Measurement Study And Clinical Significance On The Intervertebral Disc Foramina Of Chinese Adults In The Multi-slice CT Three-dimensional Reconstruction

Objective: Reconstruction the lumbar spine structure of normal peopleby Spiral CT, observat adults L4-5foramina under longitudinal diameter,transverse diameter of the change characteristics at different rotationangles and analysis,as the choice of operation approaches when theforaminal mirror technique treat L4/5intervertebral discherniation ofCountrymen to provide reference data,and observat clinical efficacy.Methods:The part one:Collect healthy Chinese volunteers withoutlumbar intervertebral discherniation symptoms and signs of lumbartrauma history, without low back pain and double lower limbs pain,numbness.According to a completely randomized design select80volunteers, men and women of the40; age26to45years old, average35.2years old.80volunteers all perfect lumbar MSCT thin layerscanning,Scan data into medical reconstruction software, for3Dreconstruction of vertebral body and intervertebral foramen.Measure:①L4-5lumbar intervertebral foramen transverse diameter(anteroposterior diameter):It’s the distance that L4vertebral body afterthe lower edge of the outer and the L5vertebral body after on line of the outer to the up and down facet junction;intervertebral foramenlongitudinal diameter(the up and down diameter):It’s the range that L4pedicle lower edge midpoint to L5pedicle on the edge of themidpoint;②In human body’s vertical shaft as the rotating center, in5°for a rotating unit counterclockwise rotate right L4-5intervertebralforamen, Measure intervertebral foramen transverse diameter(anteroposterior diameter) of different angle:It,s the distance that L4vertebral body after the lower edge of the outer and the L5vertebral bodyafter on line of the outer to the up and down facet junction,until the facetblock the L4and L5Vertebral lateral margin(Measure the leftintervertebral foramen when it alongs the vertical shaft clockwiserotate);③As the human sagittal axis for the center,in5°for a rotatingunit clockwise rotate right L4-5intervertebral foramen,measureintervertebral foramen longitudinal diameter(the up and downdiameter)of different angle：It,s the range tha L4pedicle lower edgemidpoint to L5pedicle on the edge of the midpoint，Until the L4pedicleof vertebral arch,s lateral edge prevents the upper edge midpoint of L5pedicle of vertebral arch (Measure the left intervertebral foramen when italongs the sagittal axis counterclockwise rotate);The index of male andfemale groups according to the rotation angle measuring for statisticalanalysis.Discuss the application of TESSYS in the treatment of L4/5discinsertion point of the safety interval.Discuss the safety angle interval of insert working sleeve that TESSYS treat L4/5intervertebraldischerniation(Maximum diameter of7.5mm),looking for the bestoperation approach.The part two:Collect patients data of Hunan People’s Hospital spinalsurgery who accept the TESSYS technique treat lumbar discherniationFrom2010January to2011November,Including78cases is L4/5lumbarintervertebral discherniation,age20-54years old,average37.4years old,male49cases, female29cases,Collection index is patients, operation time,bleeding volume, complications and curative effect,statistical analysis allpreoperative, postoperative1months,3months after the operation、At thelast follow-up time according to VAS,evaluat clinical efficacy.Results: The part one:①Longitudinal diameter, transverse diametercomparison of the lesbian group,s L4-5intervertebral foramen are nostatistical difference(P>0.05)；②L ongitudinal diameter, transversediameter in lateral and the samerotation angle comparison of left and right sides of the L4-5intervertebralforamen are no statistical difference(P>0.05)；③Longitudinal diameter, transverse diameter comparison of the healthyChinese volunteers from26to45years old,s L4-5intervertebral foramenare no statistical difference(P>0.05)； Along with the vertical shaftcounterclockwise rotates the right side intervertebral foramen,thetransverse diameter becomes smaller gradually,rotate about50 °,intervertebral foramen was blocked by facet; With the sagittal axis toclockwise rotate intervertebral foramen,the longitudinal diameterbecomes smaller gradually,rotate about65°,intervertebral foramen wasblocked by L4pedicle of vertebral arch.The part two:All patients were successfully performed TESSYS,operationtime48~121min,the mean63min;intraoperative bleeding less and doesnot estimate.Postoperative leg pain was alleviated.There were5cases ofpostoperative,s legs present" sunlight burning syndrome "after1weeks,Through trophic nerve, dehydration detumescence, antiphlogisticanalgesia therapy were remissed for1weeks;operation incision length0.7cm,wound healing;there were no complications after operation.Follow-up for all patients at different time points after postoperative,afollow-up time from3months to22months. patients with low back pain,leg pain score of VAS contrast preoperative score, the results of F test, P<0.01,there were significant differences.Conclusion:1.There is no significant difference in different gender,different side of normal Chinese L4-5intervertebral foramen diameterand vertical diameter.2.There is no significant difference when the normal Chinese L4-5intervertebral vertical diameter rotate the same angle of normal ChineseL4-5intervertebral foramen diameter and vertical diameter3.In order to avoid accidental injury nerve root and into the peritoneal cavity with the TESSYS，the approach angle selection for:35°<abductionangle<50°, the head tilt about45°may obtain the best operationapproach.