对571张关于图菲埃氏嵴间线的X线片及其在腰椎手术中的应用的回顾。
A review of 571 radiographs on Tuffier's inter-cristal line and its' application in lumbar spinal surgery.
作者信息
Chowdhury Ahmed, Sharma Himanshu
机构信息
Plymouth Peninsula Medical School, Tamar Science Park, Research Way, Plymouth Devon, UK.
Southwest Neurosurgery Centre, Derriford Hospital Plymouth, Plymouth, UK.
出版信息
J Spine Surg. 2018 Jun;4(2):383-387. doi: 10.21037/jss.2018.06.10.
BACKGROUND
Tuffier's line (TL) is an anatomical landmark used to identify the L4/5 interspace by palpating inter-cristal level in lumbar spinal surgery. The routine use of pre-operative pre-incision radiographs for level check by spinal surgeons is variable due to reliance on this palpation. The anatomical violation of neighbouring normal levels in microscope assisted lumbar surgery is unknown. The aim of this study was to evaluate the effects of patient-related demographic factors and radiographic parameters on TL in a cohort of patients undergoing lumbar spinal procedures.
METHODS
We retrospectively analysed 195 patients (571 radiographs) from a spinal database undergoing lumbar spinal procedures included nerve root injections, decompressions, micro-discectomies and instrumented fusions under a single surgeon. Radiographs were analysed with regard to age, gender, radiographic views (AP & lateral) and weight-bearing (wb) & non-weight bearing (non-wb).
RESULTS
The mean age was 59.8 years (range, 24-88 years). The most common level of TL was L4 vertebra (40% <60; 44% >60 years). The most common level in females was L5, while in males L4 vertebra. In 186 radiographs, 68% displayed a difference of at least one vertebral level on AP versus lateral planes. In 11 patients, there was at least 1 level vertebral difference between weight bearing & non-weight bearing radiographs.
CONCLUSIONS
TL can be affected by age, gender, radiographic views and weight bearing status variably. We recommend employing pre-incision radiographs in all microscope assisted lumbar spinal procedures to eliminate the clinical variations in inter-cristal line and thereby avoiding anatomical violation of neighbouring normal levels in microscope-assisted lumbar surgery. We highlight such variations in inter-cristal line should be given enough consideration in order to avoid a wrong level surgery. Palpatory method for level check without performing pre-incision lateral X-ray should be discouraged.
背景
图菲埃线（TL）是腰椎手术中通过触诊髂嵴水平来确定L4/5椎间隙的解剖标志。由于依赖这种触诊，脊柱外科医生术前切口前常规使用X线片进行节段检查的情况各不相同。显微镜辅助下腰椎手术中相邻正常节段的解剖学侵犯情况尚不清楚。本研究的目的是评估患者相关人口统计学因素和影像学参数对一组接受腰椎手术患者TL的影响。
方法
我们回顾性分析了来自脊柱数据库的195例患者（571张X线片），这些患者接受了包括神经根注射、减压、显微椎间盘切除术和器械融合术在内的腰椎手术，均由同一位外科医生实施。对X线片进行了年龄、性别、影像学视图（前后位和侧位）以及负重（wb）和非负重（非wb）方面的分析。
结果
平均年龄为59.8岁（范围24 - 88岁）。TL最常见的位置是L4椎体（40% <60岁；44% >60岁）。女性中最常见的位置是L5，而男性中是L4椎体。在186张X线片中，68%在前后位和侧位平面上显示至少一个椎体节段的差异。在11例患者中，负重和非负重X线片之间至少有1个椎体节段的差异。
结论
TL会受到年龄、性别、影像学视图和负重状态的不同影响。我们建议在所有显微镜辅助下的腰椎手术中使用切口前X线片，以消除髂嵴线的临床差异，从而避免显微镜辅助下腰椎手术中对相邻正常节段的解剖学侵犯。我们强调，为避免错误节段手术，应充分考虑髂嵴线的这种差异。不建议在不进行切口前侧位X线检查的情况下采用触诊法进行节段检查。
Zotero 插件