微创胸腰段侧方入路治疗骨折的解剖学研究

目的探讨微创胸腰段（T11～L2）侧方手术入路在椎体侧方的手术安全操作范围,为治疗特殊类型骨折提供解剖学依据。方法 21具成人防腐尸体标本,男11具,女10具。以克氏针模拟微创套管穿刺针,沿椎体侧方中线分别在上终板、正中心、下终板及相邻椎间盘穿刺标记为A、B、C、D点,以4点为标记点观察椎体侧方血管神经的走行分布,测量椎体侧方可供手术操作的安全区,根据血管神经的走行确定微创器械在椎体侧方的最佳穿刺置入点。结果在T11～L2各椎体侧方结扎椎体节段血管后可得到由椎体上下缘、交感干、椎体后缘或腰丛组成的＂安全窗＂,其面积由T11至L2逐渐增大：男性分别为（273.35±69.72）mm2、（409.59±74.24）mm2、（555.78±139.74）mm2、（614.36±89.46）mm2;女性分别为（173.39±46.62）mm2、（289.51±49.72）mm2、（400.85±45.44）mm2、（451.44±59.80）mm2。该侧方入路的最佳穿刺点为椎体侧方上1/2区域近终板处的A点。结论利用微创侧方手术入路在T11～L2椎体侧方上1/2区域近终板处进行穿刺置入微创器械,＂安全窗＂内进行椎管前侧方减压、单纯椎体内重建术治疗特殊类型Denis B型爆裂骨折在解剖入路上是安全可行的。

Anatomic study of minimally invasive lateral thoracolumbar approach in treatment of fractures

Objective To explore the safe working zones in minimally invasive lateral thoracolumbar(T11-L2) approach,so as to provide anatomical evidence for the treatment of special types of fractures.Methods Totally 21 adult cadaveric specimens(11 males and 10 females) were enrolled in this study.Kirschner wires were used to simulate the minimally invasive needles and inserted into the superior endplate,center,inferior endplate and adjacent discs of T11-L2 along the lateral midline of the spine.The 4 puncture points of every segment were labeled as A,B,C,and D,respectively.The distribution of vessels and nerves on the lateral side of thoracolumbar spine were observed.And the safe working zones on the lateral side of T11-L2 were measured.The best puncture point of minimally invasive device was finally determined.Results On the lateral side of vertebral body,"safe window",a safe working zone,was composed of the upper and lower edge of the vertebral body,sympathetic trunk,the posterior edge of the vertebral body or lumbar plexus after ligating segmental vessels.The "safe window" increased gradually from T11 to L2:(273.35±69.72) mm2,(409.59±74.24) mm2,(555.78±139.74) mm2,and(614.36±89.46) mm2 in males;(173.39±46.62) mm2,(289.51±49.72) mm2,(400.85±45.44) mm2,and(451.44±59.80) mm2 in females.Point at the superior 1/2 region of the lateral vertebra was taken as the best puncture site in the minimally invasive thoracolumbar approach.Conclusion It is anatomically feasible to treat the special type of Denis B burst fracture by minimally invasive lateral approach at the superior 1/2 site near the end plate of T11-L2,anterolateral decompression and vertebral reconstruction in the "safe window".