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摘要
Objective This study aims to explore the anatomical features of lumbar CT three-dimensional images in patients with lumbar disc herniation and its significance in unilateral biportal endoscopic technique. Methods A cross-sectional design was used. A total of 50 patients with lumbar disc herniation were selected from the Department of Orthopedics, the Second Affiliated Hospital of Anhui Medical University from January 2019 to June 2020. The participants included 32 males and 18 females aged 23 to 69 (64.1±13.4) years and had the following segments of lesions: L2/3 1, L4/5 18, L5/S1 23, L3/4 with L4/5 1, and L4/5 with L5/S1 6. All patients underwent lumbar disc nucleus pulposus removal by unilateral biportal endoscopic technique. All patients underwent CT scanning and volume rendering of lumbar vertebrae before operation. The overall morphological structure of lumbar vertebrae was observed by CT volume rendering. The angle between lamina, the width of lamina, the sagittal degree of facet joint, and the degree of downward movement of lamina were measured in radiation workstation software and compared among different segments and laterals. Results (1) The spinous process was smoothly linked with the bilateral vertebral plates in a herringbone shape, and the bilateral vertebral plates arc out to both sides. The included angles from L3 to L5 between the two sides of the lamina gradually increased, with values of 70°±11°, 78°±12°, and 92°±13°, respectively. No statistically significant difference was found between L3and L5 (F=42.25, P< 0.001). (2) The lower edge of the lamina extended to both sides, and the width of the lamina gradually widens from L3 to L5. The widths of the left side were (14.0±2.4), (15.7±2.6), and (18.7±2.8) mm, respectively, and those of the right side were (14.4±2.4), (16.4±2.3), and (19.2±2.8) mm, respectively. The width of the right side of each segment was larger than that of the left side, and the difference was statistically significant (t=2.13, 4.00, 2.78, all P values <0.05). (3) The end of the lamina gradually widened and expanded to form an articular surface, and its L3/4-L5/S1 gradually changed from sagittal to coronal. The left sides were 60°±10°, 50°±9°, and 42°±11°, respectively, and the right sides were 58°±11°, 48°±10°, and 40°±13°, respectively. Statistically significant difference was found between the left and right sides of the same segment compared with L3/4 (t=2.92, P=0.005), but no statistically significant difference was detected between the left and right sides of L4/5and L5/S1 (t=1.29, 1.79, all P values >0.05). (4) The degree of downward movement of lamina gradually decreased from L3 to L5, and the difference was statistically significant (F=50.39, P<0.001), which were (6.8±2.1), (5.1±2.3), and (2.4±2.3) mm, respectively. Conclusion From L3 to L5, the angle between the two sides of the lamina gradually increases, the lateral width of the lamina gradually increases, the facet joint gradually changes from sagittal to coronal, and the descending degree of the lamina gradually decreases in patients with lumbar disc herniation. Understanding the segmental changes in the anatomy of the lumbar spine can help with smooth operation, determination of the extent of lamina removal, protection of facet joints, and identify the location of the disc. ? Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.
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