成人腰椎终板冠状面后缘解剖形态学分析及其临床意义

目的　观测正常成人腰椎终板冠状面后缘的CT解剖学特征，为临床椎间融合器设计及腰椎间盘置换术等手术提供解剖学依据。 方法　将62套成人腰椎L1~5上、下缘终板冠状面后缘形态进行解剖学分型，分为3型：I型，凹形；Ⅱ型，平型；Ⅲ型，凸型，测量（1）上、下终板左侧椎弓根与终板连接的中点分别到终板中线的垂线距离（LLU，LLL）；（2）上、下终板右侧椎弓根与终板连接的中点分别到终板中线的垂线距离（LRU，LRL）；（3）上、下终板冠状面后缘中点分别到终板中线之间的垂线距离（LMU，LML）。 结果　L1~4上、下终板形态以凹型为主，L1上终板凹型占93.75%，下终板占80%；L2上终板凹型占77.27%，下终板占68.18%；L3上终板凹型占58.33%，下终板占54.17%；L4上终板凹型占66.67%，下终板占55.56%。L5上终板则以凹型和凸型为主要类型，分别为35.48%、35.48%；下终板则以凸型为主要类型，占61.29%。在L2上终板，LLU、LRU、LMU存在性别间的差异，有统计学意义（P<0.05）；在L3下终板，LLL、LRL存在性别间的差异，有统计学意义（P<0.05）。 结论　L1~4上、下终板的主要类型为凹型，而L5上、下终板较为特殊，上终板主要为凹型和凸型，下终板多为凸型。本研究对腰椎上、下终板形态分型及测量可作为人工腰椎间盘终板的设计及改进的参考依据。

A morphological classification of adult lumbar vertebral endplates at coronal plane

Objective To explore anatomic features of adult lumber vertebral endplantes under CT imaging,and provide anatomical evidence for the design of intervertebral fusion and the complications of disc arthroplasty surgery.Methods The CT data of 62 non-spinal disorders patients with 310 lumbar vertebrae from L1 to L5 were measured at the upper endplates and lower endplates separately.The posterior endplates of lumbar vertebral at coronal plane were classified into 3 types:typeⅠconcave;typeⅡflat;typeⅢconvex.The following data were measured:(1)Vertical distances from middle line of the endplate to left pedicle of the upper and lower endplates,to midpoint of the connecting endplate(LLU,LLL);(2)Vertical distances from middle line of the endplate to right pedicle of the upper and lower endplates,to midpoint the connecting endplate(LRu,LRL)(3)Vertical distances from middle line of the endplate to the midpoint of the of the posterior upper and lower endplates at coronal plane(LMu,LML).Results TypeⅠendplates had the highest proportion from L1~4 at the upper and lower endplates.At L1,L2,L3,L4,typeⅠendplate accounted for 93.75%,77.27%,58.33%,66.67%of upper endplate respectively,and 80%,68.18%,54.17%,55.56%of lower endplate respectively.TypeⅠand typeⅢwere the main types of upper endplate at L5,accounting for 35.48%,35.48%.TypeⅢwas the main type of lower endplate at L5,accounting for 61.29%.Sex difference of LLU、LRU、LMU of the upper endplates at L2 was statistically significant(P<0.05).Sex difference of LLL、LRL of the lower endplates at L3 was all statistically significant(P<0.05).Conclusions The mainly types of upper and lower endplates at L1~4 are typeⅠ,while the types of upper endplate at L5 are typeⅠand typeⅡ,the type of lower endplate at L5 is TypeⅢ.The research on morphological classification and measurement of upper and lower endplates of lumbar vertebral will be beneficial to the improvement of future design of the artificial lumbar disc prosthesis.