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山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (2): 75-82.doi: 10.6040/j.issn.1671-7554.0.2023.1079

• 临床医学 • 上一篇    

基于CT三维重建评估髂嵴对L5~S1椎间孔镜手术通道放置的影响

王金瑨1,2,刘晓阳2,葛忠鹏2,崔新刚1,2   

  1. 1.山东大学齐鲁医学院, 山东 济南 250012;2.山东第一医科大学附属省立医院脊柱外科, 山东 济南 250021
  • 发布日期:2024-03-29
  • 通讯作者: 崔新刚. E-mail:cuixingang@sdfmu.edu.cn
  • 基金资助:
    山东省自然科学基金(ZR2021MH167)

Impact of iliac crest on the placement of L5-S1 transforaminal endoscopic surgical channel based on three-dimensional CT reconstruction

WANG Jinjin1,2, LIU Xiaoyang2, GE Zhongpeng2, CUI Xingang1,2   

  1. 1. Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2024-03-29

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摘要： 目的 分析髂嵴对穿刺放置手术通道可行性的影响。 方法 回顾性分析2022年1月1日至2022年12月31日在山东省立医院行腰椎CT及腰椎DR检查的75例患者影像资料。使用Mimics 21.0软件对CT图像进行三维重建,模拟手术通道放置,评估患者L5~S1节段行PETD手术放置通道可行性。根据结果将患者分为可放置通道组和不可放置通道组,通过测量和比较两组髂嵴相对高度分级、髂嵴高度、髂嵴倾斜角、关节突倾斜角、髂嵴最高点到中线距离和髂嵴内聚角等参数之间的差异,分析髂嵴对L5~S1节段行PETD手术放置通道的影响。 结果 测量分析结果显示,可放置通道组中髂嵴高度h、髂嵴倾斜角α、髂嵴内聚角δ等髂嵴相关的解剖参数均明显小于不可放置通道组［23.65(29.33~18.50)vs 38.20(39.80~34.40),P<0.001; 20.20(24.30~16.08)vs 29.15(31.98~26.65),P<0.001; 45.35(48.03~40.70)vs 47.75(49.98~45.33),P=0.003］。随着髂嵴高度的提升,通道放置的成功率不断下降,定义为“高髂嵴”(髂嵴相对高度分级为2级)的通道建立成功率只有10%。当髂嵴高度高于31.95 mm,髂嵴倾斜角大于24.35°,髂嵴内聚角大于47.2°时,穿刺放置通道容易失败。 结论 髂嵴对于L5~S1行PETD手术放置通道的可行性具有显著影响。髂嵴越高,越陡峭(髂嵴倾斜角、内聚角越大)的患者越不容易成功放置通道。“高髂嵴”(髂嵴高于L4椎弓根下缘的患者)通常难以放置通道。

关键词: CT, 三维重建, 髂嵴, L5~S1, 椎间孔镜

Abstract: Objective To analyze the impact of iliac crest on the feasibility of puncture placement of surgical channels. Methods The imaging data of 75 patients who underwent lumbar spine CT and lumbar spine DR examination at Shandong Provincial Hospital during Jan. 1, 2022 and Dec. 31, 2022 were retrospectively analyzed. Mimics 21.0 software was used to perform three-dimensional reconstruction of CT images and simulate surgical channel placement to evaluate the feasibility of channel placement in percutaneous endoscopic transforaminal lumbar discectomy(PETD)in patients’ L5-S1 segment. Based on the results, the patients were divided into two groups. In the implantable group, the channel could be placed; in the non-implantable group, the channel could not be placed. The relative height classification of the iliac crest, height of the iliac crest, inclination angle of the iliac crest, inclination angle of the articular process, distance from the highest point of the iliac crest to the midline, and the cohesion angle of the iliac crest were compared between the two groups to analyze the effects of iliac crest on the channel placement of the L5-S1 segment. Results The measurement results showed that height of the iliac crest, inclination angle of the iliac crest, and the cohesion angle of the iliac crest were significantly lower in the implantable group than in the non-implantable group ［23.65(29.33-18.50)vs 38.20(39.80-34.40), P<0.001; 20.20(24.30-16.08)vs 29.15(31.98-26.65), P<0.001; 45.35(48.03-40.70)vs 47.75(49.98-45.33), P=0.003］. As the height of the iliac crest increased, the success rate of channel placement decreased. The success rate of channel establishment of high iliac crest(the relative height of the iliac crest was grade 2)was only 10%. When height of the iliac crest was higher than 31.95 mm, inclination angle of the iliac crest was greater than 24.35°, and the cohesion angle of the iliac crest was greater than 47.2°, the channel placement was prone to failure. Conclusion The iliac crest has a significant impact on the feasibility of the L5-S1 PETD surgical channel placement. Patients with higher and steeper iliac crest(greater iliac crest inclination angle and cohesion angle)are less likely to have the channel successfully placed. Patients with “high iliac crest”(iliac crest above the lower edge of the L4 pedicle)are often difficult to place the channel.

Key words: CT, Three-dimensional reconstruction, Iliac crest, L5-S1, Intervertebral foramen endoscope

中图分类号: 

  • R681.5
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