下腰部多裂肌周围神经血管分布特点及临床意义

Neurovascular distribution around the multifidus muscles in the low back and its clinical implications

目的通过对下腰部的局部解剖,探讨下腰部多裂肌间隙的位置和多裂肌周围的神经血管分布特点及临床意义。方法对5具尸体进行下腰部局部解剖,观察胸最长肌、腰髂肋肌和多裂肌的起止、走行和位置关系,观察脊神经后支外侧支和腰血管背支的分支、分布和走行特点,测量脊神经后支外侧皮支从多裂肌外侧缘穿入腰髂肋肌点距棘突的距离。结果翻开胸腰筋膜,可见胸最长肌和腰髂肋肌;将两者分开,可见到深面的多裂肌及其间隙;在多裂肌的后方和外侧可见脊神经后支的外侧支发出的分支及伴行的腰血管背支。结论下腰部腰椎后路手术经多裂肌间隙入路,位于多裂肌和腰髂肋肌之间,该间隙分布着大量的脊神经后支外侧支和腰血管背支,手术过程中需要注意保护。

Objective To explore the neurovascular distribution around muhifidus muscles in the low back and its clinical significance via regional dissection. Methods Five cadavers were dissected in the low back. The anatomical relationships between the longissimus thora- cis, iliocostalis and the start-stop, direction and position of multifidus muscles were observed. Branches, distribution and the characteristics of the erector spinae muscle, the lateral branches of spinal nerves and blood vessels were examined. Then measured the distances from the emerging point of the lateral cutaneous branches of spinal nerves to the spinous processes. Results After removed the deep fascia, the longis- simus thoracis was found medially and the iliocostalis was found laterally. The muhifidus muscles located deeply to the longissimus and the iliocostalis muscles. The lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar blood vessels run in the multifidus muscle gaps. Conclusion The multifidus muscle gaps contain plenty of neurovascular bundles. Surgely involving the low back often takes the advantage of the gaps between multifidus muscles. Therefore, surgeons should take caution to avoid damaging the lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar vessels during low back surgery.