腰椎关节突关节毗邻动脉的临床解剖学研究

Clinical anatomy of the arteries adjacent to the lumbar zygapophyseal joints

[目的]探讨关节突关节(zygapophyseal joints,ZJ)毗邻动脉分布规律,为减少腰椎后路开放、微创手术中动脉损伤后出血,避免影响手术操作及术后并发症提供解剖学依据。[方法]选取20具成人尸体腰段标本,显露腰椎侧方及横突前方动脉,解剖显微镜下观测自腰椎(lumbar,L)椎间孔出口区起L1~4腰动脉(lumbar Artery,LA)所发出的横突前支、背侧支,获得数据行统计学分析。[结果]L1A^L4A背侧支出现率为L4(82.50%)<L3(85.00%)<L2(87.50%)<L1(100.00%),自椎间孔出口区前上方,由前向外侧、背侧走行,发出横突前支并在跨越椎体峡部中、上1/3外侧缘后沿其表面分为升、降两肌支。升肌支出现率为L4(77.5%)<L3(82.5%)<L2(87.5%)<L1(97.5%),走行至上位ZJ背侧内下缘,发出覆盖ZJ背侧面的关节突支和进入竖脊肌的升、降支;降肌支出现率为L4(77.5%)<L3(82.5%)<L2(92.5%)<L1(97.5%),走行至下位ZJ腹侧外上缘,发出3~5支末梢动脉并继续走行分出肌支进入前方肌肉筋膜组织。两侧观察数据差异无统计学意义。[结论]ZJ毗邻动脉的走行、分布具有一定规律,掌握其解剖学特点,可有效减少后路手术出血,便于术中操作,降低重要组织损伤,避免术后血肿等并发症。

[ Objective ] To study the anatomical characteristics of arteries adjacent to the lumbar zygapophyseal joints （ZJ） and provide academic knowledge to avoid arterial bleeding and hematoma during posterior approach and endoscopic surger- ies of the lumbar vertebrae. [ Methods] We chose 20 adult human lumbar cadaver samples and exposed the arteries beside the lumbar vertebrae and anterior to the transverse processes. We subsequently observed the anterior branches of the transverse processes and dorsal branches from L1A - LnA at the outlet areas of the intervertebral foramina of L1-5. We also measured the ex- ternal diameter of each LA branch rami dorsalis and noted the distribution and migratory route of adjacent arteries on the lumbar ZJ. We collected the data and analyzed it by using statistical method. [Results] The arteries adjacent to L1/2 -L4/5 lumbar ZJ usually originated from the dorsal branch of L1A - L4A ; the occurrence rate showed L1 （ 100. 00% ） 〉 L2 （87.50%） 〉 L3 （ 85.00% ） 〉 L4 （ 82. 50% ） . The original location of the dorsal branch was usually anterosuperior to the intervertebral foramen outlet areas of L1/2 - 4/5. The branch was then distributed to the outside and backside of the ZJ. The anterior branch of the transverse process sends out branches into the ascending and descending muscle branch. The occurrence rate of the ascending branch showed L4 （77.5%） 〈 L3 （82. 5% ） 〈 L2 （87. 5% ） 〈 L1 （97.5%）, which was distributed to below the root of the upper ZJ and sent out zygapophyseal branches posterior to the ZJ. The occurrence rate of the descending branch showed L4 （77. 5% ） 〈 L3 （82. 5% ） 〈 L2 （92. 5% ） 〈 L1 （97.5%）, which was distributed to the upper root below the ZJ and sent out several branches into adjacent muscles. There was no statistically significant difference between the left and right sides. [ Conclusion] The route of the arteries adjacent to the ZJ and the relationships between them show obvious regularity. Therefore, complications such as arterial bleeding and hematoma can be effectively avoided once their anatomical characteristics are fully grasped.