CAJ | 학술논문

目的:观察下腰椎前方血管走行特点,为下腰椎前路椎间融合术,特别是腹腔镜下微创手术提供解剖学依据.方法:对60例(男女各30例)患下腰椎疾病需行前路手术治疗的患者行下腰椎三维CT血管造影(3D-CTA),观察下腰椎前方血管在椎体前的走行,测量与腰椎前方血管位置相关的解剖学参数.结果:三维CT重建图像发现腹主动脉分叉点变异较多,髂总静脉汇合点相对恒定;腹主动脉分叉点到L5椎体下缘的距离男性平均39.1mm,女性平均37.4mm;髂总静脉汇合点到L5椎体下缘的距离男性平均27.1mm,女性平均25.9mm;L5/S1椎间隙手术窗大小男性平均36.7mm,女性平均34.6mm;腹主动脉分叉角男性平均56.3°,女性平均58.9°;髂总静脉汇合角男性平均63.1°,女性平均65.7°;右髂总动脉与左髂总静脉夹角男性平均53.6°,女性平均57.3°.结论:下腰椎前方血管解剖位置具有多变性,以腹主动脉分叉点为甚,术前行腰椎3D-CTA检查能明确血管解剖,为手术尤其是腹腔镜下微创手术提供安全保障.
목적:관찰하요추전방혈관주행특점,위하요추전로추간융합술,특별시복강경하미창수술제공해부학의거.방법:대60례(남녀각30례)환하요추질병수행전로수술치료적환자행하요추삼유CT혈관조영(3D-CTA),관찰하요추전방혈관재추체전적주행,측량여요추전방혈관위치상관적해부학삼수.결과:삼유CT중건도상발현복주동맥분차점변이교다,가총정맥회합점상대항정;복주동맥분차점도L5추체하연적거리남성평균39.1mm,녀성평균37.4mm;가총정맥회합점도L5추체하연적거리남성평균27.1mm,녀성평균25.9mm;L5/S1추간극수술창대소남성평균36.7mm,녀성평균34.6mm;복주동맥분차각남성평균56.3°,녀성평균58.9°;가총정맥회합각남성평균63.1°,녀성평균65.7°;우가총동맥여좌가총정맥협각남성평균53.6°,녀성평균57.3°.결론:하요추전방혈관해부위치구유다변성,이복주동맥분차점위심,술전행요추3D-CTA검사능명학혈관해부,위수술우기시복강경하미창수술제공안전보장.
Objective:To morphoiogize the vascular configuration anteriorly to lower lumbar vertebraes and their circumferential structure,and to provide the anatomic data for anterior lumbar spine inter-body fusion es-pecially for minimal invasive surgery under laparescopy.Method:60 cases(30 cases for each sex) neccessitat-ing ALIF underwent three dimensional computed tomographic angiography(3D-CTA) anteriorly to lower lumbar vertebraes,the orientation and distribution of vessels anteriorly to lower lumbar vertebraes were depicted and the anatomic parameters with respect to vessels and their circumferential were recorded either.Result:The bi-furcation level of the ventral aorta varied significantly under 3D-CTA imaging while the confluence level of the common iliac vein was constant.The distance from the bifurcation of ventral aorta to the top of L5/S1 disc averaged 39.1mm in male and 37.4mm in female.The distance from the confluence of common iliae vein to the top of L5/S1 disc averaged 27.1mm in male and 25.9mm in female.The width of the operation window at L5/S1 disc averaged 36.7mm in male and 34.6mm in female.The bifurcation angle of the ventral aorta aver-aged 56.3° in male and 58.9° in female,the confluence angle averaged 63.1° in male and 65.7° in female,the included angle of fight common lilac artery and left common iliac vein averaged 53.6° in male and 57.3°in female.Conclusion:The vessels anteriorly to lower lumbar vertebraes varied siguificantly,especially at the bifurcation level of the ventral aorta.Pre-operafive routine 3D-CTA imaging can be used to identify the vas-cular anatomy and ensure the safety of surgical procedure especially in mini-invasive operation.