腰骶椎前路手术"有效工作区"血管应用解剖学研究

目的：比较腰骶椎“髂血管三角区”和“侧方安全区”的血管分布及手术处理后“有效工作区”的范围大小，为临床进行腰骶椎前路手术提供相关应用解剖学数据。方法：对30具成人尸体标本进行观察，比较正常“髂血管三角区”及外侧牵拉髂血管后“髂血管三角有效工作区”面积的大小；正常和安全牵拉椎前血管后“侧方安全区”以及结扎腰节段血管后“侧方有效工作区”面积的大小。结果：正常“髂血管三角区”面积为（785．85±333．91）mm2，外侧牵拉髂血管后“髂血管三角有效工作区”面积为（938．97±351．39）mm2。L5-S1水平“侧方安全区”正常情况下左侧为（148．44±64．40）mm2，右侧为（142．45±46．66）mm2；安全牵拉椎前血管情况下左侧为（178．76±72．97）mm2，右侧为（178．59±60．54）mm2；结扎腰节段血管后“侧方有效工作区”左侧为（314．80±82．47）mm2，右侧为（322．12±73．68）mm2。结论：在行L5—S1前路手术时，以“髂血管三角有效工作区”为首选，此区可以满足单钉棒或单钉板内固定的空间需求。

Anatomic study of the blood vessels in the lumbosacral anterior "effective working area"

Objective：To compare the blood vessels＇ distribution in ＂iliac blood vessel triangular area＂ and ＂lateral safe region＂ of the lumbosacral vertebrae and the range of ＂effective working area＂ after operation, so as to provide anatomic data for lumbosacral anterior operation. Methods：The range of ＂iliac blood vessel triangular area＂ in common condition and ＂iliac blood vessel triangular effective working area＂ after laterally dragging iliac blood vessels, the range of ＂lateral safe region＂ in common condition and after safely dragging lumbosacral vertebrae anterior blood vessels and the ＂ lateral effective working area＂ after ligating lumbar segmental vessels were observed and compared in 30 human cadavers. Results：The area of ＂ iliac blood vessel triangular area＂ in common condition was （785.85 ± 333.91 ）mm2 ;the area of ＂ iliac blood vessel triangular effective working area＂ after laterally dragging lilac blood vessels was （938.97±351.39 ） mm2 ; at L5 - S1 level, the left range of ＂lateral safe region＂ in common condition was （ 148.44 ± 64.40） mm2 and the right range was （ 142.45 ± 46.66） mm2 ; after safely dragging lumbosacral vertebrae anterior blood vessels, the left range of it was （ 178.76 ± 72.97 ） mm2 , and the right range was （ 178.59± 60.54） mm2 ; after ligating lumbar segmental vessels, the left range of ＂ lateral effective working area＂ was （ 314. 80 ± 82. 47 ） mm2 and the right range was （ 322. 12 ± 73. 68 ） mm2. Conclusions ： It is proper to select ＂ iliac blood vessel triangular effective working area＂ approach when carrying out anterior operation of L5 - S1. This area can satisfy the space requirement of single rod-screw or single screw-plate during internal fixation.