CAJ | 학술논문

目的：通过对胸腰移行部椎旁肌间隙( Wiltse间隙)的解剖学研究,为该区微创椎弓根螺钉固定术的开展提供形态学依据。方法选取9具(18侧)成人尸体湿性标本,局部解剖观察胸腰移行部的Wiltse间隙及其毗邻结构；选取4例(8侧)成人尸体湿性标本,模拟椎弓根螺钉固定术。结果Wiltse间隙表面由最长肌肌腱构成的竖脊肌腱膜覆盖,钝性分离最长肌内侧第1根肌腱和胸半棘肌肌腱(83%,15侧)或同时分离最长肌第1、2根肌腱(17%,3侧)即可清晰暴露胸腰移行部全部节段的Wiltse间隙。通过肌间隙可显露多裂肌、T11~T12横突和L1~L2关节突等结构,定位进钉点,模拟椎弓根螺钉固定术,将螺钉顺利置入椎弓根及椎体,术后CT示螺钉位置良好,多裂肌保持完整。结论对胸腰移行部Wiltse间隙解剖的深入认识有助于该区微创椎弓根螺钉固定术的开展。
목적：통과대흉요이행부추방기간극( Wiltse간극)적해부학연구,위해구미창추궁근라정고정술적개전제공형태학의거。방법선취9구(18측)성인시체습성표본,국부해부관찰흉요이행부적Wiltse간극급기비린결구；선취4례(8측)성인시체습성표본,모의추궁근라정고정술。결과Wiltse간극표면유최장기기건구성적수척기건막복개,둔성분리최장기내측제1근기건화흉반극기기건(83%,15측)혹동시분리최장기제1、2근기건(17%,3측)즉가청석폭로흉요이행부전부절단적Wiltse간극。통과기간극가현로다렬기、T11~T12횡돌화L1~L2관절돌등결구,정위진정점,모의추궁근라정고정술,장라정순리치입추궁근급추체,술후CT시라정위치량호,다렬기보지완정。결론대흉요이행부Wiltse간극해부적심입인식유조우해구미창추궁근라정고정술적개전。
Objective To evaluate the anatomy of paraspinal intermuscular space ( Wiltse space ) in the thoraco-lumbar spine, in order to provide a morphological basis for the minimally invasive pedicle screw fixation surgery. Methods The Wiltse space in thoracolumbar spine and its adjacent structures were observed in 9 (18 sides) cada-vers with regional anatomy. Another 4 (8 sides) cadavers were selected to simulate pedicle screw fixation. Results The surface of Wiltse space was covered by the erector spinae aponeurosis, which was constituted by the tendons of longissimus pars thoracis. After the potential space was separated bluntly between the thoracic semispinalis tendons and the first medial tendon of longissimus (83%, 15 sides) , or between the first and the second tendon of longissi-mus additionally (17%, 3 sides) . The Wiltse space in all the thoracolumbar spine was exposed clearly. Through the Wiltse space, the multifidus, T11-T12 transverse process, L1-L2 articular process were exposed. After the accurate entry points of pedicle screw were shown, the pedicle screw fixation was simulated, and the pedicle screws were inserted into pedicle and vertebral body successfully. The location of the pedicle screws were assured by posto-peration CT, and the multifidus remained intact. Conclusion In-depth understanding of the anatomy of Wiltse space in the thoracolumbar spine will contribute to the improvement of the minimally invasive pedicle screw fixation in this area.