腹腔镜前路腰骶椎间盘融合术的解剖观察及形态学分型  

Anatomical and Morphological Research for Laparoscopic Anterior Lumbar Interbody Fusion

作　　者：刘金伟[1,2] 宋磊[3] 丁自海[1] 吴涛[1] 

机构地区：[1]南方医科大学微创外科解剖研究所广东省创伤救治中心,广州510515 [2]广东省创伤救治中心乐从临床基地佛山市顺德区乐从医院,佛山528315 [3]山东省潍坊市解放军89医院骨科,潍坊261000

出　　处：《中国微创外科杂志》2009年第1期50-53,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：广东省科技厅重大专项基金(2006A36001003)

摘　　要：目的为腹腔镜前路腰骶椎间盘融合术(laparoscopic anterior lumbar interbody fusion,LALIF)提供血管解剖依据,并评估腹腔镜前路融合术在此区的可行性。方法对36具动脉灌注红色乳胶的成人防腐固定标本进行血管解剖观察,并依据腰骶椎间盘在髂间三角内暴露的比例进行分型。结果主动脉叉(aortic bifurcation,AB)高度为(41.81±13.82)mm,髂总静脉汇合处(confluence of the common iliac veins,CCIV)高度为(20.22±14.20)mm;AB夹角为51.88°±12.09°,CCIV夹角为77.08°±20.98°;椎间盘上、下缘骶正中动脉(median sacral artery,MSA)的外径分别为(1.57±0.42)mm和(1.33±0.50)mm;椎间盘上、下缘右髂血管(right iliac vessel,RIV)到MSA的距离分别为(20.83±7.73)mm和(27.60±7.80)mm;椎间盘上、下缘水平暴露椎间盘的宽度为(36.78±13.06)mm,占椎间盘宽度的(72.29±25.64)%。标准型占61.1%(22/36),狭窄型占25.0%(9/36),阻挡型占13.9%(5/36)。CCIV高度与其夹角之间存在负相关关系,但尚不显著(r=-0.287,P=0.089)。MSA的出现率为100%。结论有86.1%的病人可以安全地从前方进入腰骶椎间盘区,且61.1%的病人不用处理髂间三角两侧的髂血管就可以进行操作。Objective To study the vascular anatomy for laparoscopic anterior lumbar interbody fusion （LALIF）, and to evaluate the feasibility of the surgical approach. Methods Vascular anatomy of 36 adult human bodies were studied by infusing red latex into the arteries. They were classified according to the percentage of the exposed lumbosacral disc in the interiliac triangle. Results The mean height of the aortic bifurcation （AB） was （41.81 ± 13.82） ram, arid the height of the confluence of the common iliac vein （CCIV） was （20.22 ±14.20） ram. The angles of the AB and CCIV were （51.88 ±12.09）and （77.08 ±20.98） respectively. The width of the median sacral artery （MSA） were （1.57 ± 0.42） mm and （1.33± 0.50） mm respectively at the top and bottom of the lumbosacral disc. While the distance from the right iliac vessel （RIV） to MSA at the top and bottom of the lumbosacral disc were （20.83 ± 7.73 ）mm and （27.60 ±7.80） mm. The average width of the exposed disc was （36.78 ±13.06） mm, which accounts for （72.29 ± 25.64） % of that of the disc. According to our morphological classification, 22 specimens （61. 1% ） belong to type Ⅰ（Standard type, being exposed by more than 65% ） , 9 （25.0%） type Ⅱ （ Narrow type, being exposed by 45% to 65% ）, and 5 （13.9%） type Ⅲ （Barrier type, being exposed by less than 45% ）. The height of CCIV was negatively, but not significantly, correlate to its angle （ r = - 0. 287, P = 0. 089）. Conclusions In 86.1% of our patients, anterior approach is a safe and effective way for laparoscopic interbody fusion. Moreover, in 61.1% of the patients, the procedure can be carried out without managing the iliae vessels arround the interiliac triangle.

关 键 词：腰骶椎间盘 腹腔镜 血管解剖 形态学分型 

分 类 号：R687.3[医药卫生—骨科学] R322[医药卫生—外科学]