腰骶神经背外侧支的解剖学研究

Anatomical study of the lateral branches of lumbar and sacral dorsal ramus

中文关键词:  骶髂关节  神经支配  临床解剖学

英文关键词:Sacroiliac joint  Innervation  Clinical anatomy

中文摘要:

  【摘要】 目的：描述腰骶神经背外侧支的解剖学特征，为腰骶神经侧支射频消融术提供解剖学资料。方法：取7具正常成人腰骶部防腐大体标本（年龄42~68岁，平均54.3±8.0岁），其中男性标本5具，女性标本2具。所有标本均来源于南方医科大学。常规从L3/4椎间盘平面向标本尾端进行解剖，依次去除标本表面皮肤、多裂肌、臀大肌、臀中肌、臀小肌等，在手术显微镜下去除腰骶神经背外侧支周围的软组织，显露L3~S4 神经背外侧支。用量角器测量距骶后孔8mm处S1~S4神经背外侧支与坐标轴纵轴的夹角以及L4~L5神经背外侧支与冠状轴所成夹角。使用游标卡尺测量骶神经背外侧支在距骶后孔8mm处与后正中线之间的距离。结果：在7具防腐大体标本中共发现65条骶神经背外侧支，S1~S4神经背外侧支的数量分别为16条、19条、19条和11条。S1~S4神经背外侧支在距骶后孔8mm处与纵坐标所成夹角分别为38°±9°，45°±13°，40°±10°，以及45°±7°。S1~S4神经背外侧支在距骶后孔8mm处与后正中线之间距离分别为21.3±3.0mm、24.0±3.5mm、21.7±2.8mm 以及22.7±3.0mm。本研究还发现12条L4神经背外侧支和14条L5神经背外侧支，L4神经背外侧支的主干长度约为26.5±2.6mm，L5神经背外侧支的主干长度约为25.7±5.8mm。L4和L5神经背外侧支分别与冠状轴所成夹角分别为72°±2°，66°±4°。结论：骶髂关节背侧主要由L5~S4神经背外侧支支配，偶尔还存在L4神经背外侧支支配。

英文摘要:

  【Abstract】 Objectives: The purpose of this study was to describe the anatomical characteristics of the innervation of the dorsal aspect of sacroiliac joint and to provide anatomical data for the radiofrequency ablation of lateral branches of lumbosacral nerve. Methods: 7 lumbosacral specimens were collected from 7 embalmed adult cadavers(aged 42~68 years, mean 54.3±8.0 years) which included five males and two females. All the specimens were sourced from Southern Medical University. The surface skin, multifidus muscle, gluteus maximus, gluteus medius, and gluteus minous muscle were routinely dissected from the plane of L3/4 intervertebral disc till the end of the specimens, the soft tissues surrounding the dorsal lateral branches of the lumbosacral nerve were removed under an operative microscope as well to expose the lateral branches of the dorsal rami of L3-L4. The angles between the lateral branches of the dorsal rami of S1-S4 and the longitudinal axis at a distance of 8mm from the posterior sacral foramens, as well as the angles between the lateral branches of the dorsal rami of L4-L5 and the frontal axis were measured. The distance between the lateral branches of the dorsal rami of sacral nerve and the posterior midline at a distance of 8mm from the posterior sacral foramen were also measured. Results: A total of 65 lateral branches of sacral dorsal rami were identified in the 7 specimens, with 16, 19, 19, and 11 lateral branches of the dorsal rami of S1-S4, respectively. The angles between the lateral branches of the dorsal rami of S1-S4 and the longitudinal axis at a distance of 8mm from the posterior sacral foramens were 38°±9°, 45°±13°, 40°±10°, and 45°±7° respectively. And the distances between the lateral branches of the dorsal rami of S1-S4 and the posterior midline at a distance of 8mm from the posterior sacral foramen were 21.3±3.0mm, 24.0±3.5mm, 21.7±2.8mm, and 22.7±3.0mm, respectively. 12 lateral branches of the dorsal rami of L4 and 14 lateral branches of the dorsal rami of L5 were found. The main trunk length of the lateral branches of the dorsal rami of L4 was about 26.5±2.6mm, which of L5 was about 25.7±5.8mm. The angles between the lateral branches of the dorsal rami of L4-L5 and the frontal axis were about 72°±2° and 66°±4°, respectively. Conclusions: The dorsal sacroiliac joint was mainly innervated by the lateral branches of the dorsal rami of L5-S4, occasionally by the lateral branches of the dorsal rami of L4.