Does right lateral decubitus position change retroperitoneal oblique corridor? A radiographic evaluation from L1 to L5
Does right lateral decubitus position change retroperitoneal oblique corridor? A radiographic evaluation from L1 to L5
复制标题
右侧卧位会改变腹膜后斜通道吗？
DOI：
10.1007/s00586-016-4645-7
复制
发表时间：
2017-03-01
影响因子：
2.8
通讯作者：
Jiang, Jianyuan
中科院分区：
文献类型：
--
作者：
Zhang, Fan;Xu, Haocheng;Jiang, Jianyuan
目的探讨右侧卧位对腹膜后斜通道的影响。在穿过每个椎间盘中心的图像中，O定义为椎间盘中心，A（仰卧）或A '（右侧卧）位于主动脉或髂动脉的左外侧缘; B（仰卧）或B'（右侧卧）位于腰大肌的前内侧缘。记录每个水平的AB和A′B′（分别记录为A-Ps和A-Pr）的距离并相互比较。结果L1/2、L2/3、L3/4的A-Pr值均小于A-Ps值，且A-Pr值小于A-Ps值，A-Ps值与L1/2、L2/3、L3/4的相对腰大肌横截面积（PCSA（P < 0.05）; A-Pr在各水平间无显著性差异（p= 0.105），但L1/2似乎大于L3/4，其次是L2/3和L4/5;各水平的A-Pr不受性别的影响（Allp> 0.05）; L1/2和L3/4的A-Pr、BMI与PCSA呈直线相关。从仰卧位到右侧卧位，L2/3和L3/4将显著降低，原因可能是由于腰大肌松弛变形。使用仰卧位MRI图像进行术前ROC评估是不准确的。当在ROC最小的L4/5进行OLIF时，脊柱外科医生也应该更加谨慎。来自亚洲的患者和L1/2和L3/4腰大肌较强的患者也与相对窄的ROC相关。
PurposeTo determine if the retroperitoneal oblique corridor will be affected by right lateral decubitus position.MethodsForty volunteers were randomly enrolled and MRI scan was performed from L1 to L5 in supine and right lateral decubitus positions, respectively. In images across the center of each disc, O was defined as the center of a disc and A (supine) or A′ (right lateral decubitus) was located in left lateral border of the aorta or the iliac artery; B (supine) or B′ (right lateral decubitus) was on the anterior medial border of the psoas. The distance of AB and A′B′ (Recorded as A-Ps and A-Pr, respectively) at each level was recorded and compared to each other. The relationships between A-Pr, sex, BMI and relative psoas cross-sectional area (PCSA) at each level were also evaluated.ResultsA-Pr was significantly smaller than A-Ps at L1/2, L2/3 and L3/4 (Allp< 0.05); there was no significantly difference of A-Pr between all levels (p= 0.105), but L1/2 seemed to be larger than L3/4, followed by L2/3 and L4/5; A-Pr at each level was not affected by sex (Allp> 0.05); linear relationships were found between A-Pr, BMI and PCSA at L1/2 and L3/4.ConclusionsROC at L1/2, L2/3 and L3/4 will significantly decrease from supine to right lateral decubitus position and the reason may be due to the relaxed psoas deformation. Using MRI images in supine position for pre-operatively ROC evaluation is not accurate. Spine surgeon should also be more cautious when OLIF is performed at L4/5 where ROC is the smallest. Patients from Asia and those with strong psoas major at L1/2 and L3/4 are also associated with relatively narrow ROC.