應用“醫療影像儲存曁傳輸系統”PACS(Integrated Picture Archive & Communication System)影像測量功能在核磁共振造影測量需手術置放腰椎椎體護架椎體間大小

Application of PACS (Integrated Picture Archive & Communication System) to Measure Lumbar Disc Available Space to Install Lumbar Cage for pre-operation Planning

陳海波(Hoi-Bor Chan) ； 馬辛一(Hsin-I Ma) ； 劉敏英(Ming-Ying Liu) ； 張成富(Chen-Fu Chang)

《中華職業醫學雜誌》 12卷1期 (2005/01) Pp. 41-49

https://doi.org/10.30027/CJOM.200501.0006

摘要

近年來腰椎椎體間融合的人工代替品腰椎椎體護架(cage)。有高成功率保持上下兩節腰椎脊椎骨間的高度，維持神經孔寬度，少再發生椎間盤突出，良好的上下兩節腰椎脊椎骨融合率，這種技術蓬勃發展，快速地被廣泛的使用。但腰椎椎體護架cage之置放需較困難手術技術操作，手術中神經根牽扯刺激或傷害，脊髓硬膜撕破，腹腔主要血管或臟器傷害，併發症可引致大小便失禁，下身癱瘓，性功能障礙，嚴重可引致死亡。
手術前測量需手術腰椎椎體間大小，評估可置放空問，選譯適合椎體護架尺碼及廠牌設計，手術前評估可降低併發症及病人手術中潛在危險發生。傳統測量方法是使用，腰椎側面X光底片測量，但由於椎體是橢圓形柱狀椎體，橢圓曲線特性，椎體護架寬度越寬有效長度越小，因此腰椎側面X光底片無法提供寬度與長度之關係，而核磁共振造影或電腦斷層掃描，在腰椎軸切面影像則可提供腰椎椎體間寬度與長度之關係，由于數位化之便利性及功能強大，因此發展出『醫療影像儲存暨傳輸系統，很多醫院己把影像檢查數位化存入電腦系統中，再經由網路傳遞以供使用者於遠側電腦終端判讀影像，因強大影像操作功能，因此使用醫療影像儲存暨傳輸系統，核磁共振造影或電腦斷層掃描腰椎軸切面影像(axial view)來測量，比傳統腰椎側面X光底片測量獲得較準確寬度與有效深度關係，手術前測量需手術腰椎椎間盤大小，選擇適當之護架，若可置放空問不足，只施行單純椎間盤切除手術，減少不必要手術過程及椎體破壞，縮短手術時間，降低病人手術中潛在危險發生，降低腰椎椎體護架置放手術中醫原性傷害之發率及手術中醫師承受的精神壓力。

並列摘要

The posterior lumbar interbody fusion was developed to deal with disabling low back pain with or without sciatica as a result of abnormalities of the motion segment. Simple discectomy frequently relieves radicular leg pain, but patients may continue to suffer from low back pain following surgery. The mechanism of this pain is thought to be mechanical in nature and related to increased segmental morbility. Cages was developed for posterior lumbar interbody fusion. As any surgical procedure, Advantages are restoration of normal anatomical relationships between the motion segment and neural elements; Fusion results in deseased motion that halts further degeneration and minimizes mechanical nerve root traction; Eliminates possibility of recurrent disc herniation; Decompression of all neural elements; Optimal environment for bone healing. Disadvanages are technically demending procedure; Risk of neural, abdominal vessels and organs injury secondary to installation procedure of cage.
Hence, measure of lumbar disc space and planning installation of cage before surgery could decreased complication. Generally using lumbar lateral view plain X-ray film to measure the lumbar inter-vertebral body high, and AP (anterior and posterior) diameter. Due to vertebral body is in elliptic sharp and constructed elliptic column. lumbar lateral view X-ray plain film only provide vertebral body most large AP diameter, Actually the vertebral body more lateral the AP-diameter is more decrease. Lumbar axial view image can provide the wide and the AP diameter change relationship. Apply the measurement function of PACS (Integrated Picture Archive & Communication System) to measure the lumbar inter-vertebral body available space to install lumbar cage. It could provide more precise inter-vertebral body available space for pre-operation planning that could decrease operation of install lumbar cage complication, times and potential risk