基于CT/MRI融合建立的Kambin三角三维模型与标本测量的对比研究

Comparative study of Kambin′s triangle measurements between the three-dimensional reconstruction based on CT/MRI image fusion and cadaver

中文关键词:  三维重建  解剖  个体化治疗  Kambin三角

英文关键词:Three-dimensional reconstruction  Anatomy  Individualized treatment  Kambin′s triangle

中文摘要:

  【摘要】 目的：对比基于CT/MRI融合图像建立的Kambin三角三维（3D）模型与标本测量结果之间的差异，探讨其临床意义。方法：取10例新鲜成人腰椎标本，女6具，男4具，年龄39～76岁，平均59.5±13.0岁。先进行3D模型数据测量：将标本分别进行CT和MRI扫描，获取腰椎标本的CT及MRI影像数据并对腰椎Kambin三角行3D融合重建，在3D模型上测量腰椎神经根出口处直径（d）、神经节最大直径（D）、神经根与硬脊膜之间的夹角（A）、上关节突与椎弓根交界外侧缘点与神经根发出点之间的距离（l1）以及上关节突与椎弓根交界外侧缘点与硬脊膜的水平距离（l2）。再进行解剖数据测量：暴露硬脊膜和神经根，且在神经根和椎体之间留有少量软组织以确保神经根和椎体之间的解剖关系，用游标卡尺以及量角器测量与3D模型相同的测量参数并比较两者之间的差异。采用组内相关系数（ICC）和Bland-Altman图对标本测量数据与Kambin三角模型测量数据进行一致性分析。结果：基于CT/MRI融合图像建立的Kamin三角三维模型可清晰展现行走神经根与椎间孔区域之间的空间关系。两组间各测量指标（d、D、A、l1、l2）的平均绝对误差分别为0.41±0.24mm、0.43±0.22mm、3.54°±1.72°、1.56±0.81mm和1.56±1.03mm；两组各测量指标的配对t检验差异无统计学意义[d（t＝-1.03，P＝0.31），D（t＝-1.26，P＝0.21），A（t＝-1.54，P＝0.13），l1（t＝-1.26，P＝0.50）和l2（t＝-1.22，P＝0.23）]；两组各测量指标的组内相关系数（ICC）表明了标本测量数据与Kambin三角模型测量数据之间具有极强的相关性：d（r＝0.87），D（r＝0.92），A（r＝0.87），l1（r＝0.98），l2（r＝0.97）；Bland-Altman图显示代表差值的点几乎在差值平均线附近波动，几乎所有的差值点都落在95％的一致性区间内。结论：基于CT/MRI图像融合的3D模型可以较为准确地展现出腰椎Kambin三角内行走神经根与椎间孔区域的空间关系，对经皮椎间孔镜的手术风险评估提供了一定的可靠依据，有助于外科医生减少术中对行走神经根的损伤引起并发症的发生，实现精准、微创和个体化治疗。

英文摘要:

  【Abstract】 Objectives: To identify the deviation between the real data and the three-dimensional(3D) reconstruction of Kambin′s triangle based on CT/MRI image fusion, and to determine its clinical significance. Methods: Ten fresh lumbar cadavers were harvested, 6 females and 4 males, aged 39-76 years(average, 59.5±13.0 years). CT and MRI image data of lumbar spine specimens were obtained and fused to form a 3D reconstruction model. The measurement data included the diameter of the exportation of nerve root(d), the maximum diameter of ganglion(D), the angle between nerve root and spinal dura mater(A), the distance between the lateral border of the junction of upper articular process and the pedicle of vertebral arch and the exit point of the nerve root in the dura(l1), and the horizontal distance from the lateral border of the junction of the upper articular process and the pedicle of the vertebral arch to the dura(l2) on the 3D lumbar model. Anatomic data measurements were performed: completely exposing the dura mater and nerve roots, retaining a small amount of soft tissue between the nerve root and the vertebral body to ensure the true anatomical relation of the root and vertebral nerve. The same measurement parameters in the 3D reconstructed Kambin′s triangle model were assessed with the millimeter caliper and protractor on the cadavers and the differences were compared. Intra-group correlation coefficient(ICC) and Bland-Altman plot were used to analyze the consistency between sample measurement data and Kambin triangulation model measurement data. Results: The 3D reconstruction of Kambin′s triangle based on CT/MRI image fusion provided clear the spatial relationship between the nerve root and the intervertebral foramen. The average absolute error of d, D, A, L1 and l2 was 0.41±0.24mm, 0.43±0.22mm, 3.54°±1.72°, 1.56±0.81mm and 1.56±1.03mm, respectively. There was no significant difference in paired t test data in each group[d(t＝-1.03, P＝0.31), D(t＝-1.26, P＝0.21), A(t=-1.54, P=0.13), l1(t＝-1.26, P＝0.50) and l2(t＝-1.22, P＝0.23)]. The intra-group correlation coefficient(ICC) of the measured data indicated that there was a strong correlation between the 3D-reconstructed model of Kambin′s triangle and the cadaveric lumbar[d(r=0.87), D(r=0.92), A(r=0.87), l1(r=0.98), l2(r=0.97)]. Bland-Altman plot showed the points representing the D-value fluctuate close to the D-value mean line, and almost all of the D-value points falling within the 95% consistency interval. Conclusions: The 3D reconstruction of Kambin′s triangle based on CT/MRI image fusion can accurately and realistically show the Kambin′s triangle of lumbar spine. It may better assist surgeons to reduce the complications of injury of walking nerve root during operation and provides a reliable basis for risk assessment of percutaneous endoscopic lumbar discectomy(PELD), and achieve accurate, minimally invasive, individualized treatment.