腰椎关节突关节毗邻动脉的解剖及数字减影造影的观察  

Observation of lumbar zygapophyseal joints adjacent arterials by anatomy and DSA

作　　者：程艳[1] 孙兆忠[1] 李瑞[2] 房清敏[2] 王光林[2] 任佳彬[2] 

机构地区：[1]滨州市人民医院神经内科,山东省滨州市256610 [2]滨州医学院附属医院脊柱外科

出　　处：《中华医学杂志》2015年第27期2198-2201,共4页National Medical Journal of China

基　　金：滨州市科技发展计划项目（2011ZC0920）

摘　　要：目的对腰椎关节突关节（ZJ）及其毗邻血管进行解剖学及数字减影造影技术（DSA）观测，为腰椎后侧、后外侧手术入路提供解剖学依据。方法选取20具成人尸体腰段标本，显露腰椎侧方及横突前方动脉，解剖显微镜下观测自腰椎（L）1／2-4／5的椎间孔出口区起1～4腰动脉（LA）所发出的横突前支、背侧支，获得数据行统计学分析。选取20例无腰椎疾病者作为对照，应用DSA行血管造影检查，研究活体中腰动脉、其他来源动脉的起始、变异、分支走行。结果解剖学及DSA研究显示L1A—L4A背侧支自椎间孔出口区前上方，由前向外侧、背侧走行，发出横突前支并在跨越椎体峡部中、上1／3外侧缘后沿其表面分为升、降两肌支。升肌支走行至上位ZJ背侧内下缘，发出覆盖ZJ背侧面的关节突支和进入竖脊肌的升、降支；降肌支走行至下位ZJ腹侧外上缘，发出3—5支末梢动脉并继续走行分出肌支进入前方肌肉筋膜组织。两侧观察数据差异无统计学意义。结论ZJ毗邻动脉的走行、分布有一定规律性，掌握其解剖学特点，可有效减少后路手术出血、便于术中操作，降低重要组织损伤，避免术后血肿等并发症。Objective To investigate the arterials adjacent to the lumbar zygapophyseal joints by anatomy and DSA and aimed to provide a safe operation way for the lumbar back and posterolateral surgery by reducing operative hemorrhage in clinical treatment. Methods We selected 20 adult corpse lumbar departments and discovered the lumbar lateral artery and lumbar transverse process artery. Using anatomical microscope to observe the lumber transverse process artery and dosal artery of 1-4 lumber arteries from the lumbar spine 1/2-4/5. We also selected 20 patients without lumbar disease and used DSA to research their lumbar arteries and the starting, mutation or branch line of other artery sources in vivo. Results The anatomy and DSA results showed that the original location of dorsal branch usually at the anterosuperior of L1/2-4/5 foramen intervertebrale outlet area, then distributed to the outside and backside of ZJ. Anterior branch of transverse process sent out and branch into ascending and descending muscle branch. The ascending branch distributed to the below root of upper ZJ and sent out zygapophyseal branches which were distributing to the back of ZJ. The descending branch distributed to the upper root of below ZJ and sent out several muscle branches which were going into muscles in the front. And there were no statistically significant difference between left and right in the body. Conclusions The routes of arteries adjacent to ZJ and the relationship between them showed obvious regularity. Mastering its anatomical characteristics could effectively reduce the posterior surgical bleeding, make the operation easier, reduce the important tissue damage and then avoided the postoperative hematoma complications.

关 键 词：腰椎 椎关节突关节 动脉 数字减影造影技术 

分 类 号：R322.7[医药卫生—人体解剖和组织胚胎学] R816.8[医药卫生—基础医学]