腰椎后路椎旁肌间隙入路的解剖学与影像学观察

The anatomical and radiological observation of the paraspinal intermuscular space for paramedian approach to the lumbar spine

中文关键词:  椎旁肌间隙入路  腰椎  解剖学  MRI  CT

英文关键词:Paramedian muscle-splitting approach  Intermuscular space  Anatomy  MRI  CT

中文摘要:

  【摘要】 目的：观察腰椎周围肌间隙的解剖学与影像学特点，为腰椎后路椎旁肌间隙入路的选择和操作提供形态学依据。方法：选取18具成人尸体湿性躯干标本，一侧行局部解剖观察腰椎周围肌肉及其毗邻结构，另一侧行模拟肌间隙手术入路，观察不同肌间隙的解剖构成及其显露腰椎相关结构的特点；同时选取30例健康志愿者的腰部MRI与CT图像，观察肌间隙的影像学显示特点。结果：Wiltse间隙位于多裂肌与最长肌之间，由脂肪及疏松结缔组织填充，无血管、神经穿行；通过该间隙可清晰显露腰椎关节突关节、椎间孔及横突；75.0%的CT片和93.3%的MRI片可显示Wiltse间隙。LIMP间隙位于最长肌与髂肋肌之间，由一层薄而透明的筋膜分隔两肌，69.4%标本可见脊神经后支的肌支穿行间隙内；该间隙可满意显露椎间孔区及椎弓根；41.6%的CT片和56.6%的MRI片可显示LIMP间隙。Watkins间隙位于髂肋肌与腰方肌之间，由腰背筋膜中层及少量脂肪分隔肌肉形成，75.0%标本可见脊神经后支的皮支及伴行血管走行；该间隙可满意显露椎间孔及椎体两侧；63.3%的CT片和86.6%的MRI片可显示Watkins间隙。结论：熟悉腰椎不同肌间隙的形态特点及穿行结构，术前影像学准确观测有助于椎旁肌间隙入路的选择与操作。

英文摘要:

  【Abstract】 Objectives: To clarify the anatomic and radiographic features of the intermuscular space for paramedian approach to the lumbar spine and to provide the option and morphological basis for surgery. Methods: A total of 18 spine specimens of adult was used in this study. The anatomical description of the paraspinal muscles and adjacent elements were verified by dissecting on one side of lower back, while the other side was used by simulated diverse paramedical approach to the lumbar spine. MRI and CT scan of intermuscular space was determined on serial horizontal views of 30 healthy volunteers. Results: The Wiltse space without blood vessel or nerve distribution was noted between the multifidus and longissimus, and natural surgical access to zygapophysial joints and transverse process could be viewed. In volunteers, this space could be detected in 75% of the cases on CT and 93.3% of the cases on MRI. LIMP space existed between longissimus and iliocostalis muscle, with a thin fascia interposed, and witness ramus posterior nervorum spinalium could be seen cross this space in 69.4% of the cases. Intervertebral foramina and pedicle of vertebral arch could be easily reached via LIMP space. In volunteers, 41.6% cases on CT and 56.6% cases on MRI could be seen respectively. Watkins space was sandwiched between the sacrospinalis and quadratus lumborum formed by middle layer of thoracolumbar fascia, without blood vessel or nerve distribution in 75% cases. LIMP space could access to the intervertebral foramina and lateral border of vertebral body, and it could be seen in 63.3% and 86.6% cases on CT and MRI respectively in healthy subjects. Conclusions: The intermuscular space in the lumbar spine and its well defined features on CT and MRI can facilitate the surgical approach.