腰骶椎侧前方内固定术的应用解剖学研究

An anatomy study of anterolateral lumbosacral internal fixation

[目的]对尸体标本行解剖学观测,评估腰骶椎行侧前方内固定手术的可行性,为提高该手术的安全性提供帮助。[方法]分别在12具成人尸体标本上观察腰骶椎侧前方重要血管神经的走行及毗邻关系,并测量出左髂总静脉到L_5椎体上、下缘后侧及S1椎体上缘后侧距离V1、V2、V3;L_5神经根前支内侧缘到骶骨岬前外侧缘水平距离EF;骶骨岬前外侧缘到第1骶前孔上缘切线垂直距离AB;以及腰交感干分别到L_4/L_5,L_5/S_1椎间孔前上缘垂直距离C_1、C_2。然后将腰骶椎侧前方操作空间视为一直角梯形,分别测量出结扎牵拉动静脉前、后的梯形底边长及高度,根据梯形面积公式计算出原始面积S1及牵拉后有效面积S2。[结果]V1、V2、V3分别平均为(43.20±0.9)mm、(40.91±0.6)mm、(30.59±0.6)mm,L_4动静脉在椎体侧方走行较恒定,L_5动静脉走行变异较大;L_5神经根前支紧贴骶骨翼前方走行,位置恒定,EF平均为(15.72±2.03)mm,AB平均为(28.85±2.41)mm,C_1、C_2分别平均为(27.43±2.10)mm、(26.80±2.31)mm。S_1为(31.02±1.7)cm^2,S_2为(33.40±1.3)cm^2,两者相比较差异有统计学意义。[结论]腰骶椎侧前方初始有一定的操作空间,可允许进行侧前方内固定手术,且周围重要的血管神经走行有一定规律性,术中可通过有效结扎、牵拉避开这些结构后获得更为充足的手术空间,并可减少手术的并发损伤,提高安全性。

[ Objective] To assess the feasibility of lumbosacral vertebral anterolateral internal fixation by anatomic observa- tion in cadaver. [ Method ] The lumbosacral vertebra and important neurovascular itssues in 12 adult cadavers was dissected, and the relations with neighbourhoods were obsearved. The distance from the left iliac vein to the upper back side of L5 （ V1 ）, down back side of I_5 （ V2）, and to the upper back side of SI （ V3 ） were measured. At the same time, the horizontal distance from the anteiomedial edge of L5 nerve root to the anterolateral edge of sacral promontory（EF）, the vertical distance from an- terolateral edge of sacral promontory to the upper - edge tangent of first anterior sacral foramina （ AB）, whereas the distances from lumbar sympathetic trunk to anterior upper -edge of intervertebral foramen of IAL5 （ C1 ）, LSS1 （C2）, were measured, respectively. Then, the operating space in front of lumbosacral vertebral side was supposed as a right angle trapezoid, the trape- zoidal hemline and height were respectively measured before and after pulling the arteriovenous, the original area of S1 and theactive area of S2 were calculated according to the trapezoidal area formula. [ Result ] The length of V1, V2 and V3 were 43.20 ± 0.9mm, 40.91 ± 0.6mm, 30.59 ± 0.6mm, respec- tively. IA arteriovenous crossed constantly in lateral direction , while the L5 arteriovenous variantly crossed. L5 nerve root crossed before a clingy sacral wing, the position was constant. The average length of EF was 15.72 ± 2.03ram, the average length of AB was 28.85 ±2.41ram. The length of C1 and C2were 27.43 ±2.10mm, 26.80±2.31mm respectively. The area of S1 and s2 were 31.02 ± 1.7cm2 and 33.40 ± 1.3cm2, in- dicating a statistically significant difference. [ Conclusion ] The anterolateral edge of lumbosacral vertebrae, with a certain origi- nal space and disciplina neurovascular crossing direction, can serve as an operation space for anterolateral internal fixation.