人腰椎交感神经解剖学研究

目的对人腰椎交感神经进行解剖学研究。方法采用福尔马林固定尸体6具,去除腹主动脉、下腔静脉及周围脂肪组织,在解剖显微镜下观察腰交感干、交通支和窦椎神经走行及分布。结果按交感神经交通支与腰大肌的关系,将交感神经交通支分为浅斜支和深横支。浅斜支位于腰大肌和椎体侧方之间,呈非节段性分布;深横支横行位于腰椎椎体侧方,伴随于腰节段动、静脉,呈节段性分布。椎体和椎间盘前侧由交感干分支和内脏神经支配。椎体外侧和后外侧由交感干分支、深交通支及脊神经分支共同支配,在上腰部还接受交感神经浅斜支的非节段性支配。椎体和椎间盘后部及后纵韧带接受由深横支发出的窦椎神经支配。结论腰椎存在两种支配形式：由脊神经发出的节段性支配和通过交感神经系统分布的非节段性支配。腰交感神经系统参与腰椎及椎间盘的神经支配,可能与椎间盘源性腰痛的痛觉传递过程有关。

Anatomical study of human lumbar spine innervation

OBJECTIVE: To explore the detailed innervation of the lumbar spine of humans. METHODS: Six adult cadavers fixed in a solution containing 10% formalin were investigated under a stereomicroscope. The lumbar spine, together with the abdominal aorta, inferior vena cava and psoas muscle, was extracted. The dissection was focused on various patterns of rami communicantes (RC), including superficial oblique rami (SOR) and deep transverse rami (DTR), and their relationship to the psoas major muscle, the minute nerve supply of the anterior and posterior longitudinal ligaments, vertebral bodies and the intervertebral discs. RESULTS: Two types of RC were observed: SOR and DTR. SOR ran obliquely between the superficial heads of the psoas major muscle, connecting the sympathetic trunk and T12-L2 spinal nerves non-segmentally. DTR, running along the lumbar arteries and veins, were distributed segmentally, close to the vertebral bodies. On the anterior aspect of the lumbar spine, the anterior longitudinal ligaments received branches from the sympathetic trunk and splanchnic nerves non-segmentally. On the lateral side of the lumbar spine, the vertebral bodies and the intervertebral discs received branches from the DTR and ventral rami segmentally, branches from the sympathetic trunk, and, in the upper lumbar region, SOR non-segmentally. Within the vertebral canal, the posterior aspect of the intervertebral discs and the posterior longitudinal ligaments received the sinu-vertebral nerves originating from DTR. CONCLUSION: Exist two different types of innervation in the lumbar vertebrae: one originating directly from the spinal nerve segmentally, and one reaching the vertebral body and intervertebral disc via the sympathetic nerves non-segmentally. Therefore, sympathetic nerves are involved in the innervation of the spinal column and intervertebral disc and are likely involved in discogenic low back pain.