CAJ | 학술논문

目的观测腰背部椎旁肌间隙入路局部解剖结构,指导临床应用并评价疗效.方法解剖研究采用10具成人尸体脊柱标本进行胸腰筋膜、竖脊肌腱膜、最长肌、多裂肌及其支配的神经血管束等结构的观测,分别测量第3～4腰椎、第4～5腰椎、第5腰椎～第1骶椎椎间隙中点水平多裂肌最外缘、多裂肌与椎板汇合点及小关节突外缘至后正中线的距离.临床应用传统开放式入路(A组)和椎旁肌间隙入路(B组)分别行下腰椎后路融合术,每组100例,以临床疗效及腰椎椎旁肌MRI为评判标准.结果 ①竖脊肌腱膜与最长肌及多裂肌表面无粘连,下腰段最长肌与多裂肌间隙的接触面未见神经血管,钝性分离即可顺利暴露上关节突及横突根部,第3～4腰椎、第4～5腰椎、第5腰椎～第1骶椎椎间隙中点水平小关节突外缘、多裂肌最外缘及多裂肌与椎板汇合点至后正中线距离约为2.5～3.0 cm；②按Nakai标准B组临床疗效优于A组,MRI显示多裂肌面积B组较A组无明显萎缩.结论椎旁肌间隙入路操作简便,可减少椎旁肌的损伤,临床应用效果良好.
목적 관측요배부추방기간극입로국부해부결구,지도림상응용병평개료효.방법 해부연구채용10구성인시체척주표본진행흉요근막、수척기건막、최장기、다렬기급기지배적신경혈관속등결구적관측,분별측량제3～4요추、제4～5요추、제5요추～제1저추추간극중점수평다렬기최외연、다렬기여추판회합점급소관절돌외연지후정중선적거리.림상응용전통개방식입로(A조)화추방기간극입로(B조)분별행하요추후로융합술,매조100례,이림상료효급요추추방기MRI위평판표준.결과 ①수척기건막여최장기급다렬기표면무점련,하요단최장기여다렬기간극적접촉면미견신경혈관,둔성분리즉가순리폭로상관절돌급횡돌근부,제3～4요추、제4～5요추、제5요추～제1저추추간극중점수평소관절돌외연、다렬기최외연급다렬기여추판회합점지후정중선거리약위2.5～3.0 cm；②안Nakai표준B조림상료효우우A조,MRI현시다렬기면적B조교A조무명현위축.결론 추방기간극입로조작간편,가감소추방기적손상,림상응용효과량호.
Objective To observe the relevant surgical anatomy for the Wiltse approach to the lumbar spine and provide a theoretical basis for clinical application.Methods Ten adult cadaver specimens were applied in the anatomy study,the thoracolumbar fascia,erector spinae aponeurosis,longissimus,multifidus muscle and the neurovascular bundle and other disposable were observed,making the appropriate measurement.Application of traditional open approach (group A) and the paraspinal approach (group B) were performed under the posterior fusion of the 100 patients separately,and the clinical efficacy and lumbar paraspinal mnuscle MRI show were compared.Results There was no adhesion between the multifidus,longissimus and erector spinae aponeurosis.Special anatomical structure of multifidus and longissimus makes the smooth muscle gap blunt dissection which can be exposed to facet and transverse process.Measuring follow:L3-4,L4-5,L5-S1 intervertebral-gap points and the outer edge of a small facet,the most outer edge of the multifidus muscle and multifidus to the confluence with the lamina after the midline distance,fluctuations in the value of the three 2.5-3.0 cm.According to the standard clinical evaluation of Nakai,the clinical effect in group B was superior to that in group A,and there was no significant difference in multifidus muscle area between the two groups.Conclusions Paraspinal approach is simple,it can reduce the damage of the multifidus and the clinical application is good.