摘要
目的通过CT影像研究斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）手术通道的安全值，以及膈肌脚、腹主动脉分叉等解剖结构对手术通道的影响。方法收集2016年06月至2016年09月因腰椎退行性疾病住院行腰椎CT检查110例患者的影像资料并进行回顾性分析，男69例，女41例；年龄16-83岁，平均（47．95＋13．48）岁。在PACS影像系统中调取该110例患者的CT图像，定义斜向通道为腹主动脉（左髂总动脉）左侧缘与左侧腰大肌右侧缘之间的区域。分别测量L1-2、L2-3,L3-4、L4-5，各椎间盘水平上斜向手术通道的距离及角度；通过CT图像的连续扫描，观察膈肌脚的形态变化以及腹主动脉的走形和分叉水平是否影响手术通道的建立。结果OLIF手术通道在CT图像上的平均距离（d）分别为L1-215．90mm，L2-3，14．82mm，L3-417．57mm，L4-5，11．16mm。L1-2、L3-4水平110例患者均显示可通过该路径置入手术通道，而在L2-3，和L4-5，水平均只有107例（97．27％）可以允许置入手术通道，余3例显示腹主动脉与腰大肌紧邻，即距离为0mm；最大距离出现在L3-4水平，最大值为36．79mm。各个节段平均角度为L1-236．98°，L2-3 37．76°，L3-4 40．96°，L1-2 37．85°；其中L3-4水平角度变化范围最大（13．09°-61．93°）。腹主动脉分叉水平自L3椎体下1／3至L，椎体中1／3均有分布。依据左侧膈肌脚在腰椎侧方止点水平分为：①L1椎体水平止点组：止点水平位于L1椎体及以上，共5例（4．55％）；②L1-2椎间盘至L2椎体水平止点组：止点水平位于L1-2椎间盘及L2椎体之间，共67例（60．91％）；③L2-3椎间盘至L3椎体水平止点组：止点水平位于L2-3，椎间盘及L3椎体之间，共36例（32．72％）；④L3-4椎间盘到L4椎体水平止点组：止点水平位于L3-4椎间盘及L4椎体之间，共有2例（1．81％）。结论OLIF手术通道在L1-2、L3-4水平均显示可置入手术通道，而在L2-3和L4-5水平存在腹主动脉与腰大肌紧邻的情况；各节段手术通道置入角度相似；膈肌脚主要影响L1-2和L2-3，水平手术通道的置入，对L4-5，水平无影响；绝大多数（87％）的血管分叉水平在L4椎体上终板至L4-5椎间盘之间。
Objective To determine the radiographic feasibility of oblique lumbar interbody fusion （OLIF） corridor to treat lumbar disease at each lumbar disc level, including the corridor＇s numerical value and the influence of diaphragmatic crura and aorta abdominalis. Methods A retrospective CT study was conducted on 110 patients （including 69 males and 41 females, average age 47.95 years, range 16-83 years） that continuously collected and analyzed in the PACS system. The oblique corridor was defined as the area between the left lateral border of the aorta abdominalis（or iliae artery） and the right lateral border of the left psoas. The distances and angles of L1-2, L2-3, L3-4 and L4-5 levels were measured. Whether the change of diaphragmatic crura and aorta abdominalis affected the building of the corridor was also observed. Results The mean distances of oblique corridor to the levels of L1-L5 discs were： L1-2 15.90 mm, L2-3 14.82 mm, L3-4 17.57 mm, L4-5 11.16 mm. At the levels of L1-2 and L3-4, all of the im- ages could build the corridor. But there were only 97.27% images allowing operation at both L2-3 and L4-5, and the other 3 cases couldn＇t build the corridor since the aorta abdominalis was very close to psoas, and the distance was almost 0 mm. The max mean distance was 36.79 mm at L3-4 level. The mean angles were： L1-2 36.98°; L2-3 37.76°; L3-4 40.96°; L4-5 37.85°. The significant differ- ence was at L3-4, ranged from 13.09 to 61.93°. The level of the aortic bifurcation was from the lower third of the L3 vertebral body to the middle third of the L5 vertebral body. The levels of left diaphragmatic erura＇s ending point in the lumbar was divided into four groups： 1） Group L1 vertebral body level： the level at L1 vertebral body and above, 5 cases （4.55%）; Group L1-2 disc to L2 vertebral body level： at L1-2 disc and L2 vertebral body, 67 cases （60.91%）; Group L2-3 disc to L3 vertebral body level： at L2-3 disc and L3 vertebral body, 36 cases （32.72%）; Group L34 disc to L4 vertebral body level： at I disc and L4 vertebral body, 2 case （1.81%）. Con- clusion The OLIF corridor can be built successfully at L1-2 and L3-4. However, it may be difficuh at L2-3 and L4-5 for some patients due to the aorta abdominalis which is too close to psoas. The angles of L 1-L5 levels were similar. While the left diaphragmatic cru- ra was mainly impact the corridor insertion at L1-2 and L2- 3. And the level of the aortic bifurcation was mainly located at the upper endplate of L4 to the L4-5 disc （87%）.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第16期1021-1028,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81501933）
浙江省自然科学基金（LY17H060009）
温州市领军人才创新项目（RX2016004）
温州市科技局项目（Y20160369）
关键词
腰椎
脊柱融合术
主动脉
腹
膈
体层摄影术
螺旋计算机
Lumbar vertebrae
Spinal fusion
Aorta, abdominal
Diaphragm
Tomography, spiral computed
