腰椎椎弓根螺钉双皮质固定的椎前大血管三维重建的解剖学研究

3D reconstruction of anterior vertebral blood vessels for bi-cortical lumbar pedicle screws fixation

【摘要】目的基于造影及CT扫描对腰椎椎前大血管行三维重建及测量，探讨实施腰椎弓根螺钉双皮质固定手术的可行性及安全性。方法采用明胶．氧化铅混悬液灌注的新鲜成人标本10例，CT扫描后三维重建，测量椎弓根轴线与椎体前缘交点与大血管的解剖结构关系。L／RAD（L／RVD）：左右侧腰椎椎弓根轴线与椎体前缘的交点和腹主动脉（下腔静脉或髂动静脉）之间的距离。结果L，（RAD）与L，（LAD）分别为（0．51＋0．12）cm和（0．16±0．11）cm，L】（LVD）与L4（RVD）分别为（1．03＋0．08）cm和（0．10＋0．16）cm.L1-3L／RAD及k，LL／RVD对比均有显著性统计学意义（P〈0．05）。L1～L3腹主动脉逐渐靠近椎体前缘（0．38～0．46cm），L3-5则反之（0．46～0．16cm）。Ljq下腔静脉逐渐远离椎体前缘（1．00～0．11cm）。腹主动脉位于L1-4椎体左侧．6°～30°区域；下腔静脉位于L1-3椎体前面右侧-15°～57°，L4椎体前面．10°～60°。髂血管在L，椎体前面左内外、右内外分别为4°～10°，20°～60°，-18°～35°，．50°～70°。结论L1-5左侧双皮质椎弓根螺钉置钉过深容易损伤腹主动脉及髂血管，L1-3椎右侧椎弓根螺钉易操作，L4-5双侧损伤下腔静脉及髂血管的可能性较大。

Objective The reconstruction and measurement of the anterior large blood vessels of lumbar vertebral based on CT and 3-D reconstruction for feasibility and safety of hi-cortical pedicle screw fixation. Methods 10 fresh adult specimens with gelatin-lead oxide suspension infusion were scaned using multi-CT in order to observe the vessels for measuring the point between pedicle axis line and anterior vertebral edge. L/RAD （L/RVD） refers to the distance from the junction point between pedicle axis line and anterior vertebral edge to the abdominal aorta （inferior vena cava or iliac vein）. Results There was statistical difference between both sides of AD of vertebrae （L1-3） and VD of vertebrae （L3-5）. The abdominal aorta has a tendency to approach close to the anterior aspect of L1°3 vertebrae （0.38±0.46 cm）, but not to L1-5 （0.46-0.16 cm）. The inferior vena c＇ava was far away the anterior aspect of vertebrae of L1-.4 （1.00-0.11 cm）. At L1-4 pedicle planes, abdominal aorta located in the -60-30° area of the front of vertebrae. At L1-3 pedicle planes, inferior vena cava was located in -15°-57° area and -10°-60° for L4. Iliac artery （inside and outside） of left and fight anterior border of L5 located in 4°-10°, -200-60°, -18°-35°, -500°-70°. Concltmion In L1-5, it is quite possible to injure abdominal aorta if the left pedicle screws were over deeply planted. Screws plantation in right L1-3 is easy. When planning the screws in right pericles of L4 and L5, caution should be taken to avoid injury to iliac artery.