腰膨大动脉的显微外科解剖及其临床意义

Microsurgical anatomy and clinical significance of the artery of Adamkiewicz

目的 为腰膨大动脉所供应的下半部脊髓的缺血性损害的防治提供解剖学依据。方法 利用32具红色乳胶灌注的成人尸体脊柱标本 ,保留节段性动脉 ,经后路打开椎管暴露腰膨大动脉后 ,在手术显微镜下观察腰膨大动脉的来源、走行、分支、分布及管径。结果 每例脊髓均有 1支腰膨大动脉 ;腰膨大动脉来源于节段动脉 ,主要伴随胸 8至腰 1脊神经进入椎管到达脊髓 ;多数例子中腰膨大动脉是下半脊髓唯一的供血动脉 (2 3例 ,71.2 8%± 4.0 9% )。腰膨大动脉穿硬膜后于脊髓前正中裂分为升、降两支 ,其与降支夹角成锐角 ;降支管径是升支的 2倍。结论 腰膨大动脉对下半脊髓供血至关重要 ;外科处理涉及腰膨大动脉时 ,应注意对它的保护 ;在动脉压力降低时 。

Objective To provide anatomical data for the clinical application in the treatment of ischemic injury of lower spinal cord supplied by the artery of Adamkiewicz. Methods This experiment was carried out on 32 adult cadaver spinal cords with the segmental arteries which were observed under an operating microscope in order to study the origin, branches, distribution and caliber of the artery of Adamkiewicz. Results An artery of Adamkiewicz was found in all 32 cadavers. The artery of Adamkiewicz was derived from the intercostal artery or the lumber artery, reached the spinal cord mainly along with T 8 to L 1 nerves. In most of the cadaver (23, 71.28%±4.09%), the artery of Adamkiewicz was the only artery that supplied blood for the lower thoracic and lumbosacral spinal cord. After through the dura, the artery was divided into ascending and descending branches with a sharp angle. The caliber of the former was as one half as that of the later. Conclusions The blood supply of the lower spinal cord was mainly dependent on the artery of Adamkiewicz. Attention should be paid to it in the operation involving this part. As the arteries had a lower pressure, the descending branch of the artery of Adamkiewicz was better irrigated than the ascending branch.