| Background: Lumbar degenerative diseases often require surgery.surgery methods: Open surgery or m inimally invasive endoscopic treatm ent.Endoscopic therapy has been widely applied in lum bar degenerative diseases. The com plications are injury of dural sac and nerve root injury, which reason is due to the complexity of irregular rear lumbar vertebra bony structure. The rear lumbar vertebra bony structure has limited space natural channel, surrounding which is the dural sac and spinal nerve. Dural sac and spinal nerve are likely to be d amaged in the pro cess of setting instrument channel.The dam age is severe and irreversible.So setting instrument channel is difficult in the technology of operation, which causing a bottleneck in the development of minimally invasive technology.So doctors need to m aster firmly the anatomic structure and discus s the experience of surgery. We need to consider and explore in practice, including the change of the position.Objective: Simulated prone position of lum bar degenerative disease surgery. Measured lumbar posterior stru cture by CT three-dim ensional measurement respectively in the 0 d egree and 30 degrees prone position. Measured datas of the maximum distance between verteb ral plates in coronary posotion, the length of intervertebral foramen diameter(longitudinal diameter) in sagittal view, the distance between lower vertebral body's superior articular process point and the uppe r vertebral trailing edge in sagittal view, the distance between lower vertebral body's superior articular process and the uppe r vertebral trailing edge's m idpoint in transverse presentation. Thess datas associ ated with minimally invasive endoscopic surgery.Observe and study the lum bar posterior structure changes in lum bar degeneration patients' prone position of 0 and 30 degrees, especially the data related to minimally invasive endoscopic surg ery.To find the objective basis of best cathetering by lum bar lateral and posterior approach. The changes of lum bar spinal column structure under different prone position.after position changes, can choose for clinical lumbar degenerative disease, m inimally invasive endoscopic surgery. Can be provided anatomical basis for reasonable operation,for cathetering into the right way,for new endoscopic equipm ent design, de velopment and application. So as to improve the safety and convenience of endoscopic minimally invasive spinal surgery.Methods: There are 50 patients with lumbar degeneration(volunteers). Divided them into two groups accord ing to the m ainly lumbago and leg pain sym ptoms complain. Scanned L3- S1 using Siem ens 64 layer spiral CT. All of the patients participate in the CT examination of with spiral CT scan in prone position of 0 degree first, then in prone pos ition of 30 degr ees. Import th e acquisition of DICOM data baoholo digital medical image workstation for 3 d reconstruction. Measured datas of the maximum distance between vertebral plat es in coronary posotion, the length of intervertebral foramen diameter in sagittal view, the distance between lower vertebral body's superior articular process point and the upper vertebral trailing edge in sagittal view, the distance between lower verteb ral body's superior articular process and the upper vertebral trailing edge's m idpoint in transverse presentation. Separately fill in the related forms, and statistic th e data.Respectively statistic the da ta on lum bago group, leg pain group, men's group, women's groups, prone position 0 degree grou p and prone p osition 30 d egrees group. Set and statistical data respectively. SPSS13 software package was used to statistical anal ysis.two groups of data using analysis of variance.Results: 1.The maximum distance between vertebral plates in coron ary posotion:prone position 0 degree and 30 degr ees group have significant difference in L34, L45, L5S1 parts; 2. The length of inte rvertebral foramen diameter(longitudinal diameter) in sagittal view: prone position 0 degree and 30 degrees group also have significant difference in L34, L45, L5S1 parts; 3. the distance between lower vertebral body's superior articular process point and the upper vertebral trailing edge in sagittal view:prone position 0 degree and 30 degrees group have significant difference in L34, L45, L5S1 parts; 4. the distance between lo wer vertebral body's superior articular process and the upper verteb ral trailing edge's midpoint in transverse presentation: prone position 0 degree and 30 degrees group al so have significant difference in L34, L45, L5S1 parts; 5. After analysis the above four parameters, in the group of gender(male and female), symptoms(waist pain and lower limb pain) there is no significant difference;6. The vertebral plate gap width, sagittal position intervertebral foramen length to diam eter(longitudinal diam eter) measurement showed that the pro ne position 0 degree group less than 30 degrees, significant difference.So whether posterior is MED surgery, or endos copic surgery. prone position 30 degrees position increase vertebral plate gap, quickly and efficiently get into the spinal canal to carry out surgery. So prone position 30 degrees for spinal posterior lens get in to the workplace is very effective and help reduce the difficulty of operation. 7. The distance between lower vertebral body's superior articular process point and the uppe r vertebral trailing edge in sagittal view,the distance between lower vertebral body's superior articular process and the upper vertebral trailing edge's m idpoint in transverse presentation: measurement showed that the prone position 0 degree less than 30 degrees, significant difference. So be very careful when working in puncture and placement casing into the deep, to prevent too deep to lead to puncture needle and casing into the vascu lar in f ront of the vertebral bodies in fr ont of the vertebral bodies.Lead to the occurrence of danger and accident. Illustrate the interverteb ral foramen in the m inimally invasive sp ine surgery, using three-dim ensional preoperative CT m easurement program, is conducive to guide operation for intervertebral foramen into the app roach(remove part of the articular process an d control the depth of in sertion), to prevent the injury of the export nerve root and the running nerve root..Conclusion:Measurement results show that: 1. the maximum distance between vertebral plates in coronary posotion, L 34, L45, L5S1 parts prone position 0 degrees 30 degrees and had significant difference; 2. the length of intervertebral foramen diameter(longitudinal diameter) in sagittal view, L34, L45, L5S1 parts prone position 0 and 30 degrees also have significant di fference; 3. the distan ce between lower vertebral body's superior articular process point and the upper vertebral trailing edge in sagittal view, L34, L45, L5S1 parts prone position 0 and 30 degrees exist significant difference; 4. th e distance between lower ve rtebral body's superior articular process and the upper vertebral trailing edge's m idpoint in transverse presentation, L34, L45, L5S1 parts prone position 0 degrees and 30 degrees also have obvious difference; 5. through the analysis of, in the group of the above four parameters, gender(male and female) and symptoms(waist pain and lower limb pain group) there was no significant difference; 6. Application for further clinical observation and measured data validation.Using of intervertebral disc endoscope the surgical treatment of 22 cases of pa tients with lumbar disc prolapse with catheter in patients with 30 degrees into the spinal canal.Incision size, the incidence of complications were significantly lower than patients with 0 degrees. 7. Measured data show that for minimally invasive spine surgery, whether between vertebral plate road or intervertebral foramen in the 30 degrees are conducive to endoscopic placement of casings, reduce the damageof the nerve root and dural sac. 8. Measured data show s the intervertebral foramen in the m inimally invasive s pine surgery, using thr eedimensional preoperative CT measurement program, is conducive to guide operation for intervertebral foramen lens in to the a pproach(removal of pa rt of the articu lar process and control the depth of insertion), to prevent the injury of the export nerve root and the running nerve root. |
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