多排螺旋CT对肾后筋膜内侧附着的解剖学评估(英文)

Anatomical evaluation of multiple-detector spiral CT for medical attachment of the posterior renal fascia

背景:在解剖学上,腹膜后间隙区域的筋膜解剖及其界限一直存有争议。正确理解腹膜后间隙的解剖,有助于准确评估病变的病因、性质,预测其蔓延的范围,以及指导该区域积液引流及肾移植等外科治疗。目前关于肾筋膜的解剖和内侧附着尚存争议,而多排螺旋 CT 可良好显示腹部的解剖结构。目的:采用多排螺旋 CT 观察肾后筋膜内侧附着点的解剖情况。设计、时间及地点:回顾性病例分析,于2003-06/2007-11在潍坊医学院附属医院影像中心完成。对象:回顾性分析累及腹膜后间隙炎性病变病例 52 例的 CT 资料。方法:应用 Toshiba Akuilion16 排螺旋 CT进行扫描。52 例病例中 37 例经手术/病理证实,15 例经临床和实验室检查证实;其中阑尾炎 17 例,输尿管炎症 1 例,肾周间隙脓肿 2 例,肾旁后间隙脓肿 3 例,胰腺炎 29例。主要观察指标:观察双侧肾后筋膜的内侧附着点的解剖。结果:在肾上极水平,双侧肾后筋膜内侧均附着于腰方肌筋膜。46 例显示左侧肾后筋膜内侧在肾下极水平或锥下间隙水平附着于腰大肌筋膜外后方;50 例显示右侧肾后筋膜内侧在肾下极水平或锥下间隙水平附着于腰大肌筋膜外后方。结论:肾后筋膜的内侧附着点并不是固定不变的,在不同层面,肾后筋膜的附着点不同。

BACKGROUND： Knowledge of retroperitoneal space communications might influence catheter placement, and understanding the normal anatomy of the retroperitoneal space is a prerequisite for predicting the distribution of inflammation or other fluid collections in this region. Until recent years, the medial attachment of the posterior renal fascia remained controversial. The multiple detector spiral CT can show the abdominal anatomic details. So, using the multiple-detector spiral CT to study the anatomy of posterior renal fascia has clinical significance. OBJECTIVE： To describe the medial attachment of the posterior renal fascia by using multiple-detector spiral CT. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at Department of Radiology, Affiliated Hospital of Weifang Medical College between June 2003 and November 2007. PARTICIPANTS： A total of 52 patients with retroperitoneal inflammatory diseases were retrospectively reviewed through analysis of their CT data. METHODS： Toshiba Akuilion 16-detector spiral CT was employed for scanning. Of the 52 patients, 15 were proved by clinical and laboratory findings and 37 were proved by surgery and pathology. Among the 52 patients, t 7 suffered from appendicitis, 1 from ureteritis, 2 from abscesses in the perirenal space, 3 from abscesses in the posterior pararenal space, and 29 from pancreatitis. MAIN OUTCOME MEASURES： Medial attachment of the bilateral posterior renal fascia. RESULTS： At the level of the upper pole of kidney, the posterior renal fascia fused with the fascia of the ipsilateral quadratus lumborum muscle. Forty-six patients manifested the attachment site of the left posterior renal fascia transforming from the quadratus lumborum muscle fasciae to the psoas major muscle fascia at the level of the lower pole of kidney or the infrarenal space. Fifty patients showed the attachment site of the right posterior renal fascia transforming from the quadratus lumborum muscle fascia to the psoas major muscle fascia at the level of the lower pole of kidney or the infrarenal space. CONCLUSION： The posterior renal fascia attachment site is not the same all the time. At different levels, the attachment site of the posterior renal fascia is distinct.