经皮后外侧入路下腰椎椎间融合术的应用解剖学研究

Applicative Anatomy Study of Percutaneous Posterior-lateral Approach for Lower Lumbar Interbody Fusion

目的 探讨经皮后外侧入路下腰椎椎间融合术的解剖要点及手术方法。方法 收集2011年1月至2013年7月来宾市人民医院的40例正常成人腰椎磁共振成像（MRI）图片（男女各20例）,并测定与经皮后外侧入路下腰椎椎间融合术相关的解剖学参数;结合所测得数据在经甲醛浸泡的6具成人尸体上模拟经皮后外侧微创入路行椎间融合术（试验组）,术后沿入路经椎间隙进行横断面解剖,观察入路的解剖毗邻关系,测定椎间盘面积及所融合的面积,在另6具成人尸体上常规行后路椎间融合术（对照组）,同样测定椎间盘面积及所融合的面积。结果 ①经测定,男、女两组L3~4、L4~5测得的各项数据之间的差异无统计学意义（P〉0.05）;②试验组经皮后外侧微创入路行椎间融合的面积与对照组行常规后路椎间融合术间融合的面积间的差异无统计学意义（P〉0.05）,且融合面积均达30%以上;③沿克氏针模拟手术入路逐层解剖至腰大肌的过程中未见重要的血管、神经等结构,在侧方经皮外侧入路的手术操作区域,存在着一个由腰节段血管、腰神经、交感干组成的大小约为29mm×30 mm的相对无血管、神经的区域,为侧方经皮外侧入路手术操作的“安全范围”。结论 经皮后外侧入路行下腰椎椎间融合术是相对安全的,并椎间融合面积达到临床要求。术前在MRI图片上测定的个体化数据,对该术式有重要的指导意义。

Objective To discuss the anatomic key points and surgery methods of the percutaneous pos-terior-lateral approach for lower lumbar interbody fusion .Methods Lumbar magnetic resonance imaging slices of 40 normal adult cases were collected from Laibin People′s Hospital during Jan.2011 and Jul.2013, and the relevant anatomic parameters of the percutaneous posterior-lateral approach for lower lumbar inter-body fusion were measured.Combined with the measured data,same operation was performed on the bodies of 6 adults （ experimental group） soaked by formalin to simulate posterior-lateral percutaneous minimally inva-sive intervertebral fusion,while the other 6 adults bodies（control group） were operated by the routine rear intervertebral fusion,,then the intervertebral disc area and the fusion area of both groups were measured . Results ①TherewasnostatisticallysignificantdifferenceofimagingdataofL3~4andL4~5betweenman group and woman group （P〈0.05）; ②The fusion area of two modus operandi of lumbar interbody fusion were over 30%,there was no statistically significant difference between the two groups （P〈0.05）;③there were no significant vascular and nerves across the Kirschner wire operation approach ,and there was a 29 mm ×30 mm ′safe area′without vascular and nerves on the posterior-lateral of the lower lumbar interbody .Con-clusion The percutaneous posterior-lateral approach for lower lumbar interbody fusion is a relative safety method.And the lumbar interbody fusion area meets the clinical requirements .Measuring the individual data on MRI before operation has a great guiding significance to direct the operation .