基于MRN技术的下腰椎Kambin三角的解剖学研究

目的 测量分析正常成人下腰椎Kambin三角工作区磁共振神经显像（magnetic resonance neurography，MRN）的相关解剖数据，为下腰椎微创手术的选择和安全性评估提供参考。 方法 采用3.0 T磁共振对20名健康成年志愿者（男10例，女10例）进行腰椎L4~S1节段的MRN扫描，通过Osirix软件对图像进行神经成像并测量以下数据：神经节与上位椎弓根间距（A）、神经节与下位椎弓根间距（B）、神经根与硬膜囊夹角（α）、Kambin三角的面积（S），并对所测数据进行统计学分析。 结果 自L4~S1，同侧神经节与上位椎弓根的距离逐渐减小（P<0.05），而同侧神经节与下位椎弓根的距离无统计学差异（P>0.05）；自L4~S1，同侧出口神经根与硬膜囊夹角逐渐变小，差异有统计学意义（P<0.05）；自L4~S1，Kambin三角面积逐渐增大（P<0.05）；此外，所有测量指标同节段左右两侧对比无统计学差异（P>0.05）。 结论 MRN技术对下腰椎Kambin三角各组成结构的解剖关系显像清晰准确，便于相关解剖测量并指导临床腰椎微创手术方法的选择和手术安全性的评估。

Anatomical study of lower lumbar Kambin triangle based on MRN technique

Objective To measure and analyze the anatomical data of magnetic resonance neurography (MRN) of lower lumbar Kambin triangle working area in normal adults, so as to provide reference for the selection and safety evaluation of minimally invasive surgery of lower lumbar spine. Methods Twenty healthy adult volunteers (male: 10, female: 10) were performed magnetic resonance imaging scan at L4~S1 segment with 3.0 T MRN. The neuroimaging was performed by OsiriX software. The following data were measured: the distance between ganglion and superior pedicle (A), the distance between ganglion and lower pedicle (B), and the angle between nerve root and dural sac (α), area of Kambin triangle (S). Finally, the measured data were statistically analyzed. Results From L4 to S1 segment, the distance between ipsilateral ganglion and superior pedicle decreased gradually (P<0.05). But there was no statistical difference between ipsilateral ganglion and lower pedicle (P>0.05). From L4 to S1, the angle between ipsilateral outlet nerve root and dural sac gradually decreased, the difference was statistically significant (P<0.05). From L4 to S1, the area of Kambin triangle increased gradually (P<0.05). In addition, there was no statistical difference between the left and right sides of the same segment (P>0.05). Conclusions MRN technology can clearly and accurately visualize the anatomical relationship of the Kambin triangle structures of the lower lumbar spine, which is helpful to measure the relevant anatomical data and can guide the selection of minimally invasive surgical methods and the evaluation of surgical safety.