孙 驰,王洪立,姜建元,吕飞舟,马晓生,夏新雷.基于CT测量的腰椎间融合器长度选择分析[J].中国脊柱脊髓杂志,2016,(7):627-634. |
基于CT测量的腰椎间融合器长度选择分析 |
中文关键词: 腰椎 体层摄影术 X线计算机 椎间融合器 |
中文摘要: |
【摘要】 目的:通过CT测量分析国人腰骶椎L1~S1终板各径线及相应骨突环等解剖学参数,探讨后方入路腰椎融合手术椎间融合器长度的选择。方法:招募24名健康成年志愿者,男12名,女12名,行腰椎CT扫描及矢状面、终板面二维重建。于L1~S1各终板面测量终板中线斜径、最大斜径、最大倾斜角、侧矢状径及相应径线所覆盖前后骨突环长度,计算均值及标准差。比较同性别同节段上下终板中线斜径、最大斜径、最大倾斜角及侧矢状径,计算不同手术方式下的融合器长度。结果:中线斜径男性最大值为39.58±2.60mm,最小值为33.38±3.26mm;女性最大值为34.89±1.55mm,最小值为30.93±2.99mm;前后覆盖骨突环长度为6~8mm。最大斜径男性最大值为48.05±4.62mm,最小值为42.83±2.28mm;女性最大值为43.26±3.31mm,最小值为38.00±2.53mm;自L1至S1逐渐变大。侧矢状径男性最大值为36.48±3.26mm,最小值为32.11±2.50mm;女性最大值为31.75±1.64mm,最小值为28.36±2.32mm;前后覆盖骨突环长度为5.5~7.5mm。L2~L5较L1/2、L5/S1同节段上下终板对应参数均保持较好一致性,差异多无统计学意义。L5/S1节段上下终板四对参数中只有最大斜径差异无统计学意义(男性,P=0.0522;女性,P=0.6410)。根据拟定融合器计算公式,TLIF融合器长度男性L1~L4各节段应≥31mm,L4/5为30~38mm,L5/S1为25~38mm;女性L1~L4各节段应≥27mm,L4/5为26~34mm,L5/S1为23~33mm。TLIF入路下融合器置入角度应尽量达到最大倾斜角以选用更长融合器。PLIF融合器长度男性L1~L5各节段为28~30mm,L5/S1为26mm;女性L1~L5各节段为24~26mm,L5/S1为22mm。结论:CT测量分析可为腰椎间融合器长度的选择提供客观依据,根据终板斜径、侧矢状径及骨突环长度可初步预测手术节段椎间融合器长度。 |
Analysis of lumbar interbody cage′s length based on anatomic measurement |
英文关键词:Lumbar vertebrae Tomography X-ray computed Interbody cage |
英文摘要: |
【Abstract】 Objectives: To measure the anatomic parameters of Chinese lumbosacral vertebral endplates(L1-S1), and to explore its significance in the selection of interbody cage′s length used in transforaminal lumbar interbody fusion(TLIF) and posterior lumbar interbody fusion(PLIF). Methods: CT scan and reconstructions of lumbar and sacrum were obtained in 24 healthy adult volunteers. Mid-oblique diameter, max-oblique diameter, max-oblique angle, lat-sagittal diameter and width of apophyseal ring of L1 inferior endplate to S1 superior endplate were measured. Within the same gender and segment, mid-oblique diameter, max-oblique diameter, max-oblique angle and lat-sagittal diameter of the inferior and superior endplates were compared, and the length of the fusion under the different operation methods was calculated. Results: The maximum and minimum mid-oblique diameters were 39.58±2.60mm and 33.38±3.26mm in male, which were 34.89±1.55mm and 30.93±2.99mm in female, the width of apophyseal ring for which was within the range of 6-8mm. The maximum and minimum max-oblique diameters were 48.05±4.62mm and 42.83±2.28mm in male, which were 43.26±3.31mm and 38.00±2.53mm in female, which increased from L1 to S1. The maximum and minimum lat-sagittal diameters were 36.48±3.26mm and 32.11±2.50mm in male, which were 31.75±1.64mm and 28.36±2.32mm in female, the width of apophyseal ring for which was within the range of 5.5-7.5mm. Most of the differences between anatomic parameters of inferior and superior endplates in the same segment(L2-L5) was insignificant except for L1/2 and L5/S1. In L5/S1, there was no significant difference only in lat-oblique diameter(male: P=0.0522, female: P=0.6410). When TLIF was used, the lenght of interbody cage for L1-L4 should be no less than 31mm in male and 27mm in female. As for L4/5, it should be within the range of 30-38mm in male and 26-34mm in female. The range of length was more extensive for L5/S1, with 25-38mm in male and 23-33mm in female. When the cage was inserted, the insertion angle should be closed to max-oblique angle. When PLIF was used, the length of interbody cage for L1-L5 ranged from 28 to 30mm in male and 24 to 26mm in female. As for L5/S1, 26mm in male and 22mm in female were good choices. Conclusions: CT measurement provides the choice of lumbar interbody cage′s length with objective evidences. A preliminary estimation of the length can be made based on the oblique diameter, the lat-sagittal diameter and the width of apophyseal ring. |
投稿时间:2016-04-11 修订日期:2016-07-08 |
DOI: |
基金项目:2012年上海市科委医学重点项目(编号:12411951201);2013年上海市科技成果转化与产业化项目(编号:13DZ1940502;13DZ1940503);2014年国家自然科学基金面上项目(编号:81472036) |
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