骶丛的血供分布特点及临床意义

The zonal pattern of extrinsic blood supply of the sacral plexus and its clinical significance

目的:探讨骶丛的动脉来源、分布的解剖学特点及其临床意义。方法(:1)3具成人新鲜尸体标本,采用明胶-氧化铅微血管显影法观察骶丛的动脉分布。(2)选择15具灌注红色乳胶的防腐固定成人尸体标本,手术显微镜下解剖观察骶丛的动脉来源和分布。结果:骶丛根部的血供主要来源于骶髂腰动脉系统(sacral Iliac lumbarar terysystem,SILAS)、臀上动脉和臀下动脉。各动脉的分支之间互相吻合。L4根部血供以第4腰动脉为主;L5根部血供以髂腰动脉为主,L5～S3由骶外侧动脉分支供应,血管平均为(2.2±1.4)支(1～4支)。坐骨神经臀段出骨盆处,以臀下动脉、阴部内动脉以及梨状肌肌支供血为主,营养支动脉有(5.3±1.2)支(3～7支)。结论:骶丛的血供主要来自于SILAS,每一个动脉分支从不同方向进入骶丛后分为升支和降支,在骶丛内相互吻合。相邻血管区域的血供可以代偿,为骶丛损伤的外科救治提供了解剖学基础。

Objective： To explore the sources, anatomic distributions and clinical significance of the blood supply of sacral plexus. Methods： （1）Three fresh adult cadavers were used to observe distribution features of the sacral plexus arteries after being visualizated by gelatin-lead oxide injection. （2） The origin and distribution of the sacral plexus arteries were observed under operating microscope on 15 fixed adult cadaveric specimens perfused with red latex. Results： The vessels of the root of sacral plexus origined mainly from sacroiliac lumbar artery system （SILAS）, inferior and superior gluteal arteries, with the anastomosis among them. L4 roots were supplied by the 4th lumbar artery mainly, Ls roots by iliolumbar artery mainly, and L5-S3 by sacral lateral artery. The average number of vessels was about （2.2±1.4）. The segment of sciatic nerve, from the hip to the pelvis, was supplied by inferior gluteal artery, internal pudendal artery and muscular branch of pirifomfis arteries, with the number of （5.3±1.2）. Conclusions： The blood supply of sacral plexus mainly origins from the SILAS, and forms redunant anastomosis with each other. This compensative circulation provides anatomical basis for surgical treatment of sacral plexus injury.