腰椎椎弓根螺钉双皮质固定的椎前大血管解剖学研究

Anatomy study of anterior blood vessels for bicortical lumbar pedicle screws fixation

目的观测腰椎椎体前面与椎前大血管的解剖关系,为腰椎椎弓根螺钉双皮质固定技术提供血管解剖学依据。方法 62例成年人行腰椎CT三维重建及腹部血管成像检查(其中男32例,女30例),观测腰椎椎弓根平面椎体前面与腹主动脉、下腔静脉或髂动静脉之间的距离,腹主动脉、下腔静脉或髂动静脉相对于椎体前面的相对位置关系。结果 L1～L4椎体左侧平椎弓根平面腹主动脉距椎体前面距离为0.26～0.37 cm、位于椎体前面-7°～34°区域;L1～L3椎体右侧平椎弓根平面下腔静脉距椎体前面距离分别为1.03 cm、0.75 cm、0.36 cm,位于椎体前面17°～63°区域;L4椎体右侧、L5椎体双侧平椎弓根平面髂动静脉距椎体前面距离小于0.15 cm,位于椎前73°区域内。结论 L1～L4左侧双皮质椎弓根螺钉置钉过深容易损伤腹主动脉,L1～L3椎右侧椎弓根螺钉最容易操作完成,损伤下腔静脉的可能性较小,L4右侧、L5双侧的双皮质椎弓根螺钉最容易损伤椎前大血管。

Objective To accumulate anatomy data for bicortical pedicle screw fixation technique and survey the anatomy relationship between the lumbar vertebra and great vessels in front of lumbar. Methods Three-dimensional computed tomography reconstruction of lumbar and abdominal vascular imaging was performed in 62 cases of adults （32 male, 17 female）. The distances and spatial relation between lumbar vertebral anterior border and abdominal aorta,inferior vena cava,iliae artery were measured at the pediele plane. Results At L1 - L4 pedicle planes, abdominal aorta was 0. 26 -0. 37 cm from the left vertebral anterior border, and located in the area of -7°- 34° in front of vertebrae. At L1 - L3 pedicle planes, inferior vena cava was 1.03 em,0.75 cm,0.36 cm from the right vertebral anterior border respectively, and located in 17°-63° area. Lliac artery were less than 0.15 cm from the fight anterior border of L4 both and anterior borders of L5 ,and located in 73°area. Conclusion In L1 - L4 ,it is quite possible to injury abdominal aorta if the left pedicle screws were over deeply planted. Screws planting in right pedicles of L1 - L3 is of a little risk of injuring inferior vena cava. When planting the screws in right pedicle of L4 both and pedieles of L5 ,it should be cautious of iliac artery.