腰5骶1前路内固定手术的应用解剖学及影像学研究

发布时间：2018-04-11 00:36

本文选题：腰骶椎 + 应用解剖　；参考：《中南大学》2008年硕士论文

【摘要】： 目的:测量成人腰5骶1腹侧区域尸体标本相应的解剖学与影像学数据,为研制腰5骶1前路内固定器械提供参考。方法:(1)40套成人腰5骶1椎体干标本,测量腰5骶1椎体高度、宽度、弧度,椎弓根宽高,骨-螺钉通道长度(BSPL),椎弓根与水平面角度(TSA)以及与矢状面角度(SSA)。 (2)20套脊柱正中纵切面湿标本,测量腰5骶1椎体及其椎间盘高度,腰骶关节角(LJA)。 (3)40例正常成人的腰椎X线片和CT片,测量指标同解剖学。 (4)20具腰椎及其前面附属结构完整的尸体标本,观测主动脉分叉(AB)与髂总静脉汇合点(CCIV)至腰5椎体下缘的距离,骶正中动静脉(MSA,MSV)的发出点与走行、数量与缺失、伴行情况及腰骶椎前方交感神经丛(SHP)的走行与分布。 (5)测量L5/S1前方可供手术操作区域。结果:(1)L5椎体高30.27±2.52mm,宽51.03±3.20mm,椎弓根高11.88±2.35mm,椎弓根宽14.53±2.20mm,骨-螺钉通道长49.16±3.36mm,椎体前缘弧度133.74±13.59°。 (2)骶1椎体高31.57±3.37mm,弧长34.03±3.14mm,弧度77.25±7.12°,椎弓根高16.25±1.90mm,椎弓根宽11.17±2.15mm,骨-螺钉通道长43.94±4.60 mm。腰骶角为137.4±6.7°,腰5骶1椎间盘厚度为17.23±3.21mm。 (3)L5椎体螺钉进钉点为L5椎体下缘水平线向上12±2mm,椎体中线旁开5-6mm垂直线交点处,进钉角度为尾偏7.2±1.9°、外偏25.5±3.0°。S1椎体螺钉进钉点为S1椎体上缘水平线向下12±2mm,中线旁开6-7mm垂线交点处,进钉角度为尾偏9.0±1.1°、外偏26±2.3°。 (4)L5螺钉长度以不超过45mm、S1螺钉长度以不超过40mm为宜,螺钉直径不超过8mm为宜。 (5)L5/S1内固定手术有一可供操作区域,为一双底边重叠之梯形区,上梯形上边宽30mm,距L5椎体下缘20mm,中间底边为平腰5骶1椎间盘中点水平线,宽38mm,下梯形下底边宽25mm,距S1椎体上缘23mm,总面积约18.60cm~2。 (6)主动脉分叉到L5椎体下缘距离男性为43.86±12.24mm,女性为36.81±12.93mm,在L4/5椎间盘水平最为集中。 (7)髂总静脉汇合点到L5椎体下缘距离男性为26.85±14.72mm、女性为24.77±12.33mm,集中分布在L5椎体上分,在L4椎体中分及其以上没有分布。 (8)骶正中动脉的发出点和位置相对固定,无多支与缺失。而骶正中静脉多支的现象非常常见,82.8%由左髂总静脉发出。 (9)输尿管与髂动脉相交的位置距主动脉分叉点的距离左侧为53.35±7.48mm,右侧为45.95±2.41mm。 (10)上腹下丛在髂间三角内约85%位于偏左侧区,右侧区只占(15%),多干多见。结论:1在设计腰5骶1前路内固定系统时应考虑腰5骶1椎体相关解剖参数如LJA,SSA,TSA,BSPL等。 2腰5骶1骨-螺钉通道长度以椎前中线旁开6mm至椎弓根后缘的距离最长。 3腰5骶1前方存在一可供植入钢板的手术操作区,其形状为双底边重叠的梯形区域“(?)”形,面积约18.60cm~2。
[Abstract]:Objective: to measure the anatomical and imaging data of cadavers in the ventral region of lumbar 5 sacral 1, and to provide a reference for the development of anterior lumbar 5 sacral 1 internal fixation apparatus.Methods 40 adult lumbar 5 sacral 1 vertebral stem specimens were collected. The height, width, arc, pedicle width, length of bone-screw passage (BSPLN), pedicle and horizontal plane angle (TSA) and sagittal angle (SSA) of lumbar 5 sacral vertebrae were measured.Twenty sets of wet specimens were collected from the median longitudinal section of the spine to measure the height of the lumbar 5 sacral vertebrae and their intervertebral disc, and to measure the LJAA of the lumbosacral joint angle.Lumbar vertebrae X-ray films and CT films of 40 normal adults were measured with the same anatomical parameters.From 20 cadavers with intact lumbar vertebrae and their anterior accessory structures, the distance between the aortic bifurcation (ABV) and the confluence point of the common iliac vein (CCIV) and the lower margin of the lumbar 5 vertebrae, the origin and route, the quantity and the absence of MSAMSV of the median sacral artery and vein were observed.The concomitant status and the pattern and distribution of sympathetic plexus in anterior lumbosacral plexus.5) to measure the area available for operation in front of L5/S1.Results the vertebral body height was 30.27 卤2.52mm, the width was 51.03 卤3.20mm, the pedicle height was 11.88 卤2.35mm, the pedicle width was 14.53 卤2.20mm, the length of bone-screw passage was 49.16 卤3.36mm, the curvature of the anterior edge of vertebral body was 133.74 卤13.59 掳.2) the height of sacral vertebrae was 31.57 卤3.37mm, the arc length was 34.03 卤3.14mm, the arc was 77.25 卤7.12 掳, the pedicle height was 16.25 卤1.90mm, the pedicle width was 11.17 卤2.15mm, the length of bone-screw passage was 43.94 卤4.60mm.The lumbosacral angle was 137.4 卤6.7 掳and the lumbar 5 sacral disc thickness was 17.23 卤3.21 mm.The angle of entry nail was 9.0 卤1.1 掳and 26 卤2.3 掳respectively.The suitable length of L5 screw is not more than 45 mm and S1 screw length is not more than 40mm and the diameter of screw is not more than 8mm.L5 / S1 internal fixation has an operational area, which is a trapezoid area with overlapping bottom edges, 30 mm wide of the upper trapezoid, 20 mm from the lower edge of the L5 vertebra, and a horizontal horizontal line at the middle point of the horizontal lumbar 5 sac1 intervertebral disc.The width is 38 mm, the bottom edge of the lower trapezoid is 25 mm wide, and is 23 mm from the upper edge of the S1 vertebra, with a total area of 18.60 cm / 2.(6) the distance from aortic bifurcation to the lower edge of L5 vertebra was 43.86 卤12.24mm in males and 36.81 卤12.93mm in females, which was the most concentrated at L4 / 5 intervertebral disc level.The distance from the common iliac vein confluence to the lower margin of the L5 vertebra was 26.85 卤14.72mm in males and 24.77 卤12.33mm in females.The origin and location of the median sacral artery were relatively fixed, without multiple branches or deletions.The multiple branches of the median sacral vein were very common in 82.8% of the cases from the left common iliac vein.The distance between the intersection of the ureter and the iliac artery was 53.35 卤7.48 mm on the left side and 45.95 卤2.41 mm on the right side.(10) about 85% of the upper and lower ventral plexus were located in the left-sided region in the interiliac triangle, and the right region accounted for only 15%, and the trunk was more common.Conclusion the anatomical parameters of lumbar 5 sacral 1 vertebral body should be considered in the design of W5 sacral 1 anterior internal fixation system, such as LJASSAA TSAA BSPL and so on.2 the length of bone-screw passage in lumbar 5 sacral 1 was the longest between 6mm and posterior margin of pedicle.3There is a surgical operation area in front of lumbar 5 sacral 1, which can be implanted with steel plate. Its shape is a trapezoid area with double bottom edges overlapping.Shape, with an area of about 18.60 cm-2.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R687.3;R322

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