生殖股神经的解剖及临床意义

目的了解生殖股神经(GFN)在腰椎前路微创手术中的应用解剖学特点,提出减少生殖股神经损伤的解剖学依据。方法通过15具成人腰椎标本观察生殖股神经与腰大肌的关系,观察GFN的分型,为腰椎前路微创手术安全暴露及手术中避免生殖股神经损伤提供解剖学的依据;结果生殖股神经30%起自L1:63.3%、3.3%起自T12及L3;根据与腰大肌的关系可分为肌内段和肌外段;穿出腰大肌的位置一般位于第3腰椎和第4腰椎,GFN的穿出点距腰大肌内侧缘的距离为6.2mm(1.1～19.5mm)。结论GFN在穿出腰大肌时最容易受到损伤,L1-L2椎体的暴露最好将腰大肌前侧1/3的肌束沿肌纤维分离,将GFN包裹在肌束的内侧,将肌束向内侧牵开。而在下腰椎,可以沿腰大肌的内侧切开也可以从肌肉的前侧1/3切开,将GFN向外侧牵开,牵引力不能太大,否则容易引起神经的牵拉伤。

The clinic anatomy of genifemoral nerve in the lumbar anterior less invasive surgery

Objective To provide anatomic data for reducing genifemoral nerve injury and describe surgical landmarks in operation. Methods To study the applied anatomy of genifemoral nerve by 15 formaldehyde-preserved cadavers,observe the origin and construction of genifemoral nerve,anatomic investigation and measurement of genifemoral nerve(GFN),the relationship of genifemoral nerve and psaos muscle,providing the anatomic data for avoiding of damaging the genifemoral nerve in the lumbar anterior minimally invasive surgery. Results The GFN always 30% origin from L1,63.3% from L2 and 3.3% from T12 and L3;It could be divided into two parts including of in muscle and out of muscle according to the relationship with psoas major muscle. Conclusion Psoas muscle can be considered as surgery landmark when expose the lateral anterior of lumbar by incising the pasoas muscle,which prevent lumbar plexus injury by incising the psaos muscle ventral 2/3. Transverse process can be considered as landmark,which we can sure the position of lumbar plexus and as reference in operation.