腰椎横突间入路的临床解剖学研究

Anatomy study for lumbar intertransverse approach

目的:通过局部解剖的方法,对腰椎横突之间及其毗邻的重要解剖结构进行观测,确立稳定的解剖标志,为微创内窥镜下经腰椎横突间入路椎间融合术(intertranverse lumbar interbody fusion,ILIF)的临床应用提供参考。方法:解剖10具新鲜成人尸体,观测L1/2～L4/5横突间结构的解剖特点及神经血管分布,并以上关节突与横突交汇点(TAP)作为中心进行相关测量,包括腰椎横突间韧带长度、骨纤维孔长度和宽度、TAP距同平面上序腰神经前支的最短距离(TA)、TAP距骨纤维孔内神经血管束最短距离(TB)及TAP距同序椎间盘中心平面的垂直距离(TC),寻找可靠的解剖标志。结果:腰椎节段动脉前支80%(60/75根)和伴行静脉走行于靠近横突间韧带上缘的腹侧,紧贴上位横突下缘向外走行;动脉后支则穿骨纤维孔并继续分支。腰椎横突间韧带长度为21.9±2.2～23.1±2.2mm;骨纤维孔长度为4.2±1.0～5.1±0.8mm,宽度为3.7±0.2～4.0±0.7mm;TA为8.0±2.5～14.6±2.5mm,TB为2.9±1.1～4.5±1.2mm;TC为0.9±2.3～4.2±0.9mm。结论:腰椎TAP为中心,上至骨纤维孔神经血管束下缘,向外至腰神经前支围成的三角形区域可视为切开横突间韧带的手术安全窗;TAP和骨纤维孔是镜下显露椎间孔、椎间隙,处理节段动脉后支神经血管束的稳定解剖标志。

Objectives： To measure lumbar intertransverse structure and its adjacent elements, and to provide the reference for endoscopic intertranverse lumbar interbody fusion （ILIF）. Methods： 10 fresh adult corpses were used to observe and measure the anatomy structure of lumbar intertransverse including nerve roots, blood vessels and the adjacent elements. The length of intertranverse ligament, length and width of bone textile fiber hole, the distance from TAP to the nervi spinales（TA）, the distance from TAP to the dorsal branch neurovascular bundles （TB）, the vertical distance from TAP to the center of intervertebral disc （TC） were determined, taking the point of superior articular process and transverse process（TAP） as the center, which were used to provide accurate anatomical marker for ILIF operation. Results： 80%（60/75） lumbar artery anterior branches and venas located in the ventral side of intertranverse ligament, and attached on inferior margin of upper transverse processes. The dorsal branch neurovascular bundles sent out branches behind the bone textile fiber hole. The length of intertranverse ligament, the length and width of bone textile fiber hole, TA, TB and TC was 21.9±2.2-23.1±2.2mm, 4.2±1.0-5.1±0.8mm, 3.7±0.2-4.0±0.7mm, 8.0±2.5-14.6±2.Snnu, 2.9±1.1- 4.5±1.2mm and 0.9±2.3-4.2±0.9mm respectively. Conclusions： Centered as lumbar TAP, between superior neurovascular bundle and lateral nervi spinales, there exists a triangle region, which can be used as the safe window for ILIF surgery due to its constant presence of TAP and the bone textile fiber hole.