腰椎出口神经根与上关节突毗邻关系的CT观察

Relationship between exiting nerve roots and superior articular process: a CT study of lumbar anatomy

中文关键词:  腰椎出口神经根  上关节突  CT  腰椎间盘切除术

英文关键词:Lumbar exiting nerve roots  Superior articular process  CT  Lumbar discectomy

中文摘要:

  【摘要】 目的：通过CT多平面重建（multi-planar reformation，MPR）技术测量腰椎椎间孔内出口神经根与上关节突之间的距离，为临床经皮经椎间孔脊柱内窥镜下手术提供解剖学参考。方法：纳入2018年1月~2月在我院行腰骶部多层螺旋CT连续断层扫描的60例健康志愿者，排除既往有腰椎疾病史及腰椎手术史者，男、女各30例，年龄21~73岁（50.8±13.2岁）。将扫描得到的CT图像进行MPR，测量L1~L5椎间孔内出口神经根分别与上关节突尖部、前缘中点及根部之间的最短距离。结果：①L1~L5出口神经根与上关节突之间的距离在男、女性之间以及左右两侧之间无显著性差异（P>0.05）；②出口神经根与上关节突间距离从L1~L5逐渐增大，但仅相差约1mm，其中L5出口神经根与S1上关节突尖部、前缘中点及根部的距离最大，分别为3.91±0.50mm、4.67±0.57mm、5.77±0.56mm；③出口神经根与上关节突尖部、前缘中点及根部之间的距离逐渐增大，神经根与上关节突距离最大值为神经根与上关节根部的距离，分别为L1 4.29±0.20mm，L2 4.36±0.27mm，L3 4.61±0.44mm，L4 4.92±0.39mm，L5 5.77±0.56mm；④L1~L5出口神经根与上关节突之间距离从尖部至根部逐渐增大，根部与尖部的距离差值范围为0.92±0.31mm~1.86±0.57mm，呈近端窄远端宽的“梯形”。结论：腰椎椎间孔内出口神经根与上关节突之间的“骨－神经间隙”在三维空间内呈近似平行或近端窄远端宽的梯形；在椎间孔内置入脊柱内窥镜工作通道时为避免对出口神经根的损伤，应适当进行椎间孔扩大成形。

英文摘要:

  【Abstract】 Objectives： To measure the distance between the exiting nerve roots and the superior articular process in the lumbar intervertebral foramen by the multi-planar reformation(MPR) technique, and to provide important anatomic reference for clinical percutaneous transforaminal spinal endoscopic surgery. Methods: This study included 60 healthy volunteers who underwent multi-slice spiral CT continuous tomography from January to February 2018, 30 males and 30 females, with an average age of 50.8±13.2(21-73) years. The scanned CT images were reformatted by MPR technique to measure the distance between the exiting nerve roots and the tip of the superior articular process, the midpoint of the superior articular process, the root of the superior articular process in the L1-L5 intervertebral foramen. Results: ①The distances between the exiting nerve roots and the superior articular process in the L1-L5 intervertebral foramen were not significantly different between different genders or between the left and right side of lumbar spine(P>0.05). ②The distances between the exiting nerve root and the superior articular process gradually increased from L1 to L5, but the differences were only about 1mm. The distances between the L5 exiting nerve root and the tip, the midpoint, the root of the superior articular process were 3.91±0.50mm, 4.67±0.57mm, 5.77±0.56mm respectively. ③The distances between the exiting nerve root and the tip, the midpoint of the leading edge, the root of the superior joint gradually increased, and the maximum distances were 4.29±0.20mm in L1, 4.36±0.27mm in L2, 4.61±0.44mm in L3, 4.92±0.39mm in L4, 5.77±0.56mm in L5. ④The distance between the exiting nerve roots and the superior articular process gradually increased from tip to root in L1-L5, and the differences ranged from 0.92±0.31mm to 1.86±0.57mm, which presented a trapezoid shape. Conclusions: The three-dimensional bone-nerve space between the exiting nerve root and the superior articular process in the lumbar intervertebral foramen is approximately parallel or trapezoid shape which is narrow in proximal end and wide in distal end. To reduce the injury rate of exiting nerve roots in PELD, the foraminoplasty to enlarge the intervertebral foramen near the facet joint is strongly recommended before the introduction of 7.5mm-diameter working cannula.