中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (6): 939-944.doi: 10.12307/2023.736

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

三维重建指导单孔分体内镜治疗上腰椎椎间盘突出症的影像学标志点

刘昌震，刘  鑫，李岳飞，王建业，冯志萌，孙兆忠   

  1. 滨州医学院附属医院脊柱外科，山东省滨州市   256603
  • 收稿日期:2022-10-17 接受日期:2022-11-30 出版日期:2024-02-28 发布日期:2023-07-12
  • 通讯作者: 孙兆忠，主任医师，滨州医学院附属医院脊柱外科，山东省滨州市 256603
  • 作者简介:刘昌震，男，1997年生，山东省烟台市人，汉族，滨州医学院在读硕士，主要从事微创脊柱外科方面的研究。
  • 基金资助:
    国家重点研发计划资助项目(2017YFC0114002)，子项目负责人：孙兆忠；山东省自然科学基金资助项目(2R2017LH021)，项目负责人：孙兆忠；滨州医学院“临床+X”项目(BY2021LCX17)，项目负责人：孙兆忠；滨州医学院科技计划项目(BY2018KJ03)，项目负责人：刘鑫

Imaging landmarks of one-hole split endoscope in the treatment of upper lumbar intervertebral disc herniation under the guidance of three-dimensional reconstruction

Liu Changzhen, Liu Xin, Li Yuefei, Wang Jianye, Feng Zhimeng, Sun Zhaozhong   

  1. Department of Spine Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China
  • Received:2022-10-17 Accepted:2022-11-30 Online:2024-02-28 Published:2023-07-12
  • Contact: Sun Zhaozhong, Chief physician, Department of Spine Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China
  • About author:Liu Changzhen, Master candidate, Department of Spine Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China
  • Supported by:
    National Key Research & Development Program, No. 2017YFC0114002 (to SZZ); Natural Science Foundation of Shandong Province, No. 2R2017LH021 (to SZZ); “Clinic+X” Project of Binzhou Medical University, No. BY2021LCX17 (to SZZ); Science and Technology Plan Project of Binzhou Medical University, No. BY2018KJ03 (to LX)

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摘要：


文题释义：

三维重建技术：将患者腰椎CT薄层扫描后获得的Dicom数据导入Mimics软件后行三维重建，在获得腰椎三维模型的基础中测量相关解剖指标。
单孔分体内镜：内镜和器械在一个孔内双行分离自由操作，在无固定通道的全新理念的基础下，将单侧双通道内镜技术双孔合为一孔，同时同轴内镜技术的内镜和器械分开。既有单侧双通道内镜技术的广阔视野，又有同轴内镜360°的自由指向。


背景：单孔分体内镜技术已广泛应用于治疗腰椎退行性变疾病，但国内外尚无该技术在治疗上腰椎椎间盘突出症中安全性分析的相关文献。

目的：通过腰椎CT三维重建技术，观测上腰椎神经根、椎间隙、骨性标志点的毗邻关系，为单孔分体内镜临床手术提供依据。
方法：26例上腰椎椎间盘突出症患者行腰椎CT扫描，导入Mimics 17.0软件，测量L1/2-L3/4节段相关影像学参数：①测量垂直距离：在冠状位，上关节突冠状位关节面内侧缘和上终板交点(N)至上关节突尖部(S)距离(a)；在冠状位，N所在矢状位和下终板交点(M)至下关节突尖部(X)距离(b)；②测量水平距离：N至N所在横断面和出口神经根下缘交点(N2)距离(c)；N至N所在横断面和神经组织交点(N1)距离(d)；N1至N2距离(e)；M至M所在横断面和神经组织外侧缘交点(M1)距离(f)；M至M所在横断面和出口神经根交点(M2)距离(g)；M1至M2距离(h)；M2至N1距离(i)；上关节突矢状位关节面后缘(R)至M2距离(j)。

结果与结论：①随着节段的降低，a、b距离逐渐增大，j距离逐渐减小，L1/2节段和L2/3节段之间差异无显著性意义(P > 0.05)；②随着节段降低，d距离先减小后增大，f距离逐渐减小，c、e、g、h、i距离逐渐增大，L2/3节段和L3/4节段之间差异无显著性意义(P > 0.05)；③i距离为自然状态无牵拉神经根情况下的最短距离，M1、M2、N1、N2四点之间即为安全区面积，通过S、X分别向下、向上咬除骨质到上下终板，暴露椎间隙，向外开窗g距离到M2，可避免损伤出口神经根；④综上所述，上腰椎具有独特的解剖学特点，通过对神经根、硬脊膜、椎间隙进行相关测量，所得参数可为单孔分体内镜临床手术提供参考依据，使手术更加精准、安全。

https://orcid.org/0000-0003-2361-3187(刘昌震) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 单孔分体内镜, 上腰椎, 椎间盘突出症, 三维重建, 影像学解剖

Abstract: BACKGROUND: One-hole split endoscope technique has been widely used in the treatment of lumbar degenerative diseases, but there is no relevant literature on the safety analysis of this technique in the treatment of upper lumbar disc herniation.
OBJECTIVE: To observe the position relationship of nerve roots, intervertebral space and bone landmarks in the upper lumbar spine by three-dimensional lumbar CT reconstruction technology, and to provide a basis for the clinical operation of one-hole split endoscope surgery.
METHODS: Twenty-six patients with upper lumbar disc herniation underwent a lumbar CT scan. Mimics 17.0 software was imported to measure the related imaging parameters of L1/2 to L3/4 segments: (1) Measurement of vertical distance: In coronal view, the distance (a) from the intersection point of the medial facet of the superior articular process and the superior endplate (N) to the apex of the articular process (S); in the coronal view, the distance (b) from the sagittal intersection (M) of N and the inferior endplate to the apex of the inferior articular process (X). (2) Measured horizontal distance: the distance (c) between the cross-section of N and the lower edge of the outlet nerve root (N2); distance (d) between the cross-section of N and the intersection point of neural tissue (N1); N1 to N2 distance (e); distance (f) between the cross-section of M and the lateral edge of the nerve tissue (M1); M to M cross-section and exit nerve root intersection (M2) distance (g); distance (h) from M1 to M2; distance (i) from M2 to N1; distance (j) from the posterior edge of the articular surface (R) to M2 in sagittal view of the superior articular process. 
RESULTS AND CONCLUSION: (1) With the decrease of the segment, the distances a and b gradually increased, and the distance j gradually decreased. There was no significant difference between L1/2 and L2/3 segments (P > 0.05). (2) With the decrease of the segment, distance d first decreased and then increased; distance f gradually decreased; distances c, e, g, h and i gradually increased; and there was no significant difference between L2/3 and L3/4 segments (P > 0.05). (3) Distance i was the shortest distance without pulling nerve roots in the natural state, and the area of the safety zone was between four points M1, M2, N1, and N2. The bone was removed to the upper and lower endplates by biting the bone downward and upward through S and X, respectively, to expose the intervertebral space, and the window of distance g to M2 could be opened outward to avoid injury of the outlet nerve roots. (4) In conclusion, the upper lumbar vertebrae have unique anatomical characteristics. Based on the relevant measurements of nerve roots, spinal dura and intervertebral space, the parameters of the one-hole split endoscope technique are more accurate and safe during operation. 

Key words: one-hole split endoscope, upper lumbar spine, lumbar disc herniation, three-dimensional reconstruction, imaging anatomy

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