腰椎前路微创手术及椎体成形术的相关应用解剖、生物力学及临床应用研究

发布时间：2018-05-16 22:18

本文选题：腰椎 + 微创　；参考：《第一军医大学》2006年博士论文

【摘要】：目的和意义： 1．通过大体解剖和断层解剖的方法了解椎前血管的变异性及手术时椎前血管和输尿管可能损伤的部位，为经腹膜腰椎前路微创手术提供腰椎前方血管的解剖学依据；对腰椎前方的自主神经进行详细的解剖和组织学观察，结合手术中暴露的要求，提出避免腰椎微创前路手术损伤自主神经丛的手术方式及其解剖学依据。 2．观察腰椎侧方节段血管、腰升静脉及髂腰静脉的解剖，为腹膜后腰椎微创手术避免侧方血管的损伤提供解剖学依据；通过大体解剖和断层解剖了解腰丛在腰椎前路微创手术中的应用解剖学特点，，并提出减少腰丛损伤的解剖学依据及手术中的标志点。对腰丛及其周围的组织结构进行可视化的研究，为微创手术提供更精确的数据和解剖学资料。 3．成功的建立前路椎体间融合的后路和前路固定的有限元模型，分析比较微创前路融合后不同固定方式的生物力学特性。利用骨质疏松腰椎三维有限元模型的方法，探讨在椎体成形术中骨水泥的量、不同分布及骨水泥向椎间隙渗漏等状态下，对邻近椎体生物力学的影响。 4．通过动物实验研究探讨不同方式的腹腔镜腰椎手术可行性和安全性，确定不同腰椎节段安全有效的腹腔镜手术入路及学习曲线；初步观察后腹腔镜技术在腰椎结核手术中的应用价值。材料与方法： 1．选择30例防腐固定腰段尸体标本及120例腰椎MRI断层数据，观察下腰椎区域椎前大血管的解剖学特点，并根据手术暴露的需要做相应的解剖学测量；观察与进入下腰椎前方输尿管的应用解剖关系；观察椎前大血管分权前、分杈及分杈后的断层影像学特点，根据腰椎前方血管的断层图片判断腹主动脉的分杈点(AoB)和髂静脉汇合点(CCIV)对应椎体的位置；不同性别AoB和CCIV分杈点对应椎体位置上的差异；L5～S1前方左髂总静脉对应椎间盘的位置；经腹膜暴露L4～L5椎
[Abstract]:Purpose and significance: 1. By means of gross anatomy and sectional anatomy, the variation of anterior vertebral vessels and the location of possible injuries to the anterior vertebral vessels and ureter during operation were studied. The anatomical basis of anterior lumbar artery was provided for minimally invasive operation of anterior approach of retroperitoneal lumbar vertebrae. The anatomical and histological observation of the anterior autonomic nerve of lumbar vertebrae was carried out. Combined with the requirements of surgical exposure, the surgical methods and anatomical basis of avoiding the injury of autonomic plexus in anterior lumbar spine minimally invasive operation were put forward. 2. The anatomy of lumbar lateral segmental vessels, ascending lumbar veins and iliolumbar veins was observed to provide anatomic basis for minimally invasive operation of retroperitoneal lumbar vertebrae to avoid lateral vascular injury. The applied anatomical characteristics of lumbar plexus in lumbar anterior minimally invasive surgery were studied by gross anatomy and sectional anatomy. The anatomical basis for reducing injury of lumbar plexus and the mark points in operation were put forward. To provide more accurate data and anatomical data for minimally invasive surgery by visualizing the structure of the lumbar plexus and its surrounding tissues. 3. The finite element models of posterior and anterior fixation of anterior interbody fusion were established successfully, and the biomechanical characteristics of different fixation methods after minimally invasive anterior fusion were analyzed and compared. By using the three-dimensional finite element model of osteoporotic lumbar vertebrae, the effects of bone cement content, different distribution of bone cement and leakage of bone cement into intervertebral space on biomechanics of adjacent vertebrae in vertebroplasty were studied. 4. The feasibility and safety of different types of laparoscopic lumbar surgery were discussed through animal experiments, and the safe and effective laparoscopic approach and learning curve of different lumbar segments were determined. To observe the application value of retroperitoneal laparoscopy in lumbar tuberculosis surgery. Materials and methods: 1. The anatomical characteristics of anterior great vertebral vessels in the lower lumbar vertebrae were observed with 30 cadavers and 120 lumbar MRI sections, and the anatomical measurements were made according to the need of surgical exposure. To observe the applied anatomical relationship with the anterior ureter entering the lower lumbar vertebrae, and to observe the features of the tomographic features before, after, and after the separation of the anterior great vessels of vertebrae. According to the sectional images of the anterior lumbar artery, the position of the branches of the abdominal aorta (AoB) and the confluence point of iliac vein (CCIV) corresponds to the position of the vertebral body, and the bifurcation points of AoB and CCIV of different genders correspond to the position of the vertebral body, and the position of the left common iliac vein corresponding to the intervertebral disc in front of L _ (5) and S _ (1). Transperitoneal exposure of L4~L5 vertebrae
【学位授予单位】：第一军医大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R687.3;R322

【参考文献】