椎静脉系造影术及其形态学基础

自1940年 Batson 首次全面地描述了椎静脉系的形态以来,椎静脉系的解剖愈来愈引起学者们重视,相继有不少学者详细地阐述了椎静脉系的组成及 X 线解剖。在此基础上,1968年 Būchler 首先经股静脉选择性插管行椎静脉系造影诊断惟间盘突出。1974年 Ga-rgano 肯定了该造影术的优越性,他认为应用本法可使椎间盘突出的术前诊断正确率高达91%以上。随之椎静脉系造影术在临床应用也日趋广泛。除用于椎间盘突出外,还可用于诊断椎管内其他疾患,如椎管内占位性病变。本文收集了近年来有关椎静脉系形态、X 线表现及其椎静脉系造影术在临床应用等有关文献作一综述。     

颈内静脉的静脉丛引流模式及影响因素

目的　探讨颈内静脉的主要静脉丛引流模式以及相关因素。 方法　根据160例脑血管病患者DSA图像资料,分析动脉造影的静脉期成像。将颈内静脉的主要静脉丛分为前路引流模式（翼静脉丛）及后路引流模式,后路引流模式分为丛状引流（椎旁静脉丛）和孤立静脉引流（以颈深部静脉为主）。后路丛状引流再分为2组：椎旁静脉丛伴或不伴明显颈深部静脉引流。根据临床资料及相关危险疾病,应用卡方检验分析颈内静脉主要静脉丛引流模式的影响因素。 结果　双侧颈内动脉造影显示160例病人共320侧颈内静脉,其中19.7%（63侧）为翼静脉丛引流,16.9%（54侧）为椎旁静脉丛伴有明显颈深部静脉引流,15.6%（50侧）为椎旁静脉丛伴无明显颈深部静脉引流,10侧（3.1%）为颈深部静脉引流,5.7%（13侧）为前、后丛联合引流。χ2检验发现,年龄、伴颈内静脉异常（发育不全、狭窄、闭塞）、伴颈内静脉压迹、合并高血压病是影响颈内静脉静脉丛引流模式的独立危险因素。 结论　颈内静脉的静脉丛引流模式,以后路椎旁静脉丛引流为主,引流模式可因相关因素而改变,这对评估颅底、颈部手术及神经介入治疗具有重要价值。     

患有肝脏疾病成人骶静脉丛的解剖及临床意义

目的:为患有肝病的直肠癌的外科治疗提供解剖学基础.方法:在20具患有肝脏疾病的成人尸体上解剖观测骶静脉丛的组成及结构特点.结果:①骶静脉丛吻合丰富,呈网状弯曲如蚓.②管壁薄,管腔大、充盈扩张,缺乏静脉瓣.③骶静脉丛与直肠静脉丛、骶管椎内静脉丛有直接交通.结论:.本研究结果为直肠癌根治术的开展提供解剖学基础与参考数据.     

患有肝脏疾病成人骶静脉丛的解剖及临床意义

目的:为患有肝病的直肠癌的外科治疗提供解剖学基础。方法:在20具患有肝脏疾病的成人尸体上解剖观测骶静脉丛的组成及结构特点。结果:①骶静脉丛吻合丰富,呈网状弯曲如蚓。②管壁薄,管腔大、充盈扩张,缺乏静脉瓣。③骶静脉丛与直肠静脉丛、骶管椎内静脉丛有直接交通。结论:。本研究结果为直肠癌根治术的开展提供解剖学基础与参考数据。     

患有肝脏疾病成人骶静脉丛的解剖及临床意义

目的为患有肝病的直肠癌的外科治疗提供解剖学基础.方法在20具患有肝脏疾病的成人尸体上解剖观测骶静脉丛的组成及结构特点.结果①骶静脉丛吻合丰富,呈网状弯曲如蚓.②管壁薄,管腔大、充盈扩张,缺乏静脉瓣.③骶静脉丛与直肠静脉丛、骶管椎内静脉丛有直接交通.结论.本研究结果为直肠癌根治术的开展提供解剖学基础与参考数据.     

腰椎椎基静脉孔的解剖学观测及其临床意义

目的　通过对腰椎椎基静脉孔（BVF）的观测,为临床脊柱外科手术提供解剖学数据。  方法　(1)测量115块成人腰椎观测BVF的数目、面积、与椎体上下缘距离、与左右椎弓根最短距离。(2)解剖成人尸体13具,观察BVF的形态结构。  结果　(1) BVF以椭圆形多见,不同人体BVF数目有差异（P<0.05）,分布集中。(2) BVF与椎体上缘及左右椎弓根最短距离在不同人体间有差异（P<0.05）,与椎体上下缘距离、左右椎弓根最短距离在同一人体不同腰椎间有差异（P<0.05）。(3)尸体解剖见血管出入BVF,并有脂肪组织等软组织填充。  结论　腰椎BVF是腰椎椎体后壁面积较大的骨质缺损区。该区域与左右椎弓根之间以及与椎体上下缘之间有一无血管出入骨质的区域,为临床脊柱外科手术提供参考。     

颈椎前路减压与椎内静脉丛相关的应用解剖学研究

目的探讨颈椎前路手术中减压范围与椎内静脉丛出血问题相关的应用解剖学研究.方法选择6具新鲜尸体和12具经防腐固定的完整的成人颈部标本(C1～T1),对椎体钩突前脚间距、钩突前脚与横突孔内壁垂直距离及椎内前静脉丛两侧纵行血管间距等进行解剖观察.结果椎内前静脉丛潜行于后纵韧带内,紧贴硬脊膜背面,两条纵行血管问形成横行交通支;在C3～C7相应椎体,钩突内侧缘与横突孔内壁间距为(5.25±0.85)mm,C3～C7相应节段椎内前静脉丛两侧纵行血管间距从(11.13±0.20)mm增大到(14.98±0.27)mm.C3～C7钩突前角间距从(14.60±1.03)mm增大到(21.51±1.91)mm,钩突前后径均大于11 mm.结论颈椎前路手术减压的安全区域可以双侧钩突前角为解剖标志,在此范同内,可完全显露椎内静脉丛两侧纵行静脉,从而有效地处理椎内静脉丛术中出血问题,手术安全,减压彻底.     

骶前区静脉丛的解剖学特点及临床意义

目的：研究骶前区静脉丛（Ｖｅｎｏｕｓ ｐｌｅｘｕｓ ｏｆ ｐｒｅｓａｃｒａｌ ｒｅｇｉｏｎ ，ＶＰＰＳＲ） 的解剖学特点，为骶前区静脉破裂大出血的防治提供解剖学基础。方法：在３４ 具成人尸体上，分虽观测ＶＰＰＳＲ 的组成、管壁、瓣膜、长度及直径。结果：ＶＰＰＳＲ 管壁薄、缺少静脉瓣，呈网状。ＶＰＰＳＲ Ｓ１～５ 横干的长度和直径（ Ｆ 检验） 均有显著差异，Ｐ＜ ０ ．０５ 。其长度平均（ 珋ｘ ±ｓ） ：Ｓ１ 为３ ．２ ±１ ．５ ｃｍ ，Ｓ２ 为４ ．４ ±１ ．０ ｃｍ ，Ｓ３ 为３ ．５ ±１ ．１ ｃｍ ，Ｓ４ 为２ ．３ ±０ ．９ ｃｍ ，Ｓ５ 为１ ．０ ±０ ．３ ｃｍ ；其直径平均（珋ｘ ±ｓ） ：Ｓ１ 为１ ．２ ±０ ．７ ｍ ｍ ，Ｓ２ 为２ ．５ ±１ ．５ ｍ ｍ ，Ｓ３ 为２ ．５ ±１ ．５ ｍ ｍ ，Ｓ４为１ ．７ ±１ ．５ ｍ ｍ ，Ｓ５ 为０ ．９ ±０ ．６ ｍ ｍ 。Ｓ４ 椎体前穿通支静脉口径２ ～４ ｍ ｍ 占８ ．８ ％ ，０ ．１ ～１ ．９ ｍ ｍ 占９１ ．２ ％ 。结论：ＶＰＰＳＲ 解剖变异多、血管壁薄、缺少静脉瓣是引起ＶＰＰＳＲ 损伤大出血甚至死亡的解剖学基础。     

骶前静脉丛解剖学研究

目的：为直肠癌根治术引起骶前区静脉破裂大出血的防治提供形态学基础。方法：在30具成人尸体上,观测了骶前静脉丛的组成及其属支,管壁,瓣膜,汇入途径以及与其它静脉丛的关系。结果：骶前静脉丛壁薄,缺乏静脉瓣,吻合丰富,呈丛状,并通过骶椎体前穿通支与椎体静脉系相能,结论：骶前静脉丛来源广泛,吻合丰富,变异突出,管壁薄,大多无瓣膜,是手术误伤引起骶前静脉丛大出血的解剖学基础。     

The vertebral venous plexuses: the internal veins are muscular and external veins have valves

The internal and external vertebral venous plexuses (VVP) extend the length of the vertebral column. Authoritative sources state that these veins are devoid of valves, permitting bidirectional blood flow and facilitating the hematogenous spread of malignant tumors that have venous connections with these plexuses. The aim of this investigation was to identify morphologic features that might influence blood flow in the VVP. The VVP of 12 adult cadavers (seven female, mean age 79.5 years) were examined by macro- and micro-dissection and representative veins removed for histology and immunohistochemistry (smooth muscle antibody staining). A total of 26, mostly bicuspid, valves were identified in 19 of 56 veins (34%) from the external VVP, all orientated to promote blood flow towards the internal VVP. The internal VVP was characterized by four main longitudinal channels with transverse interconnections; the maximum caliber of the longitudinal anterior internal VVP veins was significantly greater than their posterior counterparts (P < 0.001). The luminal architecture of the internal VVP veins was striking, consisting of numerous bridging trabeculae (cords, thin membranes and thick bridges) predominantly within the longitudinal venous channels. Trabeculae were composed of collagen and smooth muscle and also contained numerous small arteries and nerve fibers. A similar internal venous trabecular meshwork is known to exist within the dural venous sinuses of the skull. It may serve to prevent venous overdistension or collapse, to regulate the direction and velocity of venous blood flow, or is possibly involved in thermoregulation or other homeostatic processes.     

The posterior intercostal vein: A thermoregulatory gateway to the internal vertebral venous plexus

The internal vertebral venous plexus (IVVP) plays a putative role in thermoregulation of the spinal cord. Cold cutaneous venous blood may cool, while warm venous blood from muscles and brown fat areas may warm the spinal cord. The regulating mechanisms for both cooling and warming are still unknown. Warm venous blood mainly enters the IVVP via the intervertebral veins. In the thoracic area these veins are connected to the posterior intercostal veins. In this study, anatomical structures were investigated that might support the mechanisms by which warmed venous blood from the intercostal muscles and the recently described paravertebral patches of brown adipose tissue are able to drain into the vertebral venous plexus. Therefore, tissue samples from human cadavers (n = 21) containing the posterior intercostal vein and its connections to the IVVP and the azygos veins were removed and processed for histology. Serial sections revealed that the proximal parts of the posterior intercostal veins contained abundant smooth muscle fibers at their opening into the azygos vein. Furthermore, the walls of the proximal parts of the posterior intercostal veins contain plicae that allow the vessel to dilate, thereby allowing it to serve as a pressure chamber. It is suggested that a cold induced closure of the intercostal/azygos opening can result in retrograde blood flow from the proximal posterior intercostal vein towards the IVVP. This blood flow would be composed of warm blood from the paravertebral brown adipose tissue and blood containing metabolic heat from the muscles draining into the intercostal veins. Clin. Anat. 26:735–740, 2013. © 2013 Wiley Periodicals, Inc.     

Morphology of the human internal vertebral venous plexus: A cadaver study after intravenous araldite CY 221 injection

Reviewing the literature on the vascular anatomy of the spinal epidural space, it appeared that the knowledge of the internal vertebral venous plexus is limited. Injection studies of the entire internal vertebral venous plexus after application of modern techniques, to the best of our knowledge, have never been performed. Based on the clinical importance of these structures, it was decided to study the human vertebral venous system after Araldite CY 221 injection, in order to update the morphological characteristics of the internal vertebral venous system. The vertebral venous systems of ten fresh human cadavers, between 64 and 93 years of age, were injected with Araldite CY 221 mixture. All cadavers were dissected and the posterior and anterior internal vertebral venous plexuses were studied in detail. The anterior part of the internal vertebral venous plexus is fairly constant. On the contrary, the posterior internal vertebral venous plexus showed a striking segmental and interindividual variability. In the thoracic area, two types of traversing veins are observed. Both types show a somewhat symmetrical “inversed V” configuration. No anatomical valves were observed. Nevertheless, anterograde flushing (via the femoral veins) of the vertebral venous system appeared to proceed much faster than retrograde flushing (via the superior vena cava). The classical picture of the internal vertebral venous plexus appears a simplification of the actual situation. Especially in the posterior part, segmental and interindividual differences are prominent. The preferential direction of the flow during flushing suggests the presence of functional valves, which are probably located in the thoracic part of the posterior internal vertebral venous plexus, resulting from the typical shape of the veins in this area. This might explain the difficulties with imaging of the posterior part of the internal vertebral venous plexus in vitro as well as in vivo. Further study is needed to determine whether the configuration of the posterior internal vertebral venous plexus in younger individuals is different, compared with the presently studied aged subjects. Anat. Rec. 249:285–294, 1997. © 1997 Wiley-Liss, Inc.     

软骨终板形态与腰椎间盘突出症之间关系的影像学研究

目的:探讨软骨终板与腰椎间盘突出症之间的关系。方法:40例无脊柱疾患与62例腰椎间盘突出症患者,分别采用螺旋CT扫描。扫描范围自L4上缘至S2上缘;扫描条件:140kV,345mAs,FOV160mm,层厚1mm,螺距1.0,Pitch 1.0,无间隔重建。利用O2图像工作站将原始扫描图像进行多平面重建(multiple planar reconstruction,MPR),再在MPR重建的基础之上行曲面重建(curve planar reconstruc-tion,CPR),测量软骨终板的最大矢状径、横径、面积、周径与形状。结果:(1)软骨终板的形态与椎间盘突出症密切相关(P均<0.01);(2)男性患者L4、5和L5、S1,女性患者L5、S1的椎间盘面积与椎间盘突出症相关(P<0.05)。结论:椎间盘软骨终板的形态与椎间盘突出症密切相关。     

Microsurgical anatomy of the internal vertebral venous plexuses

Summary Few studies have been done about the venous vascularization of the spine since neuroradiologic studies in the 1960s and 70s. The aim of this study was to clarify the topography of the internal vertebral venous plexuses in relation to the posterior longitudinal ligament and the dura. The relationships of the vv. were studied at different levels of the spine. The internal vertebral venous system of seven cadavers was injected with a blue bicomponent silicon rubber. It consisted with an anterior and a posterior venous plexus. At the cervical level, the anterior longitudinal vv. are located in a dehiscence of the periosteal layer, in the lateral part of the spinal canal. At each level, they joined the contralateral one at the midline by a retrocorporeal v. located behind the posterior longitudinal ligament. No vv. were found in the epidural space. There was a major development of the retrocorporeal v. of the axis, but it did not receive any venous drainage from the vertebral body. At the thoracic and lumbar levels, the anterior venous plexuses remain within a dehiscence of the periosteal layer, which is thinner. The retrocorporeal vv. become pre-ligamentous. We did not find any posterior venous plexuses at the cervical level, but they were evident at the thoracic level and became more voluminous and sinusoidal in the lumbar region.

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Anatomie micro-chirurgicale des plexux veineux vertébraux internes

Résumé Peu d'études ont concerné la vascularisation veineuse vertébrale interne depuis l'intérêt porté par les neuroradiologues dans les années 1960–1970. Le but de cette étude est de préciser la topographie des plexus veineux vertébraux internes par rapport au ligament longitudinal postérieur et à la dure-mère. Les rapports des veines sont étudiés aux différents étages de la colonne vertébrale.Le système veineux vertébral interne de sept cadavres a été injecté avec un élastomère de silicone bicomposant coloré en bleu. Il est constitué de deux plexus l'un antérieur et l'autre postérieur. A l'étage cervical, les veines longitudinales antérieures se situent dans un dédoublement du feuillet périosté, dans la partie latérale du canal vertébral. Elles s'anastomosent, à chaque étage, sur la ligne médiane par une veine rétro-corporéale, placée en arrière du ligament longitudinal postérieur. Nous n'avons pas retrouvé de veines dans l'espace épidural. Il existe un développement considérable de la veine rétro-corporéale de l'axis ; elle ne reçoit pas le drainage veineux du corps vertébral. A l'étage thoracique et lombaire, les plexus veineux antérieurs restent dans un dédoublement d'un feuillet périosté beaucoup plus fin. Les veines rétro-corporéales deviennent pré-ligamentaires. Nous n'avons pas retrouvé de plexus veineux postérieurs à l'étage cervical. Ils apparaissent à l'étage thoracique pour devenir plus volumineux et sinusoïdaux à l'étage lombaire.

     

Morphology of the human internal vertebral venous plexus: a cadaver study after latex injection in the 21-25-week fetus

The morphology of the anterior and posterior internal vertebral venous plexus (IVVP) in human fetuses between 21-25 weeks of gestational age is described. The results are compared to the findings of a previous morphological study of the IVVP in the aged. The morphological pattern of the anterior IVVP in the fetus is very similar with the anterior IVVP in the aged human. In contrast, the posterior IVVP in the fetus lacks the prominent transverse bridging veins that are present in the aged lower thoracic and the lumbar posterior IVVP. The background of these morphological differences is unclear. Maybe the thoracolumbar part of the posterior IVVP is subject to "developmental delay," or the observed differences in the aged may result from functional and age-related factors that trigger this part of the vertebral venous system during (erect) life. The observed age related morphological differences of the posterior IVVP support the concept of the venous origin of the spontaneous spinal epidural hematoma (SSEH).     

椎弓根的解剖学观测与临床意义

目的 为临床脊柱手术提供形态学资料.方法 对36具成人尸体的整体脊柱标本,使用游标卡尺测量C_3～L_5椎弓根的高和宽.分别计算各节段椎弓根高和宽的均值和标准差,并分段计算颈椎(C_3～C_7)、胸椎、腰椎各段椎弓根高和宽的平均值.结果 C_3～C_7的高和宽分别为6.77mm和5.50mm;胸椎分别为12.30mm和6.37mm;腰椎平均值分别为15.97mm和9.41mm.结论 提供国人椎弓根的解剖学资料,为临床椎弓根螺钉内固定提供应用解剖学基础.