脊柱T_(5～11)节段极外侧微创手术入路的应用解剖

Applied anatomy of extra-lateral minimally invasive approach at the level of T5 to T11 spine

目的为T5～11脊柱极外侧椎间融合术(XLIF)的微创手术入路的可行性和安全性提供解剖学依据。方法成人尸体标本12具,解剖观察并测量T5～11椎体侧方血管神经的走行、分布及毗邻结构,节段血管的位置及其与上下相邻椎间盘的距离。结果 T5～11节段血管走行较为恒定,节段静脉在上、节段动脉在下,走行于对应椎体的中央偏下水平。两侧交感神经干在T6～9发出内脏大神经,T10～12发出内脏小神经。奇静脉在该段脊柱的右前方,向上走行过程中逐渐向脊柱左侧偏,胸主动脉走行于该段脊柱的左前方,向下走行过程逐渐向右侧偏,右侧交感干与奇静脉的间距远大于左侧交感干与胸主动脉的间距。椎间盘水平无血管和神经紧邻。结论在T5～11脊柱行极外侧椎间融合术是可行和安全的,行椎体螺钉内固定应注意侧前方血管神经和节段血管的保护,切除椎体时必须先结扎节段血管。

Objective To provide anatomic basis for extra-lateral minimally invasive approach on T5 to T11 spinal level.Methods 12 adult cadavers were dissected to observe the course,distribution and adjacent relations of vessels and nerves around lateral T5 to T11 vertebral body.Results Vessels around T5-T11 passed through the lower part of corresponding vertebral body constantly,with the upper segmental veins,and lower segmental artery.Both sympathetic trunk of gave off the great splanchnic nerves at the level of T6-T9,and the small visceral nerves at the level of T10-T12.Azygos vein located at the right and anterior of T5 to T11 spine,and closed to the left side of the upper spine.Thoracic aorta travelled through the left and anterior of the spine,and turned to the right side gradually.The distance between the right sympathetic trunk and the azygos vein was wider compared to that between the left sympathetic trunk and the thoracic aorta.Conclusions Extra-lateral minimally invasive approach around T5-T11 thoracic spine is operable,however,vessels and nerves at the antero-lateral side of vertebral body have to be protected during the operation.