| 黎斐文,吕国华,王冰.下腰椎前路腹腔镜椎体间融合术的血管应用解剖[J].脊柱外科杂志,2004,2(1):30-32,35. |
下腰椎前路腹腔镜椎体间融合术的血管应用解剖  点此下载全文 (Fulltext) |
| 黎斐文 吕国华 王冰 |
| 416000 湖南, 吉首湘西自治州人民医院;中南大学湘雅二医院脊柱外科;中南大学湘雅二医院脊柱外科 |
| 基金项目： |
| DOI： |
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| 摘要： |
| 目的 对下腰椎（L3~S1）前路血管进行解剖学研究，分析其变异情况并探讨下腰椎前路腹腔镜下椎体间融合术的可靠性和安全性。方法 解剖30例成人尸体标本（男15例、女15例），记录腹主动脉的分叉点及髂总静脉的汇合点位置，以及动静脉血管的椎前走向；测量上述分叉点与汇合点到L5 椎体下缘的距离；测量L5/S1椎间隙手术窗大小（即平椎间隙右髂总动脉与左髂总静脉之间的距离）；记录骶正中动脉的起始点，骶正中静脉汇入点及二者的走向。结果 腹主动脉分叉点、髂总静脉汇合点分布在L4~L5之间，腹主动脉行走于椎体左前方，下腔静脉行走于椎体右前方；腹主动脉分叉点到L5椎体下缘距离，男性平均3.5 cm，女性平均3.6 cm；髂总静脉汇合点到L5椎体下缘距离，男性平均2.2 cm，女性平均2.4 cm；L5/S1椎间隙手术窗大小，男性3.7 cm，女性平均3.4 cm；骶中动脉均起源于腹主动脉分叉部后壁，在骶前沿中线左或右侧下行，骶中静脉多与之伴行。结论 腹主动脉分叉点与髂总静脉汇合点均高于L5椎体下缘，L5/S1椎间隙手术窗大小男性平均3.7 cm、女性平均3.4 cm，腹腔镜下前路L5/S1椎间隙融合术是可靠及安全的；由于血管的遮盖，L3，4、L4，5椎间隙经腹膜前路融合术没有足够的血管分离及牵开是无法进行的。 |
| 关键词：下腰椎 腹腔镜 椎体间融合术 血管应用解剖 |
| Applied vascular anatomy anterior to lower lumbar for laparoscopic spinal fusion Fulltext |
| LI Feiwen LV Guohua WANG Bing |
| Department of Orthopaedics, People's Hospital of Xiangxi Autonomous Prefecture, Hunan 416000, China |
| Fund Project: |
| Abstract: |
| Objective To determine the variability of the anterior vascular anatomy at the lower lumbar spine. To study the reliability and the safety of the operation of lower lumbar spine intervertebral amalgamation through the laparoscope. Methods This study investigated 30 human cadavers (15 males and 15 females). The bifurcation level of the Ventral aorta, the confluence level of the common iliac Vein and the course of the great vessels were recorded. The distance from the bifurcation or confluence to the top of L5/S1 disc and the width of operation window of L5/S1 disc (the distance from right common iliac artery to left common iliac vein) were determined. The origin of the middle sacral artery, the confluence of the middle sacral vein and the course of them were observed. Results The bifurcation level of the ventral aorta and the confluence level of the common iliac vein were showed from L4 to L5. The course of the ventral aorta was in the right front of vertebra, while the course of the common iliac vein was in the left front of vertebra. The distance from the bifurcation to the top of L5/S1 disc was in the average of 3.5cm for males and 3.6 cm for females. The distance from the confluence to the top of L5/S1 disc was in the average of 2.2 cm for males and 2.4 cm for females, while the width of the operation window of L5/S1 disc was in the average of 3.7 cm for males and 3.4 cm for females. The origin of the middle sacral artery was at the back of the bifurcation level, companied with the middle sacral vein often. Conclusion The bifurcation level of the ventral aorta and the confluence level of the common iliac vein were higher than the top of L5/S1 disc, The width of the operation window of L5/S1 was in the average of 3.7 cm for males and 3.4 cm for females. The anterior operation of the L5/S1 disc intervertebral amalgamation through the laparoscope is reliable and safe. However, the operation of the L3,4 disc and L4,5 disc is impossible without significant vascular dissection. |
| Keywords:lower lumbar spine laparoscope intervertebral amalgamation applied vascular anatomy |
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