背景:这项研究试图量化腰大肌形态的影像学差异,大血管解剖学,仰卧位和俯卧位之间的腰椎前凸位,以优化手术计划并最大程度地减少神经血管损伤的风险。
方法:仰卧MRI和俯卧术中CT对L2至L5水平的O-Arm的测量包括腰大肌的前后和中外侧接近度,主动脉,下腔静脉(IVC),和髂前血管到椎体.腰肌横向和纵向直径,腰大肌横截面积(CSA),腰椎全前凸,评估节段前凸。
结果:俯卧位置产生了显着的腰大肌偏侧化,尤其是在更多的尾部水平(P<0.001)。俯卧时,腰大肌稍微向前漂移,这是不重要的,但是在更多的尾段(P=0.038),前部平移的幅度显着降低,在L5处最低,实际上观察到后部回缩(P=0.032)。当俯卧时,IVC(P<0.001)和右髂静脉(P=0.005)明显向前迁移,然而,在更多的尾部水平观察到前移位减少(P<0.001)。此外,IVC在L5显著横向漂移(P=0.009)。俯卧时平均节段前凸显著增加(P<0.001)。
结论:相对于椎体,俯卧时,腰大肌表现出大量的横向活动,和后回缩,特别是在L5。IVC和右髂静脉出现明显的前活动-特别是在更多的头部水平。俯卧位增强了节段前凸,可能对优化矢状恢复至关重要。
This study sought to quantify radiographic differences in
psoas morphology, great vessel anatomy, and lumbar lordosis between supine and prone intraoperative positioning to optimize surgical planning and minimize the risk of neurovascular injury.
Measurements on supine magnetic resonance imaging and prone intraoperative computed tomography with O-arm from L2 to L5 levels included the anteroposterior and mediolateral proximity of the psoas, aorta, inferior vena cava (IVC), and anterior iliac vessels to the vertebral body.
Psoas transverse and longitudinal diameters,
psoas cross-sectional area, total lumbar lordosis, and segmental lordosis were assessed.
Prone position produced significant
psoas lateralization, especially at more caudal levels (P < 0.001). The
psoas drifted slightly anteriorly when prone, which was non-significant, but the magnitude of anterior translation significantly decreased at more caudal segments (P = 0.038) and was lowest at L5 where in fact posterior retraction was observed (P = 0.032). When prone, the IVC (P < 0.001) and right iliac vein (P = 0.005) migrated significantly anteriorly, however decreased anterior displacement was seen at more caudal levels (P < 0.001). Additionally, the IVC drifted significantly laterally at L5 (P = 0.009). Mean segmental lordosis significantly increased when prone (P < 0.001).
Relative to the vertebral body, the
psoas demonstrated substantial lateral mobility when prone, and posterior retraction specifically at L5. IVC and right iliac vein experienced significant anterior mobility-particularly at more cephalad levels. Prone position enhanced segmental lordosis and may be critical to optimizing sagittal restoration.