经皮前路腰骶轴向融合的骶前影像学及解剖学研究  

Radiographic properties and applied anatomy of presacral space in percutaneous axial lumbosacral interbody fusion

作　　者：靳松[1] 彭建强[1] 徐宏光[2] 刘平[2] 陈学武[2] 李怀斌[3] 

机构地区：[1]广东医学院附属福田医院骨外科,深圳518033 [2]皖南医学院附属弋矶山医院脊柱外科,安徽芜湖241001 [3]皖南医学院解剖学教研室,安徽芜湖241002

出　　处：《皖南医学院学报》2012年第4期294-297,共4页Journal of Wannan Medical College

基　　金：深圳市科技计划项目(201102080)

摘　　要：目的:研究测量国人成人骶前区域相关的影像学和解剖学数据,为安全精确应用经皮前路腰骶轴向融合(Ax-iaLIF)技术提供依据。方法:①回顾分析68例腰痛患者影像学资料,分别采用CT增强扫描测量双侧髂血管到S1,2间隙中点的距离;腰骶MRI正中矢状位片上测量各骶椎间隙和各椎体中点到直肠系膜的最短距离。②解剖成人尸体标本25具,测量髂内外血管、骶正中动静脉到S1,2间隙水平中点的距离及S1前孔内缘间的距离,并观察骶前静脉丛血管和神经,确定手术冠状位的"安全操作空间"。结果:影像学显示CT上距离S1,2间隙中点最近的血管均为两侧髂内静脉,双侧髂内静脉距离男性和女性分别为(57.7士4.9)mm和(70.10±9.0)mm(P<0.05);在MRI上测量,男性骶骨前缘到直肠系膜最短距离的中位数为10(3～23)mm,女性为6(3～18)mm,男性与女性比较有显著性差异(P<0.01)。解剖学数据显示:"安全操作空间"大小男性(57.60±5.11)mm、女性(70.01±8.99)mm。S1前孔内缘距离男性(34.95±3.50)mm;女性(31.98±2.99)mm。骶正中动脉无变异;骶正中静脉壁薄,变异较大,存在率为48%。结论:"安全操作空间"的影像数据与解剖数据接近,研究结果可作为国人器械和融合器的开发参考依据。在透视引导下尽可能沿骶骨正中线操作,可保证AxiaLIF技术的安全性。Objective：To examine the radiologic and neurovascular anatomic data of the presacral area in Chinese population for safe procedure in percutaneous axial lumbosacral interbody fusion（AxiaLIF）.Methods：①Radiographic data were reviewed in 68 outpatients with low back pain undergone enhanced CT scanning.Measurements included bilateral iliac vessels to the S1,2,the midpoint of the 2 clearance distance as well as lumbosacral MRI midsagittal chip measurement of the lumbosacral intervertebral space and each vertebral body point by the minimum distance of mesorectum.②Anatomical aspects：25 adult cadaveric specimens were included by measurement of internal / external iliac vessels,median sacral vein to S1,2 spaces at the midpoint of the distance and S1 distance between inner margin,and the observation of the presacral venous plexus vascular and nerve to determine coronal ＂safe zone＂ for operation.Results：CT images displayed the minimum distance of S1,2 space midline by the closest vessels with bilateral internal iliac vein.The reach within the bilateral internal iliac veins was（57.7±4.9）mm for men and（70.10±9.0） mm for women（P〈0.05）.MRI measurement exhibited the minimum distance between mesorectum and individual sacral anterior boder margin with median measurement of 10（3-23）mm in males and 6（3-18）mm in females（P〈0.01）.Anatomical data revealed the ＂safe zone＂ for operation by（57.60±5.11） mm in men and（70.01±8.99） mm in women,respectively.The distance between inner margin of bilateral anterior sacral foramina at the level of S1 was（34.95 ± 3.50） mm for malesand（31.98 ± 2.99） mm for females.No difference was seen in the median sacral artery,whereas the median sacral veins varied a lot with thinner wall and existence rate of 48%.Conclusion：The measurement data for ＂safe zone＂ operation are in relative match in radiographic findings with anatomic measurement,which can be served as reference parameter for development of instrumentation and fusion devi

关 键 词：经皮前路腰骶轴向融合术 解剖学 影像 骶前间隙 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]