正常腰神经根磁共振神经成像临床影像学特点研究

doi:10.3969/j.issn.1006-7795.2019.05.020

摘要/Abstract

摘要： 目的采用磁共振神经成像（magnetic resonance neuroimaging，MRN）技术测量正常成人腰神经根与周围毗邻结构的影像解剖学参数，为临床经椎间孔入路术式提供重要的解剖学参考。方法选取30名正常成年人，其中男性15名，女性15名，年龄（24.3±2.1）岁。通过薄层连续腰骶部磁共振扫描，序列为FATSAT脂肪抑制，分别测量如下参数：神经根发出点位置，神经节至椎弓根的距离，神经节大小，Kambin三角边长及面积。结果 30名健康成人L1~L5神经根通过薄层MRN扫描技术均获得良好显示，双侧各节段参数差异无统计学意义。随腰椎节段下移，L1至L5神经节的长径为（6.34±0.47）~（11.25±1.52） mm，短径为（4.93±0.36）~（6.19±0.62） mm；神经节距上位椎体椎弓根下缘的距离为（7.91±1.94）~（-3.13±2.54） mm，距下位椎体椎弓根上缘的距离为（9.41±1.87）~（7.14±1.79） mm；L1~L5神经根自硬膜囊发出点距椎体下缘的距离为（8.89±2.89）~（19.96±3.70） mm，神经根腋部距神经节的距离为（7.43±2.34）~（12.98±3.31） mm；L1至L5神经根与矢状面的夹角为（39.53±3.97）°~（27.56±4.45）°；Kambin安全三角面积为（153.73±37.34）~（193.19±36.15） mm²。结论随腰椎节段向尾端移动，神经根发出的位置逐渐升高，神经根移行为神经节的距离及神经节的面积逐渐增大；神经节距下位椎体椎弓根的距离以及神经根与硬膜囊的夹角逐渐减小；Kambin三角面积逐渐增大。以上参数可为经椎间孔入路术式提供重要解剖学参考。

关键词: 腰神经根, 磁共振神经成像, Kambin安全三角, 影像学测量

Abstract: Objective Magnetic resonance neuroimaging (MRN) was used to measure the imaging anatomical parameters of normal adult lumbar nerve roots and adjacent structures, providing an important anatomical reference for clinical transforaminal approach. Methods Thirty healthy adults were chosen(15 males and 15 females, aged 24.3±2.1 years old).Through a thin layer continuous lumbosacral magnetic resonance scan(the sequence was FATSAT fat suppression),the following parameters were measured:the position of origin of the nerve root, the distance from the ganglion to the pedicle, the size of the ganglion, the length and area of the Kambin triangle. Results The L1-L5 nerve roots of these 30 healthy adults were well displayed by thin-layer MRN scanning technique, and there was no difference in the parameters of the two sides. With the lumbar segment moving down, the longest diameter of the L1-L5 ganglion was (6.34±0.47) mm to(11.25±1.52)mm, and the shortest diameter was (4.93±0.36)mm to (6.19±0.62)mm. The distance between the ganglion and the lower edge of the upper vertebral pedicle was (7.91±1.94) mm to (-3.13±2.54) mm, and the distance between the ganglion and the upper edge of the lower vertebral pedicle was (9.41±1.87)mm to (7.14±1.79) mm. The distance from the L1-L5 nerve root from the dural sac to the lower edge of the vertebral body was (8.89±2.89) mm to (19.96±3.70)mm, and the distance from the origin of the nerve root to the ganglion was (7.43±2.34)mm to (12.98±3.31) mm. The angle between the nerve root and sagittal plane of the L1-L5 was (39.53±3.97)° to (27.56±4.45)°. The area of safety triangle of Kambin was (153.73±37.34) mm² to (193.19±36.15)mm². Conclusion As the lumbar segment moves toward the tail end, the position of the origin of the nerve roots gradually increases, moreover, the distance between the nerve root and the ganglion and the area of the ganglion gradually increases. The distance between the ganglion and the vertebral pedicle of the lower vertebral body gradually decreases. Besides, the angle between the nerve root and the dural sac decreases gradually. The area of the Kambin triangle gradually increases. The above parameters provide an important anatomical references for the transforaminal approach.

Key words: lumbar nerve root, magnetic resonance neuroimaging, Kambin safety triangle, imaging measurement

中图分类号:

丁一, 杨晋才, 张黎明, 杨再松, 尹鹏, 刘畅, 许春阳. 正常腰神经根磁共振神经成像临床影像学特点研究[J]. 首都医科大学学报, 2019, 40(5): 769-775.

Ding Yi, Yang Jincai, Zhang Liming, Yang Zaisong, Yin Peng, Liu Chang, Xu Chunyang. Clinical imaging characteristics of magnetic resonance neurography of normal lumbar nerve root[J]. Journal of Capital Medical University, 2019, 40(5): 769-775.

参考文献

[1] Kikuchi S, Sato K, Konno S, et al. Anatomic and radiographic study of dorsal root ganglia[J]. Spine, 1994,19(1):6-11.
[2] Marzo J M, Simmons E H, Kallen F. Intradural connections between adjacent cervical spinal roots[J]. Spine, 1987,12(10):964-968.
[3] Tubbs R S, El-Zammar D, Loubas M, et al. Intradural cervical root adjacent interconnections in the normal, prefixed, and postfixed brachial plexus[J]. J Neurosurg Spine, 2009,11(4):413-416.
[4] Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion:is it worth it?[J]. Int Orthop, 2013,37(8):1507-1510.
[5] 王振强. 腰骶丛应用解剖及临床意义[J]. 中国中医药咨讯, 2011,3(13):35-37.
[6] 倪勇, 胡伟, 郭洪敏, 等. 基于CT多平面重建技术经Wiltse入路TLIF安全性分析[J]. 济宁医学院学报, 2016,39(1):26-30.
[7] Kambin P, Bracer M D. Percutaneous Posterolateral Discectomy[J]. Clin Orthop Relat Res, 1987(223):145-154.
[8] Kambin P, Brager M D. Percutaneous posterolateral discectomy. Anatomy and mechanism[J]. Clin Orthop Relat Res, 1987(223):145-154.
[9] Yeung A T, Tsou P M. Posterolateral endoscopic excision for lumbar disc herniation:surgical technique, outcome, and complications in 307 consecutive cases[J]. Spine, 2002,27(7):722-731.
[10] 顾昕, 贺石生, 张海龙, 等. 经皮后外侧腰椎间孔入路椎间盘工作区域的解剖学研究[J]. 中华骨科杂志, 2011,31(10):1033-1037.
[11] Deyo R A, Gray D T, Kreuter W, et al. United States trends in lumbar fusion surgery for degenerative conditions[J]. Spine, 2005,30(12):1441-1445.
[12] Ma G W. Posterior lumbar interbody fusion with specialized instruments[J]. Clin Orthop Relat Res, 1985(193):57.
[13] Okuyama K, Abe E, Suzuki T, et al. Posterior lumbar interbody fusion:a retrospective study of complications after facet joint excision and pedicle screw fixation in 148 cases[J]. Acta Orthop, 1999,70(4):329-334.
[14] 阮狄克, 何勍, 丁宇, 等. PLF与PLIF手术治疗腰椎滑脱症的疗效比较[J]. 中国脊柱脊髓杂志, 2004,14(3):156-160.
[15] 张绍东, 吴小涛, 茅祖斌, 等. 后路腰椎椎间融合器融合术的并发症分析[J]. 中国脊柱脊髓杂志, 2006,16(7):493-497.
[16] 王波, 刘海鹰, 王会民, 等. 腰椎间融合结合椎弓根内固定治疗老年重度腰椎管狭窄症的临床体会[J]. 中华外科杂志, 2006,44(16):1125-1126.
[17] Appel B. Nomenclature and classification of lumbar disc pathology[J]. Neuroradiology, 2001,43(12):1124-1125.
[18] Igarashi T, Yabuki S, Kikuchi S, et al. Effect of acute nerve root compression on endoneurial fluid pressure and blood flow in rat dorsal root ganglia[J]. J Orthop Res, 2010,23(2):420-424.
[19] Murata Y, Nannmark U, Rydevik B, et al. Nucleus pulposus-induced apoptosis in dorsal root ganglion following experimental disc herniation in rats[J]. Spine, 2006,31(4):382-390.
[20] Hatashita S, Sekiguchi M, Kobayashi H, et al. Contralateral neuropathic pain and neuropathology in dorsal root ganglion and spinal cord following hemilateral nerve injury in rats[J]. Spine, 2008,33(12):1344-1351.
[21] Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression:Part 2:morphological and immunohistochemical changes of dorsal root ganglion[J]. J Orthop Res, 2010,22(1):180-188.
[22] 梁慧, 崔久法, 段峰, 等. 腰椎间盘突出症脊神经节受累程度的三维磁共振结构相干稳态成像序列评估[J]. 中国医学影像学杂志, 2014,22(10):773-776.
[23] 赵伟, 李长青, 周跃,等. 经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症[J]. 中国矫形外科杂志, 2012, 20(13):1191-1195.
[24] 王建华, 夏虹, 李树林,等. 微创经椎间孔腰椎椎间融合术的应用解剖学研究[J]. 中国脊柱脊髓杂志, 2009, 19(10):765-768.