腰椎侧面节段血管神经的应用解剖

The applied anatomic in vestigationof the lumbar segmental vessels and nerves

目的:为腹腔镜下腰椎融合术提供解剖学基础。方法:观测50侧成人尸体标本腰节段血管的走行及分布,测量相邻节段血管间距、交感干至椎间孔的垂直距离、椎体侧面中点处椎间盘上下缘至相邻节段血管的距离。结果:腰节段动、静脉较恒定地走行于椎体侧面中间浅沟内,大多数有交通支伴行。在椎间隙侧面,上、下位腰动、静脉、交感神经与腰丛之间构成了一个相对无血管神经的“安全区”,“安全区”最小面积为27.90mm×27.18mm。结论:(1)腰椎侧面的节段血管走行与分布较为恒定;(2)在腰椎间隙侧面存在相对无血管、神经的“安全区”;(3)腹腔镜下行腰椎融合术时,通过“安全区”植入融合器可减少对血管、神经的损伤。

Objective： To provide the anatomic data for lumbar interbody fusion with laparoscopy and improve the reliability of this operation. Methods： 50 sides of adult human cadavers were contributed to the investigation of the course and distribution of lumbar segmental vessels and sympathetic trunk on lateral face of the lumbar spine, the distance between adjacent segmental vessels, vertical dimension between sympathetic trunk and lumbar plexus nerve, the distance between superior or inferior border of intervertebral disc and adjacent segmental vessels. Results： On the lateral face of the lumbar vertebral body, the segmental arteries and veins accompaned with communicating branch presented constantly and run in the minor groove of the lumbar vertebral body. There was no statistic difference of measurement values as above between left and right sides （ P〉0.05 ）. There was a “safe region” in which no important vessel and nerve on the lateral face of each lumbar intervertebral space was existed. The minimum area of the “safe region” was about 27.90×27.18mm. Conclusions： Firstly,the course of lumbar segmental vessels are invariant at the lateral face of the lumbar vertebral body. Secondly,there is a “safe region” without vessels and nerves on the lateral face of the lumbar spine and it corresponds to the intervertebral space. Thirdly,it maybe avoid damaging the vessels and nerves during the operation of lumbar interbody fusion with laparoscopy on the “safe region”.