经皮腰骶轴向融合的骶前间隙相关影像学解剖测量

目的 测量骶前间隙相关解剖学影像数据,为经皮腰骶轴向融合术在国内的研发和开展提供理论依据.方法 采用X线片分析56例患者S1前孔内缘的距离;CT增强扫描测量双侧髂血管到S1/2间隙中点的距离;腰骶MRI正中矢状位片上测量各骶椎间隙和各椎体中点到直肠系膜的最短距离,为相关器械、融合器长度的设计提供数据依据.结果 21例男性和35例女性的S1前孔内缘距离分别为(34.7±3.5)mm和(32.2±3.0)mm(P<0.05),套管和融合器设计长度数据差异无统计学意义(P>0.05);CT增强扫描显示距离S1/2间隙中点最近的血管均为两侧髂内静脉,双侧髂内静脉的距离男性和女性分别为(57.6±5.2)mm和(70.0±9.1)mm(P<0.05);S2-S5椎体中点到直肠系膜的距离男性和女性差异有统计学意义(P<0.05).结论 研究结果 可作为国人器械和融合器的开发参考依据,同时为手术提供了操作的安全空间.

Relevant imaging and anatomical measurements of presacral space for axial lumbosacral interbody fusion

Objective To collect the radiological data of the presacral space for axial lumbosacral interbody fusion (AxiaLIF) and to provide theoretic rationales for research work and clinical application of AxiaLIF in China. Methods The distance between inner margin of bilateral anterior sacral foramina at the level of S1 was measured radiographically. The distance between iliac vessels and the midline at the level of S1 was measured on enhanced computed tomography (enhanced-CT) . The minimum distances between mesorectum and each sacral level or the center of each sacral vertebra were measured on the median sagittal plane of magnetic resonance imaging in order to measure the lengths of relevant instrumentation and fusion device. Results The distance between inner margin of bilateral anterior sacral foramina at the level of S1 was found to be 34. 7 ± 3. 5 and 32. 2 ± 3. 0 mm in Chinese males and females respectively ( P <0. 05 ). There was no statistical significance between the design lengths of sleeve and fusion device. The nearest vessel from sacral intervertebral space at the level of S1 was found to be the bilateral internal iliac vein on enhanced-CT with a distance of 57. 6 ± 5. 2 and 70.0 ± 9. 1 mm in males and females respectively (P < 0. 05 ). The distance from mesorectum to the center of vertebral body of S2-S5 was found to be statistically significant between males and females ( P < 0.05 ). Conclusion It is feasible to design suitable instrumentation and fusion device for the Chinese. And a safe operating zone has been designated.