CAJ | 학술논문

目的探讨胸腰段最长肌表面滋养血管的解剖学特征及在胸腰椎骨折后路经肌间隙入路手术中对其进行保护的作用.方法采用骶棘肌肌间隙入路经后路椎弓根钉棒系统复位固定治疗胸腰椎骨折并获得完整随访的患者97例,于术中观察胸腰段最长肌表面滋养血管的走行和分布,应用特殊手术器械和技术对血管进行保护.评估术后第3天、1个月、6个月及拆除内固定术后1个月的疼痛视觉模拟评分(visual analogue scale,V AS)及术前、术后6个月的胸腰段最长肌MRI影像.结果共观察97例194条最长肌402个椎弓根间区域的最长肌表面血管分布.402个区域中,94.3％的表面滋养血管呈束状,5.7％的区域中血管呈团状.在束状血管分布的379个区域中,血管束位于椎弓根区者占9.8％、椎弓根间上区76.0％、椎弓根间中区12.4％、椎弓根间下区1.8％;87.3％的血管束得以完整保留,12.7％的血管束以电凝烧灼处理.术中出血量为(21±9.3) ml.术后第3天、1个月、6个月及拆除内固定术后1个月VAS分别为(3.3±1.6)分、(2.1±1.4)分、(1.2±0.7)分、(1.1±0.7)分.术后6个月,经电凝烧灼处理的胸腰段最长肌在MRI上呈脂肪化改变.结论胸腰段最长肌表面滋养血管一般呈束状,多位于椎弓根间上区.术中保护滋养血管能减轻对最长肌的损伤,减少术后肌肉脂肪化变性.
목적 탐토흉요단최장기표면자양혈관적해부학특정급재흉요추골절후로경기간극입로수술중대기진행보호적작용.방법 채용저극기기간극입로경후로추궁근정봉계통복위고정치료흉요추골절병획득완정수방적환자97례,우술중관찰흉요단최장기표면자양혈관적주행화분포,응용특수수술기계화기술대혈관진행보호.평고술후제3천、1개월、6개월급탁제내고정술후1개월적동통시각모의평분(visual analogue scale,V AS)급술전、술후6개월적흉요단최장기MRI영상.결과 공관찰97례194조최장기402개추궁근간구역적최장기표면혈관분포.402개구역중,94.3％적표면자양혈관정속상,5.7％적구역중혈관정단상.재속상혈관분포적379개구역중,혈관속위우추궁근구자점9.8％、추궁근간상구76.0％、추궁근간중구12.4％、추궁근간하구1.8％;87.3％적혈관속득이완정보류,12.7％적혈관속이전응소작처리.술중출혈량위(21±9.3) ml.술후제3천、1개월、6개월급탁제내고정술후1개월VAS분별위(3.3±1.6)분、(2.1±1.4)분、(1.2±0.7)분、(1.1±0.7)분.술후6개월,경전응소작처리적흉요단최장기재MRI상정지방화개변.결론 흉요단최장기표면자양혈관일반정속상,다위우추궁근간상구.술중보호자양혈관능감경대최장기적손상,감소술후기육지방화변성.
Objective To study the anatomic features of surface vasa vasorum on longissimus in thoracolumbar segments,and its protection function during the internal fixation for thoracolumbar fracture via Wiltse approach.Methods From March 2010 to October 2012,a total of 97 patients with thoracolumbar fractures underwent posterior internal fixation with pedicle screw system.The trend and distribution of surface vasa vasorum on longissimus in thoracolumbar segments were observed in the operation,and the vessels were protected during the surgical procedures by using specific devices and techniques.Operative time and intra-operative blood loss were recorded.Visual analogue scale (VAS) values were evaluated after 3 days,1 month,6 months postoperatively,and 1 month after the removal of internal fixation.MRI images of longissimus in thoracolumbar segments were compared after preoperative and postoperative 6 months.Results Surface vasa vasorum distribution on 194 longissimus and 402 inter-pedicle areas of 97 patients were observed.In 402 areas,94.3％ of surface vasa vasorum presented sarciniform,while only 5.7％ of surface vasa vasorum presented tube shape.In 379 areas of sarciniform distribution,9.8％ of blood vessel bundles were located in vertebral pedicle area;76.0％ of blood vessel bundles were located in the upper inter-pedicle areas;12.4％ of blood vessel bundles were located in middle inter-pedicle areas;1.8％ of blood vessel bundles were located in lower inter-pedicle areas.In 379 areas,87.3％ of blood vessel bundles could be completely retained;12.7％ of blood vessel bundles were treated by electro coagulation and burning.Intra-operative blood loss was 21±9.3 ml.VAS values after 3 days,1 month,6 months postoperatively,and 1 month after the removal of internal fixation were 3.3± 1.6,2.1± 1.4,1.2±0.7 and 1.1±0.7.The longissimus treated with electro coagulation demonstrated pimelosis change on MRI after postoperative 6 months.Conclusion Surface vasa vasorum on longissimus in thoracolumbar segments are generally of sarciniform,and most of them are located in upper inter-pedicle areas.The protection of vasa vasorum can reduce the intra-operative lesion and postoperative pimelosis change of longissimus.