极外侧腰椎椎间融合手术入路相关的应用解剖学研究

Applied anatomy study on operative approach of extreme lateral interbody fusion

目的 通过标本解剖学研究,得出极外侧入路腰椎椎体间融合术（extremelateral interbody fusion,XLIF）在各腰椎间隙的安全入路范围,为XLIF技术提供详尽的应用解剖学数据。方法 自2016年3-4月行尸体解剖实验,观察18例成人尸体标本椎间盘侧方解剖结构及毗邻血管神经分布及极外侧入路的可行性。结果 腰椎间盘左侧手术窗大于右侧手术窗,左侧手术窗（39.91±5.97）mm,右侧手术窗（36.04±6.22）mm。用穿刺针进行模拟,穿刺角度为64°时安全性高,距离血管神经位置远。结论 腰椎间盘侧方区域可作为内窥镜手术治疗腰椎间盘疾患的区域,XLIF手术安全性良好。

Objective To explore the safe range of surgical approach in extreme lateral interbody fusion （XLIF） by anatomy study on specimens, and to provide applied anatomy data in detail for XLIF. Methods 18 adult cadavefic specimens were dissected during March 2016 to April 2016, and the anatomical structure lateral to intervertebral disc and its adjacent neurovascular distribution were observed, and the feasibility of extreme lateral approach was analyzed. Results The left surgical window（39.91±5.97mm） of lumbar intervertebral disc was larger than the fight one （36.04± 6.22 mm）. Puncture needles were used to simulate the operation. When the puncture angle was 64°, the safety was high with long distance to blood vessels and nerves. Conclusion The lateral region of lumbar intervertebral disc can be used as surgical region to treat related diseases by endoscopy, with favorable safety of XLIF operation.