脊柱胸腰段侧面的应用解剖学观测  

Applied anatomy of the lateral side of the thoracolumbar spine

作　　者：周兵[1] 刘金伟[1] 詹俊锋[1] 董玉科[1] 吴涛[1] 田喜光[1] 丁自海[1] 

机构地区：[1]南方医科大学微创外科解剖学研究所,广州510515

出　　处：《中国临床解剖学杂志》2009年第1期28-31,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的:为胸腔镜辅助下脊柱胸腰段前路椎间融合术提供解剖学基础。方法:观测22具(44侧)经防腐处理的成人尸体标本脊柱胸腰段侧面血管神经的走行、分布及毗邻关系。结果:在脊柱胸腰段侧面,上下位节段血管、交感干与内脏大神经或腰丛之间构成了一个相对无血管神经的"安全区",椎间隙恰好位于该"安全区"内。在T10/11、T11/12椎间隙,"安全区"的面积双侧存在显著性差异(P<0.05),左侧分别为17.54mm×17.53mm、20.50mm×14.56mm,右侧分别为17.54mm×27.85mm、20.50mm×21.47mm;在T12/L1、L1/2、L2/3椎间隙,同节段"安全区"的面积双侧无显著性差异(P>0.05),同侧面积向下逐渐增大,依次为24.56mm×19.95mm、27.37mm×25.31mm、28.28mm×27.51mm。结论:在脊柱胸腰段侧面,椎间隙位于一个相对无血管神经的"安全区"内,该区可为胸腔镜下前路椎间融合术提供足够的操作空间,并以椎间盘为参考标志,可减少对血管神经的损伤,减少手术并发症。Objective： To provide anatomical basis for anterior approach of thoracolumbar interbody fusion assisted by thoracoscope. Methods： 22 adult human cadaveric specimens （44 sides） were observed to record the course, distribution and relations of vessels and nerves on the lateral side of thoracolumbar spine. Results： On the lateral side of the thoracolumbar spine, there was a ＂safe region＂ without any important vessels and nerves, which were constituted by segmental vessels, sympathetic .trunk, greater splanchnic nerve or lumbar plexus. Intervertebral space located in this ＂safe region＂. At T10/11 and T11/12 intervertebral spaces, the area of ＂safe region＂ between the two sides showed significant difference （P〈0.05）. On the left side, the area of each ＂safe region＂ was about 17.54 mm×17.53 mm and 20.50 mm×14.56 mm; on the right side, about 17.54mm×27.85mm and 20.50 mm×21.47 mm respectively. However, at T12/L1, L1/2and L2/3 intervertebral spaces, there was no significant difference of the area between two sides （P〉0.05）. The areas of ＂safe region＂ at the same side increased gradually downward, which were 24.56 mm×19.95 mm, 27.37 mm×25.31 mm, and 28.28 mm×27.51 mm respectively. Conclusions： On the lateral side of the thoracolumbar spine, intervertebral space locates in the ＂safe region＂ without any important vessels and nerves. During anterior approach for thoracolumbar interbody fusion assisted by thoracoscope, the ＂safe region＂ could supply a sufficient operating space. Intervertebral disc could be considered as an anatomical landmark to help to reduce the incidence of operative complications, such as injuries of vessel and nerve.

关 键 词：胸腔镜 胸腰段 节段血管 应用解剖 

分 类 号：R322.12[医药卫生—人体解剖和组织胚胎学] R322.85[医药卫生—基础医学]