腰椎人字嵴顶点毗邻结构的观察及其临床意义

Anatomical study of the adjacent structures to the top point of the “∧” shape crest and its relevance

目的 :观察腰椎人字嵴顶点及其周围毗邻结构 ,探讨椎弓根螺钉内固定手术中的注意事项。方法 :在 5 0具成人尸体脊柱标本上观察腰神经后内侧支及腰血管后内侧支与人字嵴顶点的关系 ,并模拟手术过程。结果 :在腰椎峡部嵴上无肌肉附着 ,人字嵴内凹内有脂肪球及腰血管后内侧支 ,乳突副突韧带附着在乳突副突嵴上。结论 :损伤腰血管后内侧支是显露人字嵴顶点操作中造成出血的原因。显露人字嵴顶点时不用显露横突 ,方法简单、创伤小 。

Objective:To observe the adjacent structures to the top point of the “∧” shape crest and to discuss how to expose the new landmark of screw entrance point through posterior approach.Method:The posteromedial rami of the lumbar vessel and that of the lumbar nerves and other structures were dissected in 50 human spine specimens. Result: The posteromedial rami of the lumbar vessel was passing by the “∧” shape crest inferiorly. There was fat in the concave of the crest. There was no muscle attached to the isthmus crest. Conclusion: The “∧” shape crest was easily exposed and identified in the operation with no need to exposure the transverse process and the facet joint, the posteromedial rami of the lumbar vessel was the main cause of hemorrhage in the operation. The new landmark of screw entrance point appears to offer a easy way for insertion of the pedicle screw that leads to a very high success rate of screw insertion through posterior approach.