【摘要】 目的探讨与临床脊柱腰段椎旁肌间隙入路相关的竖脊肌腱膜(erector spinae aponeurosis,ESA)的解剖学基础。方法对9具福尔马林固定的成人尸体湿性标本进行局部解剖,观察ESA与椎旁肌间隙入路过程的局部解剖学特征;对6名健康志愿者行CT平扫,观察ESA的影像学特点。结果局部解剖中,ESA分为内侧部和外侧部,外侧部为扁平致密的腱膜,由髂肋肌胸部肌腱延续而来,覆盖在髂肋肌腰部浅层;内侧部由最长肌胸部肌腱延续而来,为几条可以分离的扁平、条状肌腱。CT横断层中,L1~L2水平,ESA仅位于多裂肌表面,两者间有分离间隙;L3水平,ESA覆盖在最长肌和多裂肌表面,与最长肌之间无分离间隙;L4~L5水平,ESA与多裂肌之间间隙仍存在,但浅面与胸腰筋膜逐渐融合,形成单一的高信号。结论 ESA在上腰椎(L1~L3)为腱性结构,可顺肌腱钝性分离,下腰椎(L3~L5)为膜性结构,可任意方向切开,竖脊肌腱膜与深面的多裂肌间存在分离间隙。更多还原

【Abstract】 Objective To investigate the anatomical basis of erector spinae aponeurosis(ESA) that is related to the lumbar spinal paraspinal intermuscular approach.Methods Nine formalin fixed adult cadavers were dissected to observe the local anatomical features of the ESA related to the intermuscular approach.Six healthy volunteers were scanned by CT and the imaging feature of ESA was recorded.Results In regional anatomy,the erector spinae aponeurosis was composed of two parts,the medial part and lateral part.The lateral part was formed by iliocostalis thoracis,and was a flat compact aponeurosis cover the iliocostalis lumborum.The medial part was formed by the longissimus thoracis,and was several detachable flat and striped tendons.In CT images,the erector spinae aponeurosis only covered multifidus at L1/L2 level.At L3 level,the erector spinae aponeurosis covered longissimus thoracis and multifidus,but no separation gap was found between the aponeurosis and the ESA.At L4/L5 level,the separation gap between erector spinae aponeurosis and the multifidus was still existed,but the erector spinae aponeurosis and the superficial thoracolumbar fascia gradually merged to form a single high signal.Conclusions The ESA is a tendinous structure at upper lumbar region(L1 ~ L3 level),and it can be separated blunt down the consecutive tendon.At lower lumbar region(L3 ~ L5 level),the ESA is a membrane structure,and can be incised in any direction,there exists separation gap between ESA and multifidus.更多还原