斜向腰椎椎间融合术手术窗的影像解剖学研究  

Research of anatomical imaging on operative window related to L_1-L_2 oblique lumbar interbody fusion

作　　者：刘列华 王杰 梁勇[3] 赵斌 赵晨[4] 吕应文 任周奎 兰阳军[5] 周强[4] 

机构地区：[1]重庆市第十三人民医院骨科,重庆400053 [2]重庆市万州区中西医结合医院骨科,重庆404000 [3]第三军医大学西南医院放射科,重庆400038 [4]第三军医大学西南医院骨科全军矫形外科中心,重庆400038 [5]第三军医大学卫勤训练基地医学综合教研室,重庆400038

出　　处：《局解手术学杂志》2016年第2期90-93,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫生和计划生育委员会面上项目(2015MSXM083)

摘　　要：目的观测L1L2斜向腰椎椎间融合术（OLIF）手术窗的应用解剖,为OLIF手术提供应用解剖学评估依据。方法 60例成年人行腹部血管成像检查及T12S1CT三维重建。观测L1L2 OLIF手术窗：血管窗、裸露窗、腰大肌肌窗、理想手术窗及实际手术窗;计算各手术窗占理想手术窗的百分比,实际手术窗按大于和小于1 cm进行统计;观察左侧肾动脉、肾静脉在L1L2 OLIF裸露窗前方的走行。结果实际手术窗有2例（3.3%）小于1 cm;其余58例（96.7%）实际手术窗均大于1 cm,且男性大于女性,差异有统计学意义（P=0.008）。血管窗、裸露窗、腰大肌肌窗分别占理想手术窗的45%、43%、12%,实际手术窗占理想手术窗的55%。左侧肾动脉、肾静脉多走行于L1中1/3至L2上1/3区域。在裸露窗前方,左侧肾动脉位于肾静脉后方走行31例（占51.7%）。结论 L1L2 OLIF手术窗的局部解剖有其特殊性,并不是所有L1L2节段都适合OLIF手术。左侧肾血管多走行于L1L2前方,OLIF术前应通过影像学检查进行解剖学评估。Objective To Observe the applied anatomy of operative window related to L1-L2 oblique lumbar interbody fusion（ OLIF）,and provide applied anatomical evidence for OLIF surgery. Methods The imaging data of 60 adults who underwent abdominal computed tomography angiography（ CTA） and T12-S1 vertebral computed tomography three-dimensional reconstruction were selected. The operative windows of L1-L2 OLIF were observed： the vascular window,bare window,psoas major window,ideal operative window and actual operative window. The operative windows’ percentage accounted for ideal operative window were calculated,the actual operative window based on an actual operative window of 〈 1 cm,≥1 cm were statistically analyzed,and the positions of the left renal artery and renal vein in front of operative window of L1-L2 OLIF were observed. Results The actual operative window was 〈 1 cm in 2 cases（ 3. 3%） and ≥1 cm in 58 cases（ 96. 7%）. In 58 cases,the difference was significant（ P = 0. 008） in gender and men were more than women. The vascular window,bare window and psoas major window accounted for the ideal operative window by 45%,43% and 12%,respectively,and the actual operative window accounted for the ideal operative window by 55%. The left renal artery and renal vein’s walking planes were at between the middle 1 /3 of L1 to up 1 /3 of L2. There were 31 cases（ 51. 7%） of the left renal artery being behind the left renal vein. Conclusion The regional anatomy of the operative window of L1-L2 OLIF has its own peculiarities,and not all L1-L2 levels are suitable for OLIF. The left renal vessels’ walking planes were in front of L1-L2. Before L1-L2 OLIF surgery,surgeons should analyze the imaging anatomimy through imaging.

关 键 词：斜向腰椎椎间融合术 血管成像 影像解剖 手术窗 

分 类 号：R681.5[医药卫生—骨科学]