| 蒲清平,郭涛,施向春,等.基于CT 血管成像技术的下腰椎侧方髂血管临床解剖学研究[J].安徽医药,2023,27(3):520-523. |
| 基于CT 血管成像技术的下腰椎侧方髂血管临床解剖学研究 |
| Clinical anatomy of lateral iliac vessels of the lower lumbar spine based on CT angiography |
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| DOI：10.3969/j.issn.1009-6469.2023.03.021 |
| 中文关键词: 腰椎 解剖学，局部 计算机体层摄影血管造影术 腹主动脉 髂总动脉 髂总静脉 |
| 英文关键词: Lumbar vertebrae Anatomy, regional Computed tomography angiography Abdominal aorta Common iliac ar?tery Common iliac vein |
| 基金项目:2021贵州省卫健委科技基金(gzwkj2021-246) |
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| 中文摘要: |
| 目的 应用CT血管成像技术探究下腰椎侧方大血管的解剖，为下腰椎侧方入路手术提供血管解剖学参考。方法 选取贵州省人民医院2016年6月至2018年11月间行腹部大血管CT血管成像病人影像资料200例(男女各100例)，进行相关观察、测量研究。(1)测量下腰椎左侧方:左髂总动脉后缘与L4-L5椎间隙上、下缘后侧及L5-S1椎间隙上、下缘后侧之间的距离；(2)测量下腰椎右侧方:右髂总静脉后缘与L4-L5椎间隙上、下缘后侧及L5-S1椎间隙上、下缘后侧之间的距离；(3)计算下腰椎侧方髂血管走行安全区“髂血管梯形”面积；(4)将测量、计算结果进行男性、女性差异性比较。结果 (1)下腰椎左侧方:左髂总动脉后缘与L4-L5 椎间隙上缘、下缘后侧的距离:男性(38.17±3.49)mm、(35.39±3.92)mm，女性(34.53±2.84)mm、(31.60±3.32)mm；左髂总动脉后缘与L5-S1椎间隙上缘、下缘后侧的距离:男性(24.97±5.96)mm、(18.86±5.91)mm，女性(20.67±4.88)mm、(14.97±4.40)mm。(2)下腰椎右侧方:右髂总静脉后缘与L4-L5 椎间隙上缘、下缘后侧的距离:男性(31.86±3.50)mm、(29.26±3.77)mm，女性(27.71±3.45)mm、(25.10±3.26)mm；右髂总静脉后缘与L5-S1椎间隙上缘、下缘后侧的距离；男性(21.92±4.63)mm、(17.59±4.81)mm，女性(18.17±4.90)mm、(14.62±3.43)mm。(3)下腰椎“髂血管梯形”(左髂总动脉、L4-L5椎间隙上缘、L5-S1椎间隙下缘、下腰椎后侧缘围成)面积左侧:男性(1 146.95±206.34)mm2、女性(956.63±143.79)mm2。右侧:男性(955.38±188.50)mm2、女性(816.25±135.48)mm2。以上指标男女两组比较均差异有统计学意义(P<0.05)。结论 下腰椎左侧方“髂血管梯形”面积明显大于右侧方“髂血管梯形”面积，且下腰椎左侧方髂总动脉靠髂总静脉之后，血管损伤风险低于右侧方，因此，若左右侧方入路均满足手术需求时，建议选择下腰椎左侧方入路。下腰椎侧方入路手术术前完善下腰椎前大血管CT血管成像，明确下腰椎左、右侧方髂血管走行，据此制定可靠规避血管损伤的手术入路方案，可有效避免血管损伤的发生。 |
| 英文摘要: |
| Objective To explore the anatomy of lateral great vessels of lower lumbar spine by CT angiography, and to provide ana?tomical reference for lateral approach of lower lumbar spine.Methods A total of 200 patients (100 males and 100 females) who re?ceived CT angiography of abdominal great vessels from The Guizhou People's Hospital from June 2016 to November 2018 were select?ed for relevant observation and measurement study. (1) On the left side of the lower lumbar spine, the distance between the posterior margin of the left common iliac artery and the upper and lower margins of the L4-L5 intervertebral space and the upper and lower mar?gins of the L5-S1 intervertebral space was measured; (2) On the right side of the lower lumbar spine, the distance between the posterior edge of the right common iliac vein and the upper and lower edges of the L4-L5 intervertebral space and the upper and lower edges of the L5-S1 intervertebral space was measured; (3) The area of "iliac vascular trapezoid" in the safe zone of the lumbar lateral iliac ves?sels was calculated; (4) The differences between men and women with the measured and calculated results were compared.Results (1)The distance between the posterior margin of the left common iliac artery and the posterior margin of the L4-L5 intervertebral space was(38.17±3.49) mm and (35.39±3.92) mm in male, (34.53±2.84) mm and (31.60±3.32) mm in female. The distance between the posterior margin of the left common iliac artery and the posterior margin of the upper and lower margins of the L5-S1 intervertebral space was(24.97±5.96) mm, (18.86±5.91) mm in males and (20.67±4.88) mm and (14.97±4.40) mm in females. (2) On the right side of the lower lumbar spine: the distance between the posterior margin of the right common iliac vein and the posterior margin of the upper and lower margins of the L4-L5 intervertebral space was (31.86±3.50) mm and (29.26±3.77) mm for males, (27.71±3.45) mm and (25.10±3.26) mm for females. The distance between the posterior margin of the right common iliac vein and the posterior margin of the upper and low?er margins of the L5-S1 intervertebral space was (21.92±4.63) mm and (17.59±4.81) mm for male, (18.17±4.90) mm and (14.62±3.43)mm for female. (3) The left side of the lower lumbar "iliac vascular trapeziform" (left common iliac artery, upper margin of L4-L5 inter?vertebral space, lower margin of L5-S1 intervertebral space, and posterior margin of lower lumbar spine) area: male (1 146.95±206.34)mm2, female (956.63±143.79) mm2. Right: Male (955.38±188.50) mm2, female (816.25±135.48) mm2. The above indicators were statisti?cally different between men and women (P<0.05).Conclusions The "iliac vascular trapezoid" area of the left side of the lower lumbar spine is significantly larger than the "iliac vascular trapezoid" area of the right side, and the risk of vascular injury of the left side of the common iliac artery of the lower lumbar spine is lower than that of the right side after the left side of the common iliac artery of the low?er lumbar spine is adjacent to the common iliac vein. Therefore, if the left and right side of the common iliac artery of the lower lumbar spine meets the surgical requirements, the left side of the lower lumbar spine approach is recommended. CT angiography of the anterior great vessels of the lower lumbar spine is improved before the operation of the lateral approach of the lower lumbar spine, and the route of the left and right iliac vessels of the lower lumbar spine is defined. Based on this, a reliable surgical approach scheme to avoid vascu?lar injury can effectively avoid the occurrence of vascular injury. |
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