目的 基于中老年腰椎矢状面MRI测量椎基静脉孔（basivertebral foramen，BF）的解剖学参数，为相关手术提供解剖学依据。方法 回顾2018年2月至2022年12月广州中医药大学第一附属医院43例成年患者，共计172例椎体的腰椎矢状面MRI，使用PACS影像系统测量L1~L4 BF的深（basivertebral foramen depth，BFD）、BF的高（basivertebral foramen height，BFH）、椎体宽（vertebra width，VW）、椎基静脉孔上端至上终板距离（the upper end of BF between the upper boundary and the endplate，VH1）以及椎基静脉孔下端至下终板距离（the lower end of BF between the lower boundary and the endplate，VH2），计算BFD与VW的比值BFD/VW以及BFH与椎体高（vertebra height，VH）的比值BFH/VH。 结果 在STIR序列中，L1椎体BFD（3.93±1.58）mm低于L3（5.26±2.34）mm与L4（5.82±2.99）mm，有统计学意义（P<0.05）；L1椎体BFD/VW（0.12±0.05）与L4（0.17±0.09）对比有统计学意义（P<0.05），且L1~L4的BFD/VW组间对比有统计学差异（P<0.05），各椎体的BFH/VH对比无统计学意义（P>0.05）。男性与女性对比，T2WI序列中L3椎体BFH男性（7.95±2.84）mm高于女性（6.30±1.93）mm，有统计学意义（P<0.05）。随着椎体序列的增长，BFD呈现逐渐增加的趋势，在STIR序列中更加明显。而BFH随椎体序列增加无明显起伏。 结论 中老年MRI矢状位STIR序列可作为其BF的临床测量标准，为腰椎手术方案的选择提供解剖学依据。
Abstract
Objective To provide further anatomical basis for lumbar vertebra operations by measuring anatomical parameters of lumbar vertebra basivertebral foramen (BF) based on sagittal MRI images. Methods Sagittal MRI images of 172 vertebral bodies of 43 adult patients admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine and Dongguan Hospital of Guangzhou University of Chinese Medicine from February 2018 to December 2022 were retrospectively analyzed. The PACS imaging system was used to measure the BF depth (BFD), BF height (BFH), Vertebral width (VW), the upper end of BF between the upper boundary and the endplate (VH1), the lower end of BF between the lower boundary and the endplate (VH2), and calculate the ratio of BFD to vertebral body width (BFD/VW) and the ratio of BFH to vertebral body height (BFH/VH). Results After comparing lumbar vertebrae, the STIR sequence showed that BFD (3.93±1.58mm) of L1 vertebrae was lower than BFD of L3 (5.26±2.34) mm and BFD of L4 (5.82±2.99) mm，which was statistically significant (P<0.05). Also in the STIR sequence, BFD/VW of L1(0.12±0.05) was lower than that of BFD/VW of L4(0.17±0.09) (P<0.05). Moreover, there were statistical differences in the comparison of BFD/VW in L1-L4 among the four groups (P<0.05). There was no statistical significance in the BFH/VH of each vertebral body (P>0.05). In the comparison between male and female, BFH of male L3(7.95±2.84) mm was higher than that of female L3(6.30±1.93) mm on T2WI, which was statistically significant (P<0.05). With the increasing of the vertebrae sequence, BFD showed a gradually increasing trend, and it was more obvious in the STIR sequence. BFH had no obvious fluctuation with the increasing of vertebral body sequence. Conclusions STIR sequence in sagittal MRI image can be used as the clinical measurement standard of BF in middle-aged and elderly patients, which providing anatomical reference for the selection of lumbar surgical treatment.
关键词
腰椎 /
/
/
椎基静脉孔 /
/
/
MRI /
/
/
数字化测量 /
/
/
解剖学
Key words
Lumbar vertebra /
/
/
Basivertebral foramen /
/
/
MRI /
/
/
Digital measurement /
/
/
Anatomy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Wang Q, Wang C, Fan S, Zhao F. Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine: basivertebral foramen collapse might cause intravertebral avascular necrosis[J]. Spine J, 2014,14(6): 1090-1091. DOI: 10.1016/j.spinee.2014.01.051.
[2] 马春明, 鞠晓华, 王孝文, 等. 腰椎椎基静脉孔的解剖学观测及其临床意义[J]. 中国临床解剖学杂志, 2014, 32(4): 405-408. DOI: 10.13418/j.issn.1001-165x.2014.04.008.
[3] Fras C, Kravetz P, Mody DR, et al. Substance P-containing nerves within the human vertebral body. An immunohistochemical study of the basivertebral nerve[J]. Spine J, 2003, 3(1): 63-67. DOI: 10.1016/s1529-9430(02)00455-2.
[4] Yeh ML, Heggeness MH, Chen HH, et al. Compressive loading at the end plate directly regulates flow and deformation of the basivertebral vein: an analytical study[J]. J Orthop Surg Res, 2006, 1: 18. DOI: 10.1186/1749-799X-1-18.
[5] 张鹤令, 李凌伟. 椎内裂隙征和椎基静脉孔相通与PKP术后骨水泥渗漏的相关性分析[J]. 重庆医学, 2015, 44(35): 5030-5032, 5037. DOI: 10.3969/j.issn.1671-8348.2015.35.046.
[6] 王素春, 施建东, 陆爱清, 等. 椎基静脉孔及椎体静脉解剖在椎体成形术中的意义[J]. 中国临床解剖学杂志, 2015, 33(6): 646-650. DOI: 10.13418/j.issn.1001-165x.2015.06.007.
[7] 朱刃, 柏松, 陈得美, 等. 胸腰椎椎基静脉孔的形态特征及与椎体后凸成型术中骨水泥渗漏的相关性研究[J]. 全科医学临床与教育, 2021, 19(11): 1020-1022. DOI: 10.13558/j.cnki.issn1672-3686.2021.011.019.
[8] Carpenter K, Decater T, Iwanaga J, et al. Revisiting the vertebral venous plexus-a comprehensive review of the literature[J]. World Neurosurg, 2021, 145: 381-395. DOI: 10.1016/j.wneu.2020.10.004.
[9] Zhao Q, Cheng L, Yan H, et al. The anatomical study and clinical significance of the sinuvertebral nerves at the lumbar levels[J]. Spine (Phila Pa 1976),2020, 45(2): E61-E66. DOI: 10.1097/BRS. 000000 0000003190.
[10] Zhang X, Li S, Zhao X, et al. The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen[J]. Spine J, 2018, 18(3): 472-481. DOI: 10.1016/j.spinee.2017.08.237.
[11] Rosenthal BD, Boody BS, Jenkins TJ, et al. Thoracolumbar burst fractures[J]. Clin Spine Surg, 2018, 31(4): 143-151. DOI: 10.1097/BSD.0000000000000634.
[12] Şentürk S, Öğrenci A, Gürçay AG, et al. Classification of radiological changes in burst Fractures[J]. Open Access Maced J Med Sci, 2018, 6(2): 359-363. DOI: 10.3889/oamjms.2018.094.
[13] Harrison NM, McHugh PE. Comparison of trabecular bone behavior in core and whole bone samples using high-resolution modeling of a vertebral body[J]. Biomech Model Mechanobiol, 2010, 9(4): 469-480. DOI: 10.1007/s10237-009-0188-8.
[14] Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review[J]. Injury, 2012, 43(7): 980-988. DOI: 10.1016/j.injury.2011.06.030.
[15] Wang C, Fan S, Liu J, et al. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty[J]. Spine J, 2014, 14(8): 1551-1558. DOI: 10.1016/j.spinee.2013.09.025.
[16] 唐志宏, 邹国耀, 肖颖, 等. 胸腰段椎体内血管分布与安全区内穿刺减少骨水泥的渗漏[J]. 中国组织工程研究, 2013, 17(3): 387-391. DOI: 10.3969/j.issn.2095-4344.2013.03.002.
[17] Yu W, Liang D, Yao Z, et al. The potential impact of basivertebral foramen morphology and pedicle screw placement on epidural cement leakage with cement-augmented fenestrated pedicle screw fixation: a multicenter retrospective study of 282 patients and 1404 augmented screws[J]. Neurosurgery, 2023, 93(1): 66-74. DOI: 10.1227/neu.0000000000002373.
[18] 赵兴, 赵凤东, 方向前, 等. 胸腰段椎体椎基静脉孔的CT影像学特征及其意义[J]. 中华骨科杂志, 2012, 32(1): 58-64. DOI: 10.3760/cma.j.issn.0253-2352.2012.01.0010.
[19] 康小燕, 薛咏春, 王星, 等. 腰椎椎基静脉孔的CT多平面重组观测[J]. 中华解剖与临床杂志, 2015, 20(4): 302-305. DOI: 10.3760/cma.j.issn.2095-7041.2015.04.005.
基金
国家自然科学基金项目（82305264）；广州市科协青年科技人才托举项目（QT-2023-022）；广州市科技市校（院）联合资助（登峰医院）基础研究项目（202201020307）；广州市科技基础与应用基础研究专题（青年博士“启航”项目 2024A04J4331）；广州中医药大学第一附属医院中青年骨干人才培育项目-青优人才（2023QY13）
PDF(1785 KB)
京ICP备08002354号-3
