腰动、静脉在脊柱前路手术中的应用解剖学研究

目的：对腰动静脉的位置分布及变异进行描述和统计分析,以提高腰骶段脊柱手术手术的安全性和有效性。方法：对30具尸体标本进行解剖学研究,主要观察（1）腰动静脉的数量与缺失,各节段腰动静脉发出点位置的定性描述,（2）腰动静脉左右共干与上下共干的概率以及腰动静脉的其他变异。结果：腰动脉的数量以及位置相对固定,有5对腰动脉的一共有5例,腰动脉发出点的位置也不是完全与腰椎对应。腰动脉左右共干的占9.6%,未见上下共干。动脉中仅有65.3%的动脉有静脉伴行。腰静脉的数量变异非常大,最少一侧仅有1支腰静脉,最多有5支,最常见的情况是3支,占36.7%。腰静脉的位置变异也较大,与椎体没有特别的规律。腰静脉的左右共干的概率要大于动脉,为38.5%,而上下共干也是腰静脉的独有的现象,总共有26支,占总数的12.5%。另外,腰静脉的其他变异多见。结论：当脊柱手术选择腹主动脉左侧入路或者腹主动脉下腔静脉之间入路时,腰动脉和腰静脉的解剖特点尤为重要。动脉的位置相对较恒定,而静脉则变异较大,缺失常见,左右共干,上下共干,静脉之间的大的交通支常见,与腰椎的对应性不如动脉,且其与动脉并非严格伴行,这些原因都造成了静脉容易损伤的原因,在手术中应该特别注意。

Applied Anatomy Research of Lumbar Artery and Vein in Lumbar and Sacral Spinal Surgery

Objective：This study investigated the anatomical features of the segmental lumbar artery and vein.The purpose is to improve the safety and the validity of lumbar and sacral spinal surgery.Methods：In our study we dissect the vascular system anterior to lumbar vertebrates of 30 cadavers to learn their characteristics.We choose the indexes to measure as follows （1） The location,numbers and variance of segmental lumbar arteries and veins.Results：The location of the segmental lumbar arteries is firmly related to the location of the vertebrate body.Five cases were found to have the fifth segmental lumbar arteries.9.6% pairs share a common initial stem.Only 65.3% arteries pair with their corresponding vein.There is great variation of the number of the segmental lumbar vein arrange from 1 to 6 mainly 3 on 60 sides of the 30 vena cava.We found that the corresponding relationships of the confluent points of the lumbar veins with the vertebrate body were not so firm as the artery with vertebrate body.And the left and right veins were not regularly paired.38.5% of the left and right veins share a common confluent stem vein and 12.5% of the veins have common confluent stem vein on the same side of the vena cava.Besides anastomoses between the segmental lumbar veins are not rare in these cases.Conclusion：In the operation we should pay special attention to the vein including segmental lumbar veins because of their great variation of their numbers,confluent point,common stem and anastomoses between them.