腰骶部腹侧血管解剖参数的测定及L5-S1前路钢板研制

Vascular anatomy anterior to lumbosacral spine and design of lumbosacral anterior fusing plate

目的对脊柱L4～S1段腹侧局部血管解剖进行研究，为L5～S1前路内固定系统的设计提供解剖学依据。方法解剖41例成人尸体标本（男性26例、女性15例），测量腹主动脉分叉点及髂总静脉汇合点到15椎体下缘的距离，上述分叉点及汇合点的夹角；测量右髂总动脉与左髂总静脉交点到L5椎体1／2高及L5～S1椎间盘间隙水平距离；测量右髂总动脉与左髂总静脉交汇点的夹角；统计髂血管交汇点与椎体的毗邻关系。结果右髂总动脉与左髂总静脉交汇点的夹角平均为71．5°，在L5椎体的1／2高处及L5～S1椎间盘间隙的水平宽度分别为（2．1±0．9）、（3．3±0．9）cm。结论右髂总动脉与左髂总静脉的走行路径决定了L5-S1腹侧的手术操作空间，95．1％的人群可以直接或通过适当松解、牵拉血管后完成L5～S1椎体间融合内固定术。

Objective To determine the variability of the anterior vascular anatomy at the lower lumbar spine and provide anatomic data for the design of L5/S1 anterior fusing plate. Methods This study investigated 41 human cadavers （26 males and 15 females）. The distance from the bifurcation or confluence to the top of L5/S1 disc and the width of operation window of L5/S1 disc （ the distance from right common iliac artery to left common iliac vein） were determined. Results The bifurcation level of the ventral aorta and the confluence level of the common iliac vein were showed from L4 to L5, The course of the ventral aorta was in the right front of vertebra and the course of the common iliac vein was in the left front of vertebra, The bifurcation angle of the ventral aorta averaged 62.8°, the confluence angle averaged 71.8°, and the right common iliac aorta and the left common iliac vein angle averaged 71.5°. The distance from the bifurcation to the top of L5/S1 disc averaged （3.8 ± 1.0） cm. The distance from the confluence to the top of L5/SI disc averaged （2.2 ± 0.8 ） cm, The distance from the confluence of the right common iliac aorta and the left common iliac vein to the top of L5/ S1 disc averaged （2. 0 ± 0. 7） cm. Conclusion Because of the bifurcation level of the ventral aorta and the confluence level of the common iliac vein are over the top of L5/S1, the placement of internal fixation device and anterior L5/S1 fusion is safe in 95.1% people.