国人脊神经系统的磁共振神经显像与测量分析研究

Lack of spinal anatomy knowledge is an important factor affecting the spinal nerve iatrogenic injury in clinical operations of spine surgery. Previous studies on the spinal nerves mostly adopted cadavers and directly measured and analyzed. We found that there were many deficiencies in spinal anatomical research and measurement by cadavers, based on our previous projects (81071438) spine anatomy studies. Our research group's preliminary study results have demonstrated that Magnetic resonance neurography(MRN) might be an ideal choice for imaging and measurement of spinal nerves. The study intends to adopt the MRN imaging and traditional anatomy operation to measure the spinal nerve structure parameters in 30 fresh cadavers, and to demonstrate the feasibility and accuracy of MRN technology by comparing the measurement results. And according to height, gender and other factors, further select 180 Han people healthy adult volunteers and have the MRN spinal nerve imaging. Measure the inherent anatomical parameters, the parameters of adjacent structures of the spinal nerves by the MRN technology, and further study the anatomical variations of spinal nerves. From an anatomical perspective, to analyze systematically the common causes of iatrogenic spinal nerve damage, to provide a scientific basis for the selection of spinal surgical program and intraoperative management in clinical practices, which will significantly reduce the incidence of iatrogenic injury of the spinal nerves.

脊柱外科临床操作中脊神经解剖学知识不足是脊神经医源性损伤的重要影响因素。以往关于国人脊柱神经结构研究多以尸体标本直接进行测量分析，我们在前期项目（81071438）脊柱解剖学系统分析的基础上发现，以尸体标本进行脊神经解剖学研究与测量存在诸多不足。我们的研究表明磁共振神经成像技术（MRN）有望成为脊神经形态成像与解剖测量的理想工具。因此，本研究拟选取30 具新鲜尸体标本分别采用MRN 成像与传统解剖操作对脊神经进行测量比较，从而验证MRN 技术对脊神经解剖学研究的准确性；进而根据身高、性别等因素选取180名汉族健康成人志愿者进行MRN 脊神经显像，对脊神经固有解剖参数和其毗邻结构的解剖学参数进行测量，综合分析脊神经解剖变异状况。从解剖学视角对常见医源性脊神经损伤的原因进行系统分析，为规范性的脊柱临床手术方案的选择制定和术中操作规范提供科学依据，它将大幅降低脊神经医源性损伤的发生。

项目背景：脊柱外科临床操作中神经形态学及功能学认知不足是医源性损伤的重要因素。磁共振神经成像技术（MRN）和弥散张量成像技术（DTI）有望成为无创的神经形态学及功能学成像与测量的理想工具，可提供神经解剖学变异状况、自身及毗邻结构解剖学特征以及神经功能障碍的精准定位信息。.研究内容：.（1）通过腰椎MRN测量国人腰骶神经根及毗邻结构解剖参数，分析经椎间孔腰椎体间融合术（TLIF）的安全性。.（2）通过腰椎MRN测量国人后路椎间融合操作空间的横向参数，分析椎间融合器的置入横向空间及宽度选择的依据。.（3）通过腰椎传统影像学及DTI成像与测量，分析腰椎局部解剖学参数与FA值的关系，探讨腰椎管狭窄症患者神经根卡压的解剖学危险因素。.（4）通过平山病颈脊髓及神经MRN和DTI测量，从形态学及功能学角度探讨平山病发病机制、责任节段定位和脊髓功能的定量评估。.重要结果：.（1）国人L1～L5神经根与上位椎弓根间距、神经根与矢状面夹角呈逐渐变小趋势。神经根与下位椎弓根间距男、女分别为（8.99±0.88）mm~（10.72±1.01）mm和（7.76±0.46）mm~（8.54±0.65）mm，大部分国人各节段均<10 mm。.（2）国人腰椎椎间隙上缘出口神经根至硬膜囊外侧缘的距离男、女分别为（7.78±1.06）mm~（12.34±1.95）mm、（7.22±0.94）mm ~（11.27±1.77）mm；椎间隙下缘出口神经根至硬膜囊外侧缘的距离分别为（13.14±1.07）mm~（17.48±2.03）mm、（12.56±1.12）mm ~（16.25±1.89）mm。.（3）腰椎硬膜囊面积大小和腰椎矢状面屈伸活动度与腰椎管狭窄症伴单侧L5神经根受压患者神经根DTI参数FA相关（R2= 0.268和0.828；P<0.05）。.（4）平山病和健康者MRN下颈椎平均颈神经根长度有显著差异；屈颈导致平山病患者DTI参数异常；平山病DTI参数显著异于健康者（FA: 0.399±0.087 vs. 0.547±0.093, P<0.05; ADC: 2.115±0.438 vs. 1.414±0.241, P<0.05）。.科学意义：术前行MRN及DTI测量分析可为规范临床脊柱外科手术方案和术中操作提供科学依据。