下腰椎前方三维CT血管造影重建及其意义  

3D-CT angiography of anterior vessels and their circumferential structure at lower lumbar vertebraes

作　　者：康忠山[1] 王文军[1] 曹琼钦[2] 朱一平[1] 晏怡果[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,421001 [2]南华大学附属第二医院放射科,湖南省衡阳市421001

出　　处：《中国脊柱脊髓杂志》2009年第7期540-544,共5页Chinese Journal of Spine and Spinal Cord

基　　金：湖南省自然科学基金资助项目(编号:07JJ3032)

摘　　要：目的:观察下腰椎前方血管走行特点,为下腰椎前路椎间融合术,特别是腹腔镜下微创手术提供解剖学依据。方法:对60例(男女各30例)患下腰椎疾病需行前路手术治疗的患者行下腰椎三维CT血管造影(3D-CTA),观察下腰椎前方血管在椎体前的走行,测量与腰椎前方血管位置相关的解剖学参数。结果:三维CT重建图像发现腹主动脉分叉点变异较多,髂总静脉汇合点相对恒定;腹主动脉分叉点到L5椎体下缘的距离男性平均39.1mm,女性平均37.4mm;髂总静脉汇合点到L5椎体下缘的距离男性平均27.1mm,女性平均25.9mm;L5/S1椎间隙手术窗大小男性平均36.7mm,女性平均34.6mm;腹主动脉分叉角男性平均56.3°,女性平均58.9°;髂总静脉汇合角男性平均63.1°,女性平均65.7°;右髂总动脉与左髂总静脉夹角男性平均53.6°,女性平均57.3°。结论:下腰椎前方血管解剖位置具有多变性,以腹主动脉分叉点为甚,术前行腰椎3D-CTA检查能明确血管解剖,为手术尤其是腹腔镜下微创手术提供安全保障。Objective：To morphologize the vascular configuration anteriorly to lower lumbar vertebraes and their circumferential structure,and to provide the anatomic data for anterior lumbar spine inter-body fusion especially for minimal invasive surgery under laparoscopy.Method：60 cases（30 cases for each sex） neccessitating ALIF underwent three dimensional computed tomographic angiography（3D-CTA） anteriorly to lower lumbar vertebraes,tbe orientation and distribution of vessels anteriorly to lower lumbar vertebraes were depicted and the anatomic parameters with respect to vessels and their circumferential were recorded either.Result：The bifurcation level of the ventral aorta varied significantly under 3D-CTA imaging while the confluence level of the common iliac vein was constant.The distance from the bifurcation of ventral aorta to the top of LS/S1 disc averaged 39.1mm in male and 37.4mm in female.The distance from the confluence of common iliac vein to the top of L5/SI disc averaged 27.1mm in male and 25.9mm in female.The width of the operation window at L5/S1 disc averaged 36.7mm in male and 34.6mm in female.The bifurcation angle of the ventral aorta averaged 56.3° in male and 58.9° in female,the confluence angle averaged 63.1° in male and 65.7° in female, the included angle of right common iliac artery and left common iliac vein averaged 53.6° in male and 57.3° in female.Conclusion：The vessels anteriorly to lower lumbar vertebraes varied significantly,especially at the bifurcation level of the ventral aorta.Pre-operative routine 3D-CTA imaging can be used to identify the vascular anatomy and ensure the safety of surgical procedure especially in miniinvasive operation.

关 键 词：下腰椎 腹腔镜 腰椎间融合 三维CT血管造影 

分 类 号：R814.42[医药卫生—影像医学与核医学] R681.5[医药卫生—放射医学]