L5/S1前路手术相关椎前大血管的影像解剖学研究

Imaging anatomical research of lumbosacral anterior great vessels for anterior L5/S1 interbody surgery

中文关键词:  血管解剖  前路腰椎椎间融合术  血管成像  L5/S1椎间盘

英文关键词:Vascular anatomy  Anterior lumbar interbody fusion  Computer tomography angiography  L5/S1 intervertebral disc

中文摘要:

  【摘要】 目的：通过腹部血管成像检查和腰骶椎CT三维重建观测腰骶椎前方大血管的局部解剖，为L5/S1前路手术提供术前血管解剖学评估依据。方法：62例正常成年人，男32例、女30例，行腹部血管成像检查和腰骶椎CT三维重建。观察髂血管间隙双侧髂血管的构成情况，测量髂间三角解剖参数：髂间三角顶点到L5椎体下缘的距离；L5椎体下缘、S1椎体上缘髂血管间距；髂间三角顶点偏离正中矢状面的距离；L5/S1椎间隙宽度。根据髂间三角顶点到L5椎体下缘的距离（＞1.2cm；0.6~1.2cm；＜0.6cm且＞0；≤0）定义Ⅰ、Ⅱ、Ⅲ、Ⅳ型髂间三角。计算髂间三角面积、L5/S1椎间盘显露百分比。结果：髂血管间隙由左侧髂静脉、右侧髂动脉组成占54例（87%）；双侧均为髂动脉或髂静脉各占4例（6.45%）、2例（3.23%）；左侧髂动脉、右侧髂静脉占2例（3.23%）。Ⅰ、Ⅱ、Ⅲ、Ⅳ型髂间三角分别为42（67.7%）、11（17.7%）、7（11.3%）、2（1.6%）例。Ⅰ、Ⅱ、Ⅲ型各解剖参数比较，差异有显著性意义（P＜0.05）。L5/S1椎间隙宽度为5.3±0.6cm。Ⅰ、Ⅱ、Ⅲ型髂间三角显露面积分别为5.00cm2（1.42～11.90cm2）、1.04cm2（0.49～2.12cm2）、0.33cm2（0.10～0.92cm2），椎间盘显露百分比分别为78.3%、59.4%、42.5%。结论：腹部血管成像检查能够清晰显示腰骶椎前方大血管走行及分布情况，有助于L5/S1前路手术策略的制定。

英文摘要:

  【Abstract】 Objectives: To provide preoperative assessment of vascular anatomy by using 3D reconstruction computer tomography angiography(CTA) for anterior L5/S1 interbody surgery. Methods: 62 adult patients were selected, including 32 males and 30 females. The distribution of iliac vessels, anatomic parameters of interiliac triangle including distance from the included angle vertex of interiliac triangle to the inferior boundary of L5, distance between the left and right iliac vessels on the level of the inferior boundary of L5 and of the superior boundary of S1, distance between the included angle vertex of interiliac triangle and the middle of sagittal plane and the width of L5/S1 intervertebral space were measured. According to the distance between the included angle vertex of interiliac triangle and the inferior boundary of L5(＞1.2cm; 0.6-1.2cm; ＜0.6cm and ＞0; ≤0), type Ⅰ, Ⅱ, Ⅲ and Ⅳ interiliac triangle was defined respectively. The area of the interiliac triangle and the exposure percentage of lumbar L5/S1 disc were measured. Results: 54 cases(87%) had iliac vessels gap constituted by left iliac vein and right iliac artery, 4 cases(6.45%) by bilateral iliac arteries and 2 cases(3.23%) by iliac vein and 2 cases(3.23%) by left iliac artery and right iliac vein respectively. There were 42, 11, 7 and 2 cases of type Ⅰ, Ⅱ, Ⅲ and Ⅳ interiliac triangle, respectively. The differences of anatomical parameters among type Ⅰ, Ⅱ, Ⅲ were statistically significant(P<0.05). The width of L5/S1 intervertebral space was 5.3±0.6cm. The exposure area of type Ⅰ, Ⅱ, Ⅲ iliac vascular triangle was 5.00cm2(1.42-11.90cm2), 1.04cm2(0.49-2.12cm2), 0.33cm2(0.10-0.92cm2), respectively, and the exposure disc percentages was 78.3%, 59.4%, 42.5%, respectively. Conclusions: Lumbosacral computer tomography angiography can clearly display the course and distribution of lumbosacral anterior vessels, which contributes to surgical strategies of anterior L5/S1 interbody surgery.