下腰椎侧方血管神经及毗邻结构的应用解剖

目的:为下腰椎微创极外侧椎体间融合术(XLIF)提供解剖学依据。方法:解剖30具成人尸体,观测下腰椎侧方血管神经及毗邻结构的走行、分布及毗邻关系。结果:腰L1、L2、L3节段血管走行、分布比较恒定,走行于相应椎体的中央偏下水平,但L4动、静脉走行变异较大,其中36.7%(11例)走行于L4/L5间隙表面;L3～L5椎间孔外口处脊神经的直径及脊神经前支距下位椎间盘的距离均逐渐增大;脊神经前支与椎体正中矢状面的夹角L3～L4增大,而L5却减少到L3的水平;L3～L5左右侧手术窗均逐渐增大,且同一节段水平左侧手术窗大于右侧。结论:由于两侧髂嵴的遮挡,XLIF在L5/S1间隙难于进行,在L3/L4、L4/L5间隙可以顺利进行。

Applied anatomy of vessels, nerves and adjacent structures of the lower lumbar vertebrae

Objective:To provide anatomic data for lower lumbar spine interbody fusion through the extreme lateral approach (XLIF). Methods:This study investigated 30 human cadavers to record the course, distribution and relationship of vessels and nerves and their adjacent structures of lower lumbar vertebrae. Results:The course and location of the 1st, 2nd and the 3rd lumbar arteries and veins were more constant, which followed the center of the corresponding lumbar vertebrae. However, the 4th lumbar artery and vein varied greatly. Vessels of 11 (36.7%)of all samples coursed on the surface of L4/5 interspace. The diameters of L 3~5 spinal nerves around intervertebral foramen and the distance from the anterior branches of those nerves to the corresponding lower disc gradually increased. The angles between the anterior branches of the L 3~4 spinal nerves and the median sagittal planes of corresponding vertebral body increased, but decreased again at the L5 level. The operation windows of L 3~5 gradually increased and the left ones were wider than the right. Conclusions:The XLIF of L 3 /L 4 , L 4 /L 5 disc is safe, reliable and practical. However the L 5 /S 1 disc interbody fusion is impossible for the block of bilateral iliac crests.