Yu Penghui, Wang Yanfang, Wu Xiuyu, Liu Zhenghai, Liu Fang, Li Qiao, Lin Lusheng, Li Yanbing
Department of Human Anatomy, Hunan University of Medicine, Huaihua, 418000, Hunan, China.
School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, Guangdong, China.
Surg Radiol Anat. 2020 Feb;42(2):103-110. doi: 10.1007/s00276-019-02303-x. Epub 2019 Aug 22.
To reconstruct the three-dimensional safe triangle areas at L1-5 based on the computed tomography digital data, analyze the safe scopes for the puncture location and angles, and provide anatomic references for percutaneous lumbar discectomy.
Computed tomography data from patients and control group were imported from the database and anatomical reference parameters were measured in Mimics software. The rebuilt model was rotated clockwise along the M-axis to measure the inscribed circle radius of the safe triangle at different angles. Based on the outer diameter of the largest cannula, the safe angles were calculated. The distances between points on the projection of safe triangle-inscribed circle and the upper lumbar spinous process were measured. Similarly, while the safe triangle was on the left side, the model was contra-rotated to measure all the parameters.
There was no significant difference between the patient and control group in both the least distance between the selected anatomical reference locations and the safe triangle-inscribed circle radius at L4-5. According to the series which had a largest cannula of 2.5 mm, the safe puncture angles increased with the descending disc levels. The optimal angles were 40°-45° for L1-2, 45°-50° for L2-3, 50° for L3-4, and 55° for L4-5 separately. The differences between genders in the distances of paired reference points were significant.
Individual safe localization of the percutaneous puncture could be obtained by analyzing the three-dimensional relationship between the puncture localization and anatomical landmarks.
基于计算机断层扫描数字数据重建L1 - 5节段的三维安全三角区，分析穿刺位置和角度的安全范围，为经皮腰椎间盘切除术提供解剖学参考。
从数据库中导入患者及对照组的计算机断层扫描数据，并在Mimics软件中测量解剖学参考参数。将重建模型沿M轴顺时针旋转，测量不同角度下安全三角区的内切圆半径。根据最大套管外径计算安全角度。测量安全三角区内切圆投影上各点与上位腰椎棘突之间的距离。同样，当安全三角区在左侧时，对模型进行反向旋转以测量所有参数。
患者组与对照组在所选解剖学参考位置之间的最小距离以及L4 - 5节段安全三角区内切圆半径方面均无显著差异。对于最大套管为2.5 mm的系列，安全穿刺角度随椎间盘节段降低而增大。L1 - 2节段的最佳角度分别为40° - 45°，L2 - 3节段为45° - 50°，L3 - 4节段为50°，L4 - 5节段为55°。配对参考点距离在性别上的差异具有显著性。
通过分析穿刺定位与解剖标志之间的三维关系可获得经皮穿刺的个体安全定位。
