【摘要】 目的观测脊柱胸腰段脊神经的形态及周围结构,了解它们详细的解剖关系,同时改进前路手术的径路及操作程序。方法在16具成人尸体标本上,测量T10~L3脊神经的直径、椎间孔外口处脊神经距椎体上缘的距离占椎体高度的百分比、脊神经与椎体外缘的夹角,并观察椎间孔外口处神经与血管的排列走行;从而在临床工作中改进前路手术的径路和操作程序。结果T10~L3脊神经直径逐渐增粗,椎间孔外口处脊神经距椎体上缘的距离占椎体高度的百分比逐渐增加,椎间孔外口处脊神经与椎体外缘间的夹角逐渐减小。椎间孔外口处脊神经与血管的排列自上而下为静脉、神经、动脉。出椎间孔外口的神经、血管伴行,静脉在最上方,动脉或在神经下方,或越至神经上方,或与神经并排行走。临床上,对58例胸腰椎骨折伴脊髓损伤患者行前路手术。径路改进前35例术中平均失血670ml,手术时间平均199min;改进后23例术中平均失血435ml,手术时间平均137min。55例患者术后随访6～18个月,平均9个月,脊柱序列均恢复正常,无植骨块塌陷及高度丢失现象,无内固定失败;神经功能获1级以上恢复者52例(94.5%)。结论通过解剖学研究和临床技术改进,有效减少了胸腰段前路手术的手术时间和术中出血,减轻了手术创伤,降低了术后并发症的发生率。更多还原

【Abstract】 Objective To observe the morphology of thoracolumbar spinal nerve roots and their surrounding structures, in order to find out their anatomical relationship and to improve surgical procedures as well as to reduce the operative injury and complications. Methods 16 adult cadavers were studied anatomically. The diameters of spinal nerve roots from T10 to L3 at the outlet of intervertebral foramen, the percentages of the distance from spinal nerve roots to the upper border of corresponding vertebral bodies in vertebral height, the angles between spinal nerve roots with lateral border of vertebrae were measured and analyzed. The surgical incision and procedure for the treatment of thoracolumbar fracture were designed and applied in 58 patients of thoracolumbar injury. Results The diameters of spinal nerve roots increased gradually from T10 to L3 in the intervertebral foramen. The percentages of the distance from spinal nerve roots to the upper border of vertebrae in vertebral height gradually became larger too. The angles between spinal nerve roots with vertebral bodies diminished gradually. Around intervertebral foramen, the pattern of spinal nerves and blood vessels was arranged in order as vein, nerve and artery from above down below. The nerves and vessels extended out of the intervertebral foramen together. In clinical practice, 58 cases of thoracolumbar injury were surgically treated with traditional anterior approach and "renal" incision in 35 cases, and with modified anterior approach in "┑" shape in 23 cases. Prior to the modification of surgical techniques, the mean amount of blood loss was 670 ml, the mean operation time was 199 min; however, by the modification of surgical procedures, the mean amount of blood loss decreased to 435 ml, and the mean operation time reduced to 137 min. In an average follow-up of 9 months, the spine recovered to normal curvature and alignment in all cases; the fusion rate was 100%; no failure of implant occurred; neurological function was improved at least one grade in 94.5%. Conclusion Modified anterior approach is helpful to reduce operative injuries and complications. It makes surgical manipulation feasible comparing to the traditional approach.更多还原