자기공명영상을 이용한 한국 성인의 엉치뼈틈새와 척수원뿔 사이거리 연구
Morphometric Analysis of Distances between Sacral Hiatus and Conus Medullaris Using Magnetic Resonance Image in Korean Adult
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초록
이 연구에서는 경막바깥신경성형술 시행에 있어서 중요한 엉치뼈틈새에서 경막주머니종말부 및 척수원뿔사이의 거리를 자기공명영상에서 계측하여 한국인의 생체 연구에 대한 기초 자료를 제공하고자 한다. 허리통증으로자기공명영상을 촬영한 환자 중 척추압박골절이나 척추전방전위증 그리고 기형 등이 없는 환자 200명 (남자 88명, 여자 112명)을 대상으로 하였으며, 평균 연령은 54.3세 (20~84세), 평균 신장은 161.3 cm (135~187 cm)이었다. T2강조자기공명영상을 이용하여 엉치뼈틈새에서 경막주머니종말부 그리고 척수원뿔 사이 거리를 계측하여 성별 및 신장에 따른 상관관계를 분석하였다. 엉치뼈틈새꼭지에서 경막주머니종말부까지 거리는 62.8±9.4 mm, 엉치뼈틈새꼭지에서 척수원뿔까지 거리는 232.2±21.8 mm, 엉치뼈틈새꼭지에서 경막주머니종말부 사이 최소 거리는 34.8 mm, 최대거리는 93.9 mm, 엉치뼈틈새꼭지에서 척수원뿔 사이 최소 거리는 155.0 mm, 최대 거리는 284.0 mm이었다. 엉치뼈틈새꼭지에서 경막주머니종말부까지, 그리고 엉치뼈틈새꼭지에서 척수원뿔까지 거리는 모두 여성이 남성보다 짧게 나타났고 (p<0.05), 엉치뼈틈새꼭지에서 경막 종말부 및 척수원뿔 사이 거리는 신장에 대해 유의한 상관관계를 보였다(p<0.01). 이 연구의 결과는 한국 성인의 엉치뼈틈새에서 경막주머니종말부 및 척수원뿔 사이 거리에 대한 생체 계측 자료를 제공하며, 경막바깥공간에 대한 임상적 시술의 안전성 확보와 한국인의 체형에 맞는 카테터 개발에 도움이 될 것이라 생각한다.
Abstract
The purpose of this study was to provide basic biometric data on Korean adults through magnetic resonance imaging (MRI)-based measurements of the distances between the apex of sacral hiatus (SH) and the termination of dural sac (DS), and between SH and conus medullaris (CM) because they are critical to the performance of epidural neuroplasty. A total of 200 patients (88 males and 112 females) with back pain, who had no spine fracture, significant spinal deformity, and spondyloisthesis were selected for this study. The subjects were of mean age 54.3 (20~84) years and mean height 161.3 cm (135~187). T2-weighted MRI images were used for correlation analysis to evaluate the relationships between the distances, and variables such as sex and height. In all patients, the mean distance between SH and DS was 62.8±9.4 mm and the mean distance between SH and CM was 232.2±21.8 mm. The minimum distance and the maximum distance between SH and DS were 34.8 mm and 93.9 mm respectively, and the minimum distance and the maximum distance between SH and CM were 155.0 mm and 284.0 mm respectively. In female patients, both the distances between the SH and DS, and between SH and CM were shorter when compared to those of the male patients (p<0.05). Both the distances between SH and DS and between SH and CM showed a significant correlation with height (p<0.01). The results of this study will provide a useful biometric data on the distances between SH and DS and between SH and CM in Korean in ensuring clinical safety and in the development of more effective catheterization techniques for epidural neuroplasty in Korean.
참고문헌 (24)
- Racz G, "Percutaneous lysis of epidural adhesions: evidence for safety and efficacy", Pain Pract, 8, pp.277~286 (2008)
- Hsu E, "Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome", Anesth Analg, 118, pp.215~224 (2014)
- Erdine S, "Precautions during epidural neuroplasty", Pain Pract, 2, pp.308~314 (2002)
- Ho KY, "Acute monoplegia after lysis of epidural adhesions: A case Report", Pain Pract, 8, pp.404~407 (2008)
- Bogduk N, "The sacrum. Clinical anatomy of the lumbar spine and sacrum", pp.59~61 (2005), Elsevier Churchill Livingstone
- Senoglu N, "Landmarks of the sacral hiatus for caudal epidural block: an anatomical study", Br J Anaesth, 95, pp.692~695 (2005)
- Sekiguchi M, "An anatomic study of the sacral hiatus: a basis for successful caudal epidural block", Clin J Pain, 20, pp.51~54 (2004)
- Demiryürek D, "MR imaging determination of the normal level of conus medullaris", Clin Imaging, 26, pp.375~377 (2002)
- Louis R., "Topographic relationship of the vertebral column, spinal-cord, and nerve roots", Anat Clin, 1, pp.3~12 (1978)
- 권순욱, "The Tip Level of the Conus Medullaris by Magnetic Resonance Imaging and Cadaver Studies in Korean Adults", 대한체질인류학회지, 29(2), pp.47~51 (2016), 대한체질인류학회
- Macdonald A, "Level of termination of the spinal cord and the dural sac: a magnetic resonance study", Clin Anat, 12, pp.149~152 (1999)
- Becker SH, "Cost benefits of picture archiving and communication system", J Am Med Assoc, 1, pp.361~371 (1994)
- Deyo RA, "Herniated lumbar intervertebral disk", Ann Intern Med, 112, pp.598~603 (1990)
- Shin SW, "Low back pain: Review of anatomy and pathophysiology", J Korean Med Assoc, 49, pp.656~664 (2006)
- Suk SI, "Lumbar disc disease", pp.218~220 (2004), Newest Medical Journal
- Modic MT, "Magnetic rresonance imaging of intervertebral disk disease: Clinical and pulse sequence considerations", Radiology, 152, pp.103~111 (1984)
- Barson AJ, "The vertebral level of termination of spinal cord during normal and abnormal development", J Anat, 106, pp.489~497 (1970)
- Kim DC, "Anatomical studies on the vertebral column and spinal cord of korean subjects: Part Ⅱ. Study on the adult", Seoul J Med, 2, pp.149~163 (1961)
- Joo SP, "The variation of position of the conus medullaris in korean adults: A magnetic resonance imaging study", J Korean Neurosurg Soc, 30, pp.451~455 (2001)
- Park SJ, "Normal variation of lumbosacral thecal sac on MR", J Korean Radiol Soc, 34, pp.565~569 (1996)
- Ko HY, "Normal variations of the spinal cord termination", J Korean Acad Rehabil Med, 22, pp.1040~1043 (1998)
- Ko HY, "Variations of end level of the dural sac", J Korean Acad Rehabil Med, 23, pp.805~808 (1999)
- A. Y. Nasr, "Vertebral level and measurements of conus medullaris and dural sac termination with special reference to the apex of the sacral hiatus: anatomical and magnetic resonance imaging radiologic study", Folia Morphologica, 75(3), pp.287~299 (2016), VM Media SP. zo.o VM Group SK[DOI]
- Mustafa MS, "Morphometric study of sacral hiatus in adult human Egyptian sacra: Their significance in caudal epidural anesthesia", Saudi J Anaesth, 6, pp.350~357 (2012)