腰丛的解剖及其在腰椎前外侧入路微创手术中的临床意义

The clinic anatomy of lumbar plexus in the lumbar anteriolaterally approach minimally invasive surgery

目的了解腰丛在腰椎前外侧人路微创手术中的应用解剖学特点。方法通过15具成人腰椎标本、2具腰段的断层图片和3个数字人腰段数据集，观察腰丛的走行及其与腰大肌及腰椎横突的关系。结果L2-5腰丛在腰椎侧方的组成具有一定的规律性，正面按从外到内的顺序排列，侧面按从腹侧到背侧的顺序排列。腰神经出椎问孔的角度从L1到L5逐渐增加。横突与腰丛的关系紧密。断层解剖显示，腰丛在不同节段始终位于腰大肌的后1／3，因此在切开腰大肌暴露腰椎时，切开位置不宜超过腰大肌的后1／3，腰大肌的前2／3是切开安全区。结论暴露腰椎侧前方切开腰大肌时，注意不要超过腰大肌的前2／3，以避免腰丛的损伤。横突可以作为手术中的解剖学标志，用以明确腰丛的解剖位置，避免术中腰丛损伤。

Objective To provide anatomic data for reducing lumbar plexus nerve injury. Methods The applied anatomy of lumbar plexus was studied by 15 formaldehyde-preserved cadavers, two groups of sectional images of lumbar segment and three series of virtual chinese human dataset. Results Arrangement of the lumbar nerve was regular. From anterior view, lumbar plexus nerve arranged from lateral to medial from L2 to L5 ; from lateral view, lumbar nerve arrange from ventral to dorsal from L2 to L5. The angle degree between the lumbar nerve and lumbar increased from L1 to L5. The lumbar plexus nerve was revealed to be in close contact with transverse process. By sectional anatomy, all parts of the lumbar plexus nerve were located in the dorsal third of the psoas major. The safety zone of the psoas major to prevent nerve injuries was ventrally 2/3. Conclusions Psoas major can be considered as surgery landmark when expose the lateral anterior of lumbar by incising the pasoas muscle. Incising the psaos muscle ventral 2/3 can prevent lumbar plexus injury. Transverse process can be considered as landmark for the position of lumbar plexus in operation.