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目的:通过CT测量分析国人腰骶椎L1~S1终板各径线及相应骨突环等解剖学参数,探讨后方入路腰椎融合手术椎间融合器长度的选择。方法:招募24名健康成年志愿者,男12名,女12名,行腰椎CT扫描及矢状面、终板面二维重建。于L1~S1各终板面测量终板中线斜径、最大斜径、最大倾斜角、侧矢状径及相应径线所覆盖前后骨突环长度,计算均值及标准差。比较同性别同节段上下终板中线斜径、最大斜径、最大倾斜角及侧矢状径,计算不同手术方式下的融合器长度。结果:中线斜径男性最大值为39.58±2.60mm,最小值为33.38±3.26mm;女性最大值为34.89±1.55mm,最小值为30.93±2.99mm;前后覆盖骨突环长度为6~8mm。最大斜径男性最大值为48.05±4.62mm,最小值为42.83±2.28mm;女性最大值为43.26±3.31mm,最小值为38.00±2.53mm;自L1至S1逐渐变大。侧矢状径男性最大值为36.48±3.26mm,最小值为32.11±2.50mm;女性最大值为31.75±1.64mm,最小值为28.36±2.32mm;前后覆盖骨突环长度为5.5~7.5mm。L2~L5较L1/2、L5/S1同节段上下终板对应参数均保持较好一致性,差异多无统计学意义。L5/S1节段上下终板四对参数中只有最大斜径差异无统计学意义(男性,P=0.0522;女性,P=0.6410)。根据拟定融合器计算公式,TLIF融合器长度男性L1~L4各节段应≥31mm,L4/5为30~38mm,L5/S1为25~38mm;女性L1~L4各节段应≥27mm,L4/5为26~34mm,L5/S1为23~33mm。TLIF入路下融合器置入角度应尽量达到最大倾斜角以选用更长融合器。PLIF融合器长度男性L1~L5各节段为28~30mm,L5/S1为26mm;女性L1~L5各节段为24~26mm,L5/S1为22mm。结论:CT测量分析可为腰椎间融合器长度的选择提供客观依据,根据终板斜径、侧矢状径及骨突环长度可初步预测手术节段椎间融合器长度。
OBJECTIVE: To analyze the anatomical parameters of L1 ~ S1 endplate of lumbosacral vertebrae and the corresponding osteochondral ring of the lumbosacral vertebrae in Chinese by CT measurement and to explore the choice of the length of lumbar fusion lumbar fusion surgery. Methods: Twenty-four healthy adult volunteers were enrolled. Twelve male and 12 female volunteers underwent lumbar CT scan and two-dimensional reconstruction of the sagittal plane and the terminal plane. The mean diameter, maximum diameter, maximum inclination angle, sagittal diameter of sagittal plane and the length of sagittal ring before and after covered by the corresponding radial line were measured at L1 ~ S1 endplates. Mean and standard deviation were calculated. Comparison of the same section with the upper and lower endplate midline diagonal, maximum oblique diameter, maximum inclination angle and sagittal diameter, calculate the length of the cage under different surgical methods. Results: The maximum value of diagonal men in the midline was 39.58 ± 2.60mm, the minimum was 33.38 ± 3.26mm; the maximum was 34.89 ± 1.55mm in women and the minimum was 30.93 ± 2.99mm; The maximal slant diameter of male was 48.05 ± 4.62mm, the minimum was 42.83 ± 2.28mm; the maximum of female was 43.26 ± 3.31mm, the minimum was 38.00 ± 2.53mm; and gradually increased from L1 to S1. The maximum sagittal male height was 36.48 ± 3.26mm, the minimum was 32.11 ± 2.50mm. The maximum sagittal height was 31.75 ± 1.64mm and the minimum was 28.36 ± 2.32mm. The sagittal length of the sagittal ring was 5.5 ~ 7.5mm. L2 ~ L5 than L1 / 2, L5 / S1 with the corresponding parameters of the upper and lower end plates were consistent, the difference was no statistically significant. There was no statistically significant difference in maximum diagonal diameter between the four pairs of parameters in the upper and lower endplate of L5 / S1 segment (male, P = 0.0522; female, P = 0.6410). According to the formula of the proposed fusion cage, the lengths of L1 ~ L4 in the TLIF cage should be ≥31mm in length, 30 ~ 38mm in L4 / 5 and 25 ~ 38mm in L5 / S1. The female L1 ~ L4 should be ≥27mm in each segment, / 5 is 26 ~ 34mm, L5 / S1 is 23 ~ 33mm. TLIF approach into the fusion cage placement angle should try to reach the maximum tilt angle to choose longer cages. The length of the PLIF fusion cage was 28-30 mm for each segment of L1-L5 and 26 mm for L5 / S1. The female L1-L5 segments ranged from 24-26 mm in diameter and had a L5 / S1 of 22 mm. Conclusion: CT measurement can provide an objective basis for the choice of the length of lumbar interbody fusion. According to the diameter of oblique end of the plate, the sagittal diameter of the sagittal plane and the length of the osteochondral ring can be used to predict the length of the intervertebral fusion.