单侧双通道内镜的上段腰椎影像解剖测量△

Imaging anatomic measurements of upper lumbar spine for unilateral biportal endoscopy

摘要:

[目的] 描述单侧双通道内镜下上腰椎神经根、椎间隙毗邻关系，为临床手术提供依据。[方法] 21 例腰椎管狭窄症患者行腰椎 CT 脊髓造影，建立三维模型，测量 L1/2~L3/4椎板下缘关节突交点和椎板上缘关节突交点分别至硬脊膜外侧缘、上位腰椎下终板、下位腰椎上终板、神经根起点下缘、下关节突外侧缘与峡部人字嵴交点距离；神经根起点下缘至上位腰椎下终板、下位腰椎上终板距离；上位腰椎下关节突外侧缘至下位腰椎弓根峡部内侧缘距离。[结果]L_1/2~L_3/4椎板下缘关节突交点和椎板上缘关节突交点在硬脊膜外侧缘以内、椎间隙以下、神经根起点下缘以上，节段越低距离越小 (P＜0.05)；椎板下缘关节突交点、椎板上缘关节突交点至下关节突外侧缘与峡部人字嵴交点的距离随节段降低逐渐增大 (P＜0.05)；腰神经根起点下缘在椎间隙水平以下，节段越低距离越小 (P＜0.05)；上位腰椎下关节突外侧缘投影紧邻下位腰椎弓根峡部内侧缘，不同节段差异无统计学意义(P＞0.05)。[结论]上腰椎有明显解剖学特点。腰椎管狭窄症上下减压范围大，同侧相邻节段减压、开窗略大可致半椎板缺损；向外减压必使部分下关节突、峡部缺损。

Abstract:

[Objective] To describe the relationship between the nerve root and intervertebral space of the upper lumbar spine under unilateral biportal endoscopy, and to provide an evidence for the real surgical treatment of spinal stenosis. [Methods] Radiographic docu- ments were obtained from 21 patients with lumbar spinal stenosis, including lumbar CT myelography, CT three-dimensional reconstruction. From L_1/2 to L_3/4 segment, the distances were measured including those between the laminar inferior edge-facet medial edge and the laminar superior edge-facet medial edge to the lateral edge of the dural sac, the lower endplate of the upper lumbar spine, the upper endplate of the lower lumbar spine, the lower edge of the nerve root origin, and the facet lateral edge-herringbone crest edge. In addition, the distance be- tween the upper and lower lumbar endplates at the lower edge of the nerve root origin, as well as the distance from the lateral edge of the in- ferior articular process of the upper lumbar spine to the medial edge of the isthmus of the pedicle of the lower lumbar spine were measured. [Results] From L1/2 to L3/4 segment, the laminar inferior edge-facet medial edge and the laminar superior edge-facet medial edge points were within the outer edge of the dural sac, the lower intervertebral space and inferior edge of the nerve root, the smaller the distance (P＜ 0.05) . The distance from the laminar inferior edge-facet medial edge point and the laminar superior edge-facet medial edge point to the facet lateral edge-herringbone crest edge gradually increased with the segment downward (P＜0.05) . The lower edge of the nerve root origin was below the level of intervertebral space, and the lower the segment, the smaller the distance (P＜0.05) . The projection of the lateral edge of the inferior articular process of the upper lumbar spine was adjacent to the medial edge of the isthmus of the pedicle of the lower lumbar spine (P＞0.05) . [Conclusion] There are obvious anatomical characteristics of the upper lumbar spine. In lumbar spinal stenosis, with larg- er upper and lower decompression range, and the hemi-laminal defect might be induced by decompression of adjacent segments on the same side and slightly larger laminal fenestration, while futher decompression might result in partial defect of inferior articular process and isthmus.