腰椎椎旁大血管走行及其与腰椎位置关系的CT观测

The travelling of paravertebral major vessel and its relationship with lumbar spine: a CT report

中文关键词:  腰椎  椎旁血管  影像学测量  CT

英文关键词:Spine  Prevertebral vessels  Imaging measurement  CT

中文摘要:

  【摘要】 目的：观察腰椎椎旁大血管走行情况及其与腰椎的位置关系，为腰椎后路手术提供指导。方法：选取50例在我院行腹部CT增强扫描患者的影像资料，其中男性34例，平均年龄53岁，平均身高174cm，平均体重68kg；女性16例，平均年龄54岁，平均身高167cm，平均体重63kg。采用PACS 11.0软件系统分别测量L1/2～L5/S1椎间盘水平椎旁大血管（腹主动脉、下腔静脉、髂动静脉及其分支）与椎体前、后面的相对位置关系，及其与椎体前、后面之间的距离。结果：男性椎旁动脉距椎体前、后面的距离分别为35.86±7.84mm、46.48±8.51mm；女性分别为32.15±6.03mm、41.57±6.72mm；男性椎旁动脉位于椎体前、后面的范围分别为10.87°±27.54°、7.61°±19.12°；女性分别为15.16°±31.85°、10.87°±22.48°；男性椎旁静脉距椎体前、后面的距离分别为35.86±7.84mm、46.48±8.51mm；女性分别为32.15±6.03mm、41.57±6.72mm；男性椎旁静脉位于椎体前、后面的范围分别为10.87°±27.54°、7.61°±19.12°；女性分别为15.16°±31.85°、10.87°±22.48°。男性椎旁动静脉距椎体前面和后面的距离均大于女性，差异均有显著性（P＜0.05），而椎旁动静脉与椎体前、后面的相对位置关系男女之间无显著性差异（P>0.05）。腹主动脉分叉位置12例（24%）在L4椎体下半部，32例（64%）在L4/5椎间隙；髂总动脉分叉位置29例（58%）在L5/S1椎间隙，12例（24%）在S1椎体的上半部；髂总静脉汇合位置42例（84%）在L5椎体上半部；髂内外静脉汇合位置16例（33%）在L5/S1椎间隙，27例（53%）在L5椎体的下半部。结论：腰椎椎旁血管的分叉位置变异较大，女性椎旁动静脉距椎体前、后面距离更小，腰椎后路手术中咬除腰椎间盘时应该注意把握腰椎与椎旁血管的角度与距离，谨防误伤椎旁血管。

英文摘要:

  【Abstract】 Objectives: To observe the paravertebral major vessels and its relationship with lumbar spine, and to provide a theoretical basis for posterior lumbar surgery. Methods: 50 cases underwent enhanced abdominal CT in our hospital, and there were 34 males, with an average age of 53 years, an average height of 174cm, an average weight of 68kg, and 16 females, with an average age of 54 years, an average height of 167cm, an average weight of 63kg. The relationship and distance between lumbar vertebral anterior region and abdominal aorta, inferior vena cava, iliac vein and their branches were measured at the disc plane with PACS 11.0 software system. Meanwhile, the relationship and distance between lumbar vertebral posterior region and abdominal aorta, inferior vena cava, iliac vein and their branches were measured. The relationship between lumbar vertebral(anterior and posterior region) and paravertebral vessels for male and female was measured also. Results: In L1/2-L5/S1, the distance form paravertebral artery to lumbar vertebral anterior border and posterior border was 35.86±7.84mm and 46.48±8.51mm in male, respectively; while in female, the distance was 32.15±6.03mm and 41.57±6.72mm, respectively; the relationship between paravertebral artery and lumbar vertebral anterior and lumbar vertebral posterior region was 10.87°±27.54° and 7.61°±19.12° in male, respectively; while in female, it was 15.16°±31.85° and 10.87°±22.48°, respectively. The distance form paravertebral vein to lumbar vertebral anterior and posterior region was 35.86±7.84mm and 46.48±8.51mm in male, respectively; while it was 32.15±6.03mm and 41.57±6.72mm in female, respectively; the relationship between paravertebral vein and lumbar vertebral anterior and lumbar vertebral posterior region in male was 10.87°±27.54° and 7.61°±19.12°, respectively; while in female, it was 15.16°±31.85° and 10.87°±22.48°, respectively, which showed significant differences between male and female, with male having greater distance of form paravertebral venous to lumbar vertebral anterior border and posterior border than female. However, there was no sex-related significant difference of the relationship between paravertebral venous and lumbar vertebral anterior and posterior region. Abdominal aortic bifurcation in 12 patients(24%) at the lower half of L4, and 32 cases(64%) at the level of L4/5 disc; 29 cases(58%) had llliac artery bifurcation sited at the L5/S1 disc, and 12 cases(24%) at the upper half of the S1 vertebra; 42 cases(84%) had illiac vein confluence sited at the upper half of the L5 vertebra; internal and external iliac vein confluence in 16 patients(33%) located at the L5/S1 disc, and 27 cases(53%) at the lower half of the L5 vertebra. Conclusions: Bifurcation of lumbar paraspinal vascular varies greatly, especially in female. Paravertebral vascular should be paid attention when performing posterior discectomy.