰骶椎融合术的骶骨进入点位置处于S1椎体正中中下份处，国人经直肠后间隙入路放置1.2cm直径工作管道及骶骨进入点处穿刺、钻孔是安全可行的。

英文摘要:

  【Abstract】 Objective：To investigate the feasibility of the axial lumbosacral interbody fusion via retrorectal approach in Chinese.Method：80 lumbosacral lateral X-ray films from normal adults（40 males and 40 females） were selected，the entry point in sacrum was determined by measuring of the L5 inferior and the S1 anterior part from the lumbosacral lateral X-ray.The CT images of pelvic were obtained from these 80 patients without sacral fracture and pelvic tumor，the distance from the anterior edge of middle of the sacrum to the posterior edge of the rectum was measured at S3 and S4 plane，which was the safe distance for establishing working channel.40 dry and normal adult sacrum specimens were used to measure the distance between the medial edge of anterior sacral foramina on the planar of the sacral horizontal line，which was the safe distance on coronal plane.The working channel with the largest diameter of 1.2cm was established in two adult corpses（1 male and 1 female），based on the surgical protocol of AxiaLIF（axial lumbosacral interbody fusion），the lumbosacral region and rectal space were exposed through autopsy.The injury to the anatomical structure around working channel was observed.Results：The entry point in sacrum for normal male and female was（71.6±14.8）% and（66.9±18.6）% from the lumbosacral lateral X-ray film，the distance of retrorectal space was 9.9±4.7mm and 9.7±4.6mm for S3 and S4 planar respectively on CT scan of male pelvic，while was 6.0±2.6mm and 5.9±2.4mm respectively on CT scan of female pelvic，which showed significant sex-related difference（P＜0.05）.The distance between the bilateral medial edge of anterior sacral foramina on the planar of the sacral horizontal line（TS1、TS2、TS3、TS4）　was 3.1±0.3mm、2.9±0.2mm、2.7±0.2mm and 2.6±0.2mm respectively，which showed significant difference（P＜0.05）.The procedure of sham operation on the adult corpse went with no difficulty，the working channel with diameter of 1.2cm was established successfully with no injury to adjacent major structure.The distance between medial iliac vessels and the sacral entry point was 5.0cm and 5.6cm for male and female respectively.Conclusion：As for AxiaLIF approach in Chinese, the entry point lies in the lower half of S1 vertebral.It is safe and reliable for tapping and placing a working tube of a diameter of 1.2cm under this approach.