数字化技术对椎间孔镜穿刺的指导作用
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同济大学附属上海市东方医院

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上海市卫生与计划委员会科研项目、江西省自然科学基金项目、上海市浦东新区卫生系统重点学科建设项目


The guiding effect of digital technology on intervertebral foramen puncture
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East Hospital, Tongji University, Shanghai

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    摘要:

    目的:运用数字化技术重建成人腰椎并测量L3-L1椎间孔、关节突、神经根及硬膜囊等各结构之间的距离,探讨数字化技术对椎间孔镜穿刺的指导作用。 方法:选取40名志愿者,男女各20名,采集腰椎影像学资料进行数字化处理,测量椎间孔的高度、宽度、椎间隙上下终板水平出口根到上关节突的距离、椎间隙上下终板水平神经根内缘与硬膜囊外缘的距离,探讨椎间孔、神经根变化趋势及穿刺定位的方法。 结果:L3-S1各节段测量结果左右两侧相比较无统计学意义(P>0.05),自上而下各腰椎间孔高度和宽度呈降低趋势,工作通道的范围也依次增大,神经根的倾斜角度也逐渐增大。 结论:通过数字化技术可以发现从上到下,神经出口根倾斜角度逐渐增大,工作通道可操作范围逐渐增大,但L5-S1节段由于髂嵴及上关节突的阻挡,L5-S1节段穿刺角度必须大于髂嵴与上关节突连线与冠状面、横断面的夹角,同时由于椎间孔入口狭窄,需磨除部分阻挡的上关节突。通过数字化进行术前评估,对指导个体化手术入路具有重要意义。

    Abstract:

    Objective The digital technique was used to reconstruct the adult lumbar vertebrae and measurement the distance between the intervertebral foramen, articular processes, nerve roots and dural sac of the segments of L3-S1. To discussed the guiding effect of digital technique on intervertebral foramen puncture. Methods Choose 40 volunteers,20 males and 20 females, collecting them lumbar image data for digitization and measure the heigh and width of the intervertebral foramen, the distance from the superior articular processes surface to the exiting nerve root at the upper and lower end plat level, the distance between the inner edge of the never root and the outer edge of the drual sac at the upper and lower end plat level. Explore the trend of intervertebral foramen and nerve root, the method of puncture positioning. Results The measurement results were not have statisticallt significant between left and right of L3-S1 segments(P>0.05). From top to bottom the height and width of the lumbar intervertebral foramen are decreasing, the range of working channels are increased, the angle of inclination of the nerve roots also increased. Conclusion Through digital technology can be found with the angle of inclination of the exiting nerve root increased the operating range of the working channel is gradually increased. In the segment of L5-S1 due to the block of spasm and superior articular processes, the angle of puncture must be greater than the angle between point to point with the iliac crest and superior articular process and the coronal plane and cross section. At the same tine,it is necessary to remove the superior articular process of block due to the narrow entrance of the intervertebral foramen in the segment of L5-S1. It’s important to guiding the individualized surgical approaches with using digital technique to preoperative evaluation.

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  • 收稿日期:2019-01-21
  • 最后修改日期:2019-05-06
  • 录用日期:2019-06-03
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