Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, China.
Orthop Surg. 2020 Aug;12(4):1173-1181. doi: 10.1111/os.12728. Epub 2020 Jun 28.
To investigate the changes in the lumbar intervertebral foramen (LIVF) dimensions from neutral supine to direct anterior approach (DAA)-specific hyperextension supine position through a standardized three-dimensional (3D) reconstruction computerized tomography (CT) method.
A total of 35 healthy volunteers (18 men and 17 women) were included in this retrospective study. The mean age of enrolled subjects was 28.9 ± 5.0 years. In September 2018, all the individuals underwent a 3D CT scan of the lumbar spine in neutral and 30° hyperextension supine positions, which mimicked the patient's position in DAA total hip arthroplasty (THA). The dimensions of the LIVF, including foraminal area, height, and width, were measured on 3D reconstructed CT models at all lumbar foraminal levels. Foraminal area was defined as the area bounded by the adjacent superior and inferior vertebral pedicles, the posterosuperior boundary of the inferior vertebral body, the surface of the intervertebral disc posteriorly, the posteroinferior boundary of the superior vertebral body, and the surface of the ligamentum flavum anteriorly. Foraminal height was defined as the longest distance between the border of the superior and the inferior pedicle. Foraminal width was defined as the shortest distance between the posteroinferior edge of the superior vertebrae and the opposing boundary. Subgroup analysis and multiple linear regression were used to evaluate the relationship between percentage changes of the LIVF dimensions and side, sex, and age.
The LIVF dimensions varied significantly between the two positions at all levels (P < 0.05). From neutral to hyperextension supine position, the foraminal area reduced by 20.1% at lumbar 1-2 (L ), 22.6% at L , 19.9% at L , 18.1% at L , and 12.0% at lumbar 5-sacral 1 (L -S ) level, respectively; the foraminal height reduced by 9.5% at L , 10.5% at L , 9.5% at L , 9.6% at L , and 6.1% at L -S level, respectively; the foraminal width reduced by 12.8% at L , 14.5% at L , 13.0% at L , 10.4% at L , and 8.4% at L -S level, respectively. The changes in LIVF dimensions were biggest at L level and smallest at L -S level. Subgroup analysis showed that there were no significant differences in the percentage changes of LIVF dimensions between the sexes and sides (P > 0.05). Multiple linear analysis showed that the percentage changes of LIVF dimensions were not related to side, sex, and age (P > 0.05).
The dimensions of the LIVF showed significant decrease at all levels in the DAA-specific hyperextension supine position compared with the neutral supine position, and the percentage changes of LIVF dimensions were not influenced by side, sex, and age.
通过标准化的三维（3D）重建计算机断层扫描（CT）方法，研究中立仰卧位到直接前路（DAA）专用过伸仰卧位时腰椎椎间孔（LIVF）的尺寸变化。
本回顾性研究共纳入 35 名健康志愿者（18 名男性，17 名女性）。纳入受试者的平均年龄为 28.9±5.0 岁。2018 年 9 月，所有个体均在中立位和 30°过伸仰卧位进行腰椎 3D CT 扫描，以模拟 DAA 全髋关节置换术（THA）中患者的体位。在所有腰椎椎间孔水平，通过 3D 重建 CT 模型测量 LIVF 的尺寸，包括椎间孔面积、高度和宽度。椎间孔面积定义为由相邻的上、下椎弓根，下椎体的后上边界，椎间盘的后表面，上椎体的后下边界和前黄韧带的表面围成的区域。椎间孔高度定义为上、下椎弓根之间的最长距离。椎间孔宽度定义为上椎体的后下边缘与对侧边界之间的最短距离。使用分组分析和多元线性回归来评估 LIVF 尺寸百分比变化与侧别、性别和年龄之间的关系。
在所有水平，LIVF 的尺寸在两个体位之间差异均有统计学意义（P<0.05）。从中立位到过伸仰卧位，椎间孔面积分别减少了 20.1%（L1-2 节段）、22.6%（L2-3 节段）、19.9%（L3-4 节段）、18.1%（L4-5 节段）和 12.0%（L5-S1 节段）；椎间孔高度分别减少了 9.5%（L1 节段）、10.5%（L2-3 节段）、9.5%（L3-4 节段）、9.6%（L4-5 节段）和 6.1%（L5-S1 节段）；椎间孔宽度分别减少了 12.8%（L1 节段）、14.5%（L2-3 节段）、13.0%（L3-4 节段）、10.4%（L4-5 节段）和 8.4%（L5-S1 节段）。L 水平的 LIVF 尺寸变化最大，L-S 水平的 LIVF 尺寸变化最小。分组分析显示，LIVF 尺寸百分比变化在性别和侧别之间无统计学差异（P>0.05）。多元线性分析显示，LIVF 尺寸的百分比变化与侧别、性别和年龄无关（P>0.05）。
与中立仰卧位相比，DAA 专用过伸仰卧位时 LIVF 的各尺寸均有显著减小，而 LIVF 尺寸百分比变化不受侧别、性别和年龄的影响。
