CAJ | 학술논문

目的分析退行性腰椎侧凸病例腰丛分布的MRI影像特点,评价MRI神经显像的应用价值与极外侧椎体间融合(XLIF)手术入路的神经功能安全性.方法 2012年7月至2013年2月中山大学附属第三医院脊柱外科对19例退行性腰椎侧凸采用MRI三维快速稳态采集成像序列多平面容积三维重建,左、右侧凸分别为11例、8例,通过L1-2至L4-5各椎间隙中点水平层面轴位图像测量腰丛前缘至手术入路穿刺路径即椎间盘矢状面中心点垂直线(椎间盘矢状面中垂线)的距离,设定正、负值分别表示腰丛前缘位于椎间盘矢状面中垂线后、前方.结果 L1-2至L4-5间隙凹侧腰丛前缘距椎间盘矢状面中垂线距离在左侧凸/右侧凸病例依次为(13.7±2.5)mm/(12.9±5.5)mm、(8.3 ±4.7)mm/(8.5±5.7)mm、(2.7±3.6)mm/(2.5±7.2)mm和(-4.2±3.8) mm/(-3.8±7.1)mm,均较凸侧腰丛分布位置偏后.结论 L1-2与L2-3间隙两侧、L3-4间隙凹侧腰丛行走于椎间盘矢状面中垂线后方腰大肌内;L3-4间隙凸侧和L4-5间隙两侧腰丛则移行至椎间盘矢状面中垂线前方,术前MRI腰丛显像对XLIF入路安全性评估有参考价值.
목적 분석퇴행성요추측철병례요총분포적MRI영상특점,평개MRI신경현상적응용개치여겁외측추체간융합(XLIF)수술입로적신경공능안전성.방법 2012년7월지2013년2월중산대학부속제삼의원척주외과대19례퇴행성요추측철채용MRI삼유쾌속은태채집성상서렬다평면용적삼유중건,좌、우측철분별위11례、8례,통과L1-2지L4-5각추간극중점수평층면축위도상측량요총전연지수술입로천자로경즉추간반시상면중심점수직선(추간반시상면중수선)적거리,설정정、부치분별표시요총전연위우추간반시상면중수선후、전방.결과 L1-2지L4-5간극요측요총전연거추간반시상면중수선거리재좌측철/우측철병례의차위(13.7±2.5)mm/(12.9±5.5)mm、(8.3 ±4.7)mm/(8.5±5.7)mm、(2.7±3.6)mm/(2.5±7.2)mm화(-4.2±3.8) mm/(-3.8±7.1)mm,균교철측요총분포위치편후.결론 L1-2여L2-3간극량측、L3-4간극요측요총행주우추간반시상면중수선후방요대기내;L3-4간극철측화L4-5간극량측요총칙이행지추간반시상면중수선전방,술전MRI요총현상대XLIF입로안전성평고유삼고개치.
Objective To analyze the magnetic resonance neural imaging distribution of lumbar plexus in patients with degenerative lumbar scoliosis and evaluate its value and the safety of extreme lateral interbody fusion (XLIF).Methods Three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequences of lumbar spine were scanned on 19 patients with degenerative lumbar scoliosis,including levoscoliosis (n =11) and dextroscoliosis (n =8).All images were sent to workstation for multiplanar volume reconstruction to analyze the distribution of lumbar plexus from L1-2 to L4-5 level.The axial image distance (AID) was measured between anterior edge of lumbar plexus and sagittal central perpendicular line (SCPL).SCPL was drawn perpendicularly to the sagittal plane of intervertebral disc and passed through its central point.It was actually the pathway of guide wire implanting procedure and the ongoing axis of work channel during XLIF.With respect to SCPL,the distance with a positive value indicated posterior neural tissue whereas a negative value anterior neural tissue.The differences of AID were compared between convex and concave sides and among different cases and levels.Results From L1-2 to L4-5 level,the AID on the concave side in levoscoliosis or dextroscoliosis cases was (13.7 ± 2.5) mm/ (12.9 ±5.5) mm,(8.3 ±4.7) mm/(8.5 ±5.7) mm,(2.7 ±3.6) mm/(2.5 ±7.2) mm and (-4.2 ± 3.8) mm/(-3.8 ± 7.1) mm respectively.They were located significantly posteriorly to the relevant disc compared to those on the convex side at the same intervertebral space (P ＜ 0.05).The differences of AID at the same side,concave or convex side,was significant (P ＜ 0.05).No significant differences of lumbar plexus distribution existed between levoscoliosis and dextroscoliosis cases (P ＞ 0.05).Conclusion Lumbar plexus passes through psoas posteriorly to SCPL on both side at L1-2,L2-3 level and on the concave side at L3-4 level.And they shift anteriorly to SCPL on the convex side at L3-4 level and on both sides at L4-5 level.It indicates a ventral migration of lumbar plexus from L1-2 to L4-5 level.Preoperative magnetic resonance neural imaging is valuable for assessing the safety of XLIF approach.Operation from the concave may reduce the risk of injury to lumbar plexus.