基于CT三维重建技术的腰椎横突间入路解剖学研究

作者：汤俊君，王新伟，袁文，董军，顾韬

【摘要】 [目的]采用CT增强三维重建技术对腰椎横突间区域进行模拟解剖学研究，探讨此区域骨性结构和血管分布的特点及临床意义。[方法] 对20名正常志愿者L3～S1节段进行CT增强+三维重建检查，在三维重建图形上测量横突长度、上下横突间距、椎间孔外椎间隙高度及斜径，观查横突间区域血管走行特点并测量血管内径，然后进行统计分析及评价。[结果]腰椎横突长度L3>L5>L4，上下横突间距和椎间孔外椎间隙高度均为L3、4>L4、5>L5S1，椎间隙斜径3个节段间比较无显著差异;同节段相比L3、4、L4、5节段上下横突间距大于椎间孔外椎间隙高度，而L5S1节段上下横突间距与椎间孔外椎间隙高度则无显著差异。横突前方血供均源自腰椎节段动脉，其主要分为主支从支型和主支分叉型两类，L3、4以主支从支型(87.5%)为主，L4、5以主支分叉型(92.5%)为主。穿过横突间的血管支主要位于此区域的内侧(80%)，而大多横突前的血管(96%)跨过侧后方椎间隙下行。横突间区域血管内径L4、5>L3、4，左右两侧相比无明显差异，主要血管支中内径平均最大值可达5.3±0.6 mm。[结论]横突间及小关节区域血管丰富，走行具有一定规律，熟悉此区域解剖结构并注意操作可减少术中出血;L3、4、L4、5节段行横突间入路腰椎椎体间融合术具有一定可行性。

【关键词】 横突间; 手术入路; CT三维重建; 腰椎椎体间融合术

　　Abstract: [Objective]To mimesis the anatomic research by contrasted enhancement and 3D reconstruction CT examination of lumbar intertransverse area, then discuss the feature of anatomy and blood supply and the clinical significance of this area. [Method]Contrasted enhancement and 3D reconstruction CT examination was performed in 20 volunteers on the lumbar segment L3～S1, then the statistical analysis and evaluation was made by measuring the length of transverse process, the distance of upper and lower transverse process, the height of extraforminal intervertebral space, the oblique diameter of intervertebral space, the blood vessels’ internal diameter and observing the distribution of the blood vessels in the intertransverse area.[Result]The order of the length of transverse process was L3>L5>L4, the order of the distance of upper and lower transverse process and the height of extraforminal interbertebral space was L3、4>L4、5>L5S1, the oblique diameter for interbertebral space had no significant difference between three segments. The distance of upper and lower transverse process was bigger than the height of extraforminal interbertebral space in the same segment in L3、4 and L4、5, but in segment L5S1there wasn’t significant difference. All the blood supply w

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