摘要
目的 了解国人骶前区域血管、神经的解剖关系,为准确、安全应用经皮前路腰骶轴向融合(AxiaLIF)技术提供解剖学依据.方法 选用成人尸体标本20具,男12具,女8具;年龄31～75岁,平均48岁.观察骶前区解剖关系,测量髂内外血管、骶正中动静脉到S1.2间隙水平中点的距离及S1前孔内缘间的距离,并观察骶前静脉丛血管的特点和S1神经根走向,确定手术冠状位的'安全操作空间'.结果 双侧髂内静脉距离S1,2间隙水平中点的距离最短,'安全操作空间'男性为(57.58±5.20)mm、女性为(69.95±9.09)mm,两者间差异具有统计学意义(P<0.05).距S1前孔内缘距离:男性为(34.95±3.50)mm;女性为(31.98±2.99)mm.骶正中动脉变异较小,存在率100%,居中占10%;骶正中静脉壁薄,变异较大,存在率为60%.骶正中动、静脉在S1,2间隙水平其平均外径分别为(0.96±O.36)mm和(2.05±0.60)mm.骶前区静脉丛壁薄,且大多数血管缺少静脉瓣,相互汇合成网状.S1神经根出骶前孔后偏向前内下走行.结论 在'安全操作空间'范围内,不超过S1神经前孔的内缘,并在X线透视引导下尽可能沿骶骨正中线操作,可保证经皮腰骶轴向融合的安全性.
Objective To observe neurovascular anatomy of the presacral area, in aiming to provide Chinese anatomy data for the percutaneous axial lumbosacral interbody fusion (AxiaLIF). Methods Twenty human cadavers were investigated in our study. There were 12 males and 8 females,with an average age of 48 (range from 31 to 75years old). The distance of the presacral space from the sacral midline to the internal ilial vascular bundle, the middle sacral vascular bundle at the S1,2 level were measured. The characteristic of venous plexus of presacral region and S1 nerve roots were studied, to determine the safety space in coronal plane. Results There were no differences between male and female in the distance of the sacral midline and bilateral vessels at the S1,2 level (P >0.05). The interval of bilateral internal iliac veins was 57.58±5.20 mm and (69.95±9.09) mm respectively. There are significant differences between male and female group (P< 0.05). The mean distance between bilateral medial margin of anterior sacral foramina was (34.95±3.50) mm and (31.98±2.99) mm in male and female respectively. The middle sacral arteries were found in all cases , but the middle sacral veins were found in 12 cases. The middle sacral arteries were found on the midline in 2 cases; on the left side in 14 cases; in right side in 4 cases. The diameter of the middle sacral arteries and middle sacral veins was measured as (0.96±0.36) mm and (2.05±0.60) mm at the S1,2 level. The Venous plexus of presacral region which formed network had found to have thin venous wall without venous valve. The S1 nerve roots was found to decline laterally after coming out of anterior sacral foramina. Conclusion In this study, we defined the 'coronal safe zone' within the presacral space. This 'safe zone' may guide surgeons when utilizing percutaneous axial lumbosacral interbody fusion (AxiaLIF). In order to ensure the saftey, the operation should be performed within the safe zone in fluoroscopic application.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2009年第12期1131-1134,共4页
Chinese Journal of Orthopaedics
基金
芜湖市科技攻关项目(2008723)
关键词
腰椎
骶骨
脊柱融合术
解剖学
局部
Lumbar vertebrae
Sacrum
Spinal fusion
Anatomy
regional
