脊柱腰骶段前路内固定术操作空间的解剖测量  

Anatomic study of the blood vessels in the anterior lumbosacral interbody fusion

作　　者：刘发平[1] 方丹[1] 周玉刚[1] 

机构地区：[1]解放军第188医院骨科,广东潮州521000

出　　处：《局解手术学杂志》2016年第5期373-376,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的通过观测腰骶段腹侧血管的解剖数据,确定手术操作空间,保障前路内固定术的可行性及安全性。方法随机选取32例成年人腹部血管CTA影像学资料,观察其腰骶椎腹侧血管的走行、交汇特点,测量交汇点至L5椎体下终板的距离、髂血管在L5椎体下终板的水平间距、L5/S1椎间盘横径,计算出手术操作空间的大小,并进行初步分型。结果腰骶椎腹侧手术操作空间主要由左髂总静脉与右髂总动脉构成(87.4%)。在本研究中,A型人群占87.4%,L5下终板位置血管间隙(3.8±1.1)cm,操作空间(5.2±1.2)cm2,L5/S1椎间盘显示比例73.2%;B型人群占6.3%,L5下终板位置血管间隙(4.2±0.5)cm,操作空间(7.1±0.2)cm2,L5/S1椎间盘显示比例81.0%;C型人群占6.3%,L5下终板位置血管间隙(1.0±0.7)cm,操作空间(1.3±0.7)cm2,L5/S1椎间盘显示比例31.2%。A、B、C型解剖参数比较,差异具有统计学意义(P<0.05)。结论普通人群中大多数腰骶椎腹侧具备足够手术操作空间,可进行前路内固定融合术,但是术前须进行影像学的筛查。Objective To observe the blood vessels distribution in iliac blood velles triangular area of the lumbosacral vertebrae and confirm the range of safety working area,so as to provide anatomic data for anterior lumbosacral interbody fusion. Methods CTA imaging data of abdominal vessels were randomly collected from 32 adult patients. Observed the distribution and intersection features of lumbosacral vertebral ventral blood vessels. Measured the distance from the bifurcation or confluence to the L5 dise,level interval of iliaca vessels in the inferior boundary of L5,and width of L5/ S1 intervertebral space. And then computed the range of safety working area and conducted a preliminary classification. Results The lumbosacral vertebral ventral operation space is mainly（87. 4%） composed of left iliac vein and right common iliac artery. In this study,patients of type A accounted for 87. 4%,vascular clearance of the L5 dise was（3. 8 ± 1. 1） cm,safety working area was（5. 2 ± 1. 2） cm2,and the display ratio of L5/ S1 was 73. 2%. Patients of type B accounted for 6. 3%,vascular clearance of the L5 disewas（4. 2 ± 0. 5） cm,safety working area was（7. 1 ± 0. 2） cm2,and the display ratio of L5/ S1 was 81. 0%. Patients of type C accounted for6. 3%,vascular clearance of the L5 dise was（1. 0 ± 0. 7） cm,safety working area was（1. 3 ± 0. 7） cm2,and the display ratio of L5/ S1was31. 2%. The differences of anatomical parameters among the three types were statistically significant（ P 0. 05）. Conclusion The study showed that most ordinary people have enough operation space in the lumbosacral vertebral ventral,which is suitable for anterior lumbosacral interbody fusion,but it is necessary to take preoperative imaging screening.

关 键 词：腰骶椎腹侧血管 解剖 前路内固定术 分型 

分 类 号：R681.5[医药卫生—骨科学] R322[医药卫生—外科学]