作　　者： (王洪立）; (张宇轩）; (马晓生）; (夏新雷）; (吕飞舟）; (姜建元）;

机构地区： 复旦大学附属华山医院骨科,复旦大学脊柱外科中心,上海200040

出　　处： 《中华骨科杂志》 2017年第16期1014-1020,共7页

摘　　要： 目的基于解剖学研究评估腰椎不同节段进行斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）中发生交感神经损伤的风险。方法选择健康成人志愿者24名（男女各12名），采用Siemens磁共振MAGNETOMYerio3．0T进行常规腰椎扫描。于L2,3、L3,4、L4,5，椎间隙中央层面轴位T2加权像上辨识左侧腰交感干、腹主动脉、左侧腰大肌等解剖结构，测量OLIF手术入路相关解剖学参数和左侧交感干与毗邻结构的解剖学参数。不同性别之间对应参数比较采用成组t检验；不同节段之间对应参数比较采用最小显著差异（LSD）单因素方差分析。结果OLIF手术入路相关解剖学参数和左侧交感干与毗邻结构的解剖学参数自L2,3-L4,5节段均呈规律性变化。健康成年国人L2,3-L4,5，左侧腰大肌前缘至腹主动脉的距离男性为（13．65±4．10）mm-（9．42±4．00）mm，女性为（13．89±3．18）mm-（8．38±3．33）mm，均呈明显下降趋势。L2,3-L4,5，节段左侧交感干至腹主动脉的距离男性为（10．76e3．89）mm-（6．68±3．39）mm，女性为（11．52±3．02）mm～（6．12±2．95）mm，亦均呈明显递减趋势。国人不同节段之间OLIF手术操作范围存在明显差异，L2,3，节段OLIF手术操作空间相对较大，交感神经损伤风险相对较小；左侧腰交感干在L。椎间隙层面走行位置更加偏前、偏内，在OLIF手术过程中存在较大的损伤风险。结论L2,3-L4,5，节段左侧交感干位于或紧邻OLIF手术操作通道，OLIF术中存在一定的交感神经损伤风险；但L2,3、L3,4、L4,5，不同节段OLIF术中发生交感神经损伤的风险亦有差异。 Objective To assess the risk of sympathetic nerve injury in oblique lumbar interbody fusion （OLIF） in dif- ferent lumbar spine segments based on anatomical study. Methods Twenty-four healthy adult volunteers （12 male and female） were selected and routine lumbar spine scanning was performed with MAG MAGOMOM Verio 3.0 T. The anatomical structures of left lumbar sympathetic trunk, abdominal aorta and left psoas muscle were identified on T2 images of L2,3, L3,4, L4,5 intervertebral space. And the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and adjacent structures were measured. The t-test was used to compare the parameters between the different sexes. The compari- son of the data between the different segments was performed by the least significant difference （LSD） single factor analysis of vari- ance. Results From the L2,3 to L4,5 segments, the anatomical parameters of the OLIF operation approach and the anatomical pa- rameters of the left sympathetic trunk and the adjacent structures showed regular changes. The distances between the anterior mar- gin of the left psoas muscle and the abdominal aorta from L2,3 to L4,5 were 13.65±4.10 mm to 9.42 ± 4.00 mm in adult healthy male individuals, and 13.89±3.18 mm to 8.38 ± 3.33 mm in female individuals, showing a significant downward trend. The distances be- tween the left sympathetic trunk and the abdominal aorta from L2,3 to L4,5 were 10.76±3.89 mm to 6.68±3.39 mm in adult healthy male individuals, and 11.52±3.02 mm to 6.12±2.95 mm in female individuals, also showing a significant downward trend. There were significant differences in the operation area of OLIF surgery between different segments. The operation area of OLIF surgery was relatively large in L 2.3 segment, and the risk of sympathetic nerve injury was relatively small. The left lumbar sympathetic trunk in the L3,4 intelvertebral space was walking front and inside, and there was a greater risk of injury in the OLIF surgery.

关 键 词： 腰椎 脊柱融合术 交感神经系统 解剖学 局部