L_(5)/S_(1)节段前路腰椎椎体间融合术的神经解剖学分析

Neuroanatomical analysis of L_(5)/S_(1) segments anterior lumbar interbody fusion

目的观察L_(5)~S_(1)椎体腹侧的腰自主神经,为L_(5)/S_(1)节段前路腰椎手术提供神经解剖学数据。方法将10具成人腰骶部标本用于解剖学观察,仔细去除腹腔内脏器,然后在显微镜下分离出L_(5)~S_(1)椎体腹侧的腰自主神经,并观察其形态、走行、分布规律等解剖学特征。采用精确到0.01 mm的游标卡尺测量上腹下丛的长度及其右侧缘分别在L_(5)下终板平面(D2)和S_(1)上终板平面(D3)与腹正中线的距离,上腹下丛右侧缘在L_(5)下终板平面与右髂总/内动脉之间的距离(D4)、在S_(1)上终板平面与右髂内动脉之间的距离(D5)及其最右侧缘与腹正中线的距离(D6)。结果上腹下丛由腹主动脉丛、肠系膜下丛以及双侧的第3和第4腰内脏神经的神经纤维汇合而成,主要分布于L_(5)/S_(1)椎间隙腹侧,其主干长度为(59.10±5.31)mm。D2在腹正中线左侧(3.72±3.09)mm,D3在腹正中线右侧(1.79±6.00)mm,D6在腹正中线右侧(4.74±5.60)mm,D2与D3之间有统计学差异(F=6.666,P=0.019),D2与D6之间也有统计学差异(F=17.502,P=0.010),但是D3与D6之间无统计学差异(F=1.296,P=0.270)。D4为(17.42±6.99)mm,D5为(20.58±9.01)mm,二者之间无统计学差异(F=0.767,P=0.393)。上述数据在不同性别之间均无统计学差异(P>0.05)。结论在L_(5)/S_(1)椎间盘平面上,右髂总/内动脉逐渐走向腹中线外侧,故其与上腹下丛之间的距离逐渐增大。上腹下丛右侧缘和右髂总/内动脉之间的距离远大于其与腹正中线的距离,且在右髂总/内动脉和腹正中线之间存在极其少量的腰自主神经纤维。

Objective To observe the lumbar autonomic nerves on the ventral side of the L_(5) to S_(1),thereby providing neuroanatomical data for L_(5)/S_(1) segments anterior lumbar surgery.Methods Ten adult lumbosacral specimens were used for anatomical observation,the abdominal visceral organs were carefully removed,the lumbar autonomic nerves on the ventral side of the L_(5) to S_(1) were separated under the microscope,and its anatomical features including morphology,course and distribution were observed.The length of the superior hypogastric plexus,the distances between its right margin and the median abdominal line on the L_(5) inferior endplate level(D2)and S_(1) superior endplate level(D3),the distances between the right margin of superior hypogastric plexus and the right common/internal iliac artery on the L_(5) inferior endplate level(D4)and the right internal iliac artery on the S_(1) superior endplate level(D5),and the distance between its rightmost margin and the median abdominal line(D6)were measured using a vernier caliper accurate to 0.01 mm.Results The superior hypogastric plexus was formed by the abdominal aortic plexus,the inferior mesenteric plexus,and the 3rd and 4th lumbar splanchnic nerves,which was mainly distributed on the ventral side of the L_(5)/S_(1) intervertebral space,with(59.10±5.31)mm of its main trunk length.D2 was(3.72±3.09)mm on the left side of the abdominal midline,D3 was(1.79±6.00)mm on the right side of the abdominal midline,D6 was(4.74±5.60)mm on the right side of the abdominal midline,and there were statistically significant differences between D2 and D3(F=6.666,P=0.019),and D2 and D6(F=17.502,P=0.010),but there was no statistical difference between D3 and D6(F=1.296,P=0.270).D4 was(17.42±6.99)mm,D5 was(20.58±9.01)mm,and there was no statistical difference between them(F=0.767,P=0.393).There was no statistically significant difference in the above data between different genders(P>0.05).Conclusion On the L_(5)/S_(1) intervertebral disc level,the right common/internal iliac artery gradually moves towards the lateral side of median abdominal line,thus increasing its distance from the superior hypogastric plexus.The distance between the right margin of the superior hypogastric plexus and the right common/internal iliac artery is significantly greater than its distance from the median abdominal line,and there is an extremely small amount of lumbar autonomic nerve fibers between the right common/internal iliac artery and the median abdominal line.