摘要
背景:后入路行下腰椎体次全切除重建可损伤腰骶丛神经。目的:观测腰骶丛神经根间距离和对应腰椎体冠状截面的大小关系,为后入路行下腰椎体次全切除重建的安全性提供解剖学依据。方法:解剖20具成人尸体的双侧腰骶丛和对应腰椎椎体,观察腰骶丛神经的走行特点。测量双侧L_2-L_5相邻腰神经根自硬膜囊发出处之间距离、双侧L_2-L_5腰神经根由硬膜囊发出处至邻近神经根链接处距离;测量L_3-L_5椎体高度和中横径长度;测量双侧L_3-L_5脊神经神经根与硬膜囊夹角。结果与结论:(1)L_3椎体单侧腰骶丛间面积平均值较对应椎体冠状面积半值平均值小30 mm^2左右;(2)L_4椎体单侧腰骶丛间面积平均值较对应椎体冠状面积半值平均值大100-150 mm^2;(3)L_5椎体单侧腰骶丛神经间面积平均值较对应椎体冠状面积半值平均值男性大15 mm^2,女性大180 mm^2;(4)后入路次全切除L_3,L_4,L_5椎体并重建时腰骶丛神经根无解剖上的危险,而次全切除L_4安全性最高。
BACKGROUND:Reconstruction of low lumbar vertebrae using subtotal vertebrectomy through posterior approach can result in severe damage to lumbosacral plexus.OBJECTIVE:To explore the distance between lumbosacral nerve roots and the relationship between the lumbosacral plexus and lumbar vertebrae in the coronary plane,providing anatomical basis for the reconstruction of low lumbar vertebrae by subtotal vertebrectomy through posterior approach.METHODS:Posterior dissections of the lumbosacral plexus and corresponding vertebrae were performed bilaterally on 20 adult cadavers.We measured the distance from the inferior border of the superior nerve root to the superior border of the next-most inferior nerve root was measured,at the point where the nerve roots emerged from the common dural sac;the distance along each nerve root from its emergence from the common dural sac to its first connection with the plexus of the adjacent root,and these measurements were taken at L2-L5 bilaterally.The height and diameter of the posterior margin of L3-L5 vertebrae,and the angle between the nerve root and dural sac from L3 to L5 bilaterally were measured.RESULTS AND CONCLUSION:The mean area of the unilateral lumbosacral plexus at L3 was about 30 mm^2 smaller than the corresponding hemivertebrate in the coronary plane.The mean area of the unilateral lumbosacral plexus at L4 was about 100-150 mm^2 larger than the corresponding hemivertebrate in the coronary plane.The area of the lateral lumbosacral plexus at L5 was about 15 mm^2 in males larger than the corresponding hemivertebrate in the coronary plane,and it was about 180 mm^2 in females.In summary,reconstruction of low lumbar vertebrae by subtotal vertebrectomy at L3,L4 and L5 through posterior approach is feasible without the risk of damaging the surrounding nervous structures,especially at L4.
作者
朱爱国
张烽
朱建炜
金国华
Zhu Aiguo;Zhang Feng;Zhu Jianwei;Jin Guohua(Department of Orthopedics,Rudong People’s Hospital,Rudong 226400,Jiangsu Province,China;Department of Orthopedics,Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu Province,China;Department of Anatomy,Medical School of Nantong University,Nantong 226001,Jiangsu Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第4期573-577,共5页
Chinese Journal of Tissue Engineering Research
