中国人Wiltse椎旁肌间隙入路的观察与测量

Observations and measurements of Wiltse paraspinal sacrospinalis splitting approach in Chinese people

背景:应用Wiltse椎旁肌间隙入路可减少手术对椎旁肌的损伤,但目前对于最长肌与多裂肌间隙解剖位置的确定仍无精确的标准。目的:通过对国人尸体解剖和腰椎MRI影像的观察测量,熟悉椎旁肌间隙入路的局部结构特点,确定腰椎不同节段椎旁肌间隙的具体位置,为此入路的临床应用提供经验和参考。方法:采用10具经防腐处理的成人尸体标本进行解剖观察,寻找并钝性分离双侧最长肌与多裂肌间隙,测量L2和L4棘突水平最长肌与多裂肌间隙距后正中线距离。采用400例患者腰椎MRI的影像资料进行观察,测量L2/L3-L5/S1各椎间盘水平双侧最长肌与多裂肌间隙至后正中线距离,分析其与性别、年龄的关系。结果与结论:10具尸体最长肌与多裂肌间隙表面均未见重要血管、神经分布,间隙底部可见上关节突及横突根部,L2棘突水平最长肌与多裂肌间隙距后正中线距离为(2.3±0.3)cm,L4棘突水平最长肌与多裂肌间隙距后正中线距离为(3.4±0.6)cm。400例患者腰椎MRI影像资料中,L2/L3-L5/S1椎间盘水平最长肌与多裂肌间隙至后正中线距离依次为(19.71±1.93)mm、(23.49±2.49)mm、(27.49±2.84)mm和(31.36±3.15)mm,与患者性别、年龄无显著相关性。实验为Wiltse椎旁肌间隙入路的临床应用提供了有价值的参考,建议在进行椎旁肌间隙入路手术之前常规进行MRI测量,减少医源性损伤。

BACKGROUND： Application of Wiltse paraspinal sacrospinalis splitting approach can reduce paraspinal muscle injuries caused by operations, but there are still no precise criteria to determine anatomic locations of longissimus-multifidus cleavage planes. OBJECTIVE： To have an intimate knowledge of structural characteristics of Wiltse paraspinal sacrospinalis splitting approach, to determine specific locations of longissimus-multifidus cleavage planes in different lumbar segments, and to provide experiences and references for its clinical applications by observations and measurements of autopsies and magnetic resonance images in Chinese people. METHODS： Ten embalmed adult cadavers were used for anatomical observations. The natural cleavage planes between longissimus and multifidus were noted and bluntly dissected bilaterally. Measurements were done between these planes and the midline at levels of spinous processes of L2 and L4. 400 patients’ images of lumbar spines were also used for observations. Measurements were taken bilaterally between longissimus-multifidus cleavage planes and the midline at levels of discs from L2/L3 to L5/S1. The correlations between these distances and sex or age were analyzed. RESULTS AND CONCLUSION： No important vessels or nerves were found in the longissimus-multifidus cleavage planes of all 10 cadavers. Superior facets and roots of transverse processes could be exposed at the bottom of the planes. At L2, the mean distance was（2.3±0.3） cm; at L4,（3.4±0.6） cm. Of all 400 images, the mean distances from L2/L3 to L5/S1 were respectively（19.71±1.93） mm,（23.49±2.49） mm,（27.49±2.84） mm and（31.36±3.15） mm. No strong correlation was discovered between sex or age with respect to measured distances. This study provides valuable references for clinical application of Wiltse paraspinal sacrospinalis splitting approach. We suggest routine measurements of magnetic resonance imaging before surgeries to reduce iatrogenic injuries.