腰椎微创手术中腰椎节段动脉损伤的研究进展  

esearch progress on lumbar segmental arteries injury during mis-invasive lumbar spine surgery

作　　者：伍宇轩 包贝西[1] 闫辉[1] 唐家广 Wu Yuxuan;Bao Beixi;Yan Hui;Tang Jiaguang(Department of Orthopaedics,Beijing Tongren Hospital of Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科,北京100730

出　　处：《中华解剖与临床杂志》2022年第6期444-448,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨腰椎节段动脉的解剖及其在腰椎微创手术中的损伤的研究进展。方法以“腰椎节段动脉/lumbar segmental artery”“腹膜后血肿/retroperitoneal hematoma”“医源性损伤/introgenic injury”为关键词,检索中国知网、万方数据、维普数据库及PubMed等数据库1996年1月—2021年8月公开发表的相关文献153篇文献。剔除内容不符合、无法获取原文、重复性研究或存在设计缺陷的研究,最终纳入40篇文献,其中3篇中文、37篇英文。总结腰椎节段动脉的解剖特点,重点阐述腰椎节段动脉在前方及侧方融合手术、椎体成形术、椎间孔镜手术等腰椎微创手术中的损伤风险以及预防和处理策略。结果腰椎节段动脉常由4对成对的动脉(L_(1)~L_(4))及/或L5动脉构成,L5节段动脉来源的变异性较大,存在率较低。腰椎节段动脉损伤会造成出血、腹膜后血肿、脊髓缺血梗死等严重后果。术前应充分评估手术区域内节段动脉的解剖结构及走行,选择合适的术式,术中操作小心谨慎、密切观察病情,如不慎发生动脉损伤时,根据具体情况选择合适的处理对策。结论腰椎节段动脉损伤在微创手术中的发生率虽然较低,但一旦发生会造成严重的术后并发症,因而手术者要引起关注。为预防和减少术中腰椎节段动脉的损伤,了解和评估其解剖结构、选择合适的术式及处理策略至关重要。Objective To explore the anatomy of lumbar segmental arteries and its research progress in minimally invasive lumbar spine surgery.Methods"腰椎节段动脉/lumbar segmental artery""腹膜后血肿/retroperitoneal hematoma"and"医源性损伤/iatrogenic injury"were used as key words to identify articles about the anatomy of lumbar segmental arteries in CNKI,Wanfang,Weipu,and PubMed database from January 1996 to August 2021.We searched literatures related to the anatomy of lumbar segmental arteries,anterior lumbar interbody fusion,lateral lumbar interbody fusion,percutaneous vertebroplasty,and percutaneous endoscopic lumbar discectomy.A total of 153 literatures were searched,and 40 literatures were finally included after excluding the literatures that did not met the inclusion criteria.Among them,three were written in Chinese,and 37 were written in English.Then,we summarized the risks of lumbar segmental artery injuries in these minimally invasive lumbar spine surgeries and the coping strategies.Results Lumbar segmental arteries are often composed of four pairs of arteries(L_(1)–L_(4))and/or L5 artery.The source L5 segmental artery has more variabilities and has a lower presence rate.Injuries to the lumbar segmental arteries during iatrogenic procedure may cause serious consequences including bleeding,retroperitoneal hematoma,and spinal infarction.Conclusion During spinal surgery,injuries of lumbar segmental arteries are uncommon but can cause serious life-threatening consequences if they occur.As surgeons,having a detailed operation plan before surgery,understanding the anatomical position,carefully conducting the surgical procedures,observing the patients,and having contingency plans to control artery bleeding are very important.

关 键 词：腰椎节段动脉 腰椎椎间融合术 椎体成形术 腹膜后血肿 医源性损伤 

分 类 号：R687.3[医药卫生—骨科学]