腰椎前路手术中保护生殖股神经的临床解剖学

Clinical anatomy of genifemoral nerve during the anterior approach of lumbar spine surgery

目的为腰椎前路手术中避免生殖股神经（Genitofemoral nerve，GFN）损伤提供解剖学依据。方法在15具成年尸体标本上选择易于触及的椎间盘中点为标志，观察GFN在腰大肌中走行、分支的形态特点及穿出点位置，测量并进行统计学处理。结果GFN穿出腰大肌的位置主要集中在L3-4节段；GFN自腰大肌内穿出前未分支者占83．33％（25侧），穿出前已分支者占16．67％（5侧）；根据GFN的走行分3型：Ⅰ型，在腰大肌内远离腰椎体走行；Ⅱ型，紧贴腰椎体走行；Ⅲ型，生殖支和股支分别穿出腰大肌，且两支在腰大肌内隔有肌纤维组织。结论在显露L2-4椎体前外侧时容易损伤GFN。Ⅰ型剥离腰大肌时紧贴椎体并向外侧牵开肌肉；Ⅱ型及Ⅲ型采用经腰大肌入路劈开肌纤维束，可避免损伤GFN。

Objective To provide anatomic basis for avoiding or reducing genitofemoral nerve （GFN） injury during the anterior approach of lumbar spine surgery. Methods The midpoint of intervertebral discs were chosen as the mark point for observing morphologic features, branch types and distributions of the GFN in 15 adult cadaveric specimens （30 sides）. The data were analyzed statistically. Results GFNs passed through psoas major mainly at L3 or L4 levels. For 25 sides （83.33%）, GFNs had no any branches before its reaching to psoas major, however, 5 sides （16.67%） appeared pre-branches before passing psoas major. GFNs can be classified into three types. For type Ⅰ , GFN passed through psoas major, but far away from lumbar vertebral body; for type Ⅱ , GFN closed to lumbar vertebral body during its course; for type Ⅲ, femoral and genital branches passed through psoas major separately. Conclusions GFN is easy to be injured in exposing anterolateral side of L2-4 vertebral body. Therefore, during the surgery process, psoas major muscular bundles of GEF should be striped and pulled laterally, or exposed from muscle fibers to avoid GEN inury.