腰椎前路手术相关自主神经和血管的临床解剖学分析.pdfVIP

网状分布在腹主动脉前方，其神经纤维左侧较右侧更加密集。SHP 神经主干形态 变异较大，主要位于腰骶部腹中线左侧，分四种类型。SHP 主干长度约为59.38 ± 12.86mm ，宽度约 11.25±2.92mm ，该神经丛在骶骨岬水平的平均宽度约 19.49± 5.10mm 。 2 ：下腰椎侧面，L2-3 、L3-4 、L4-5 椎间隙左、右侧各有一个相对无血管神经的“安 全区”，椎间隙位于其中。此区间可为腰椎前方入路椎间融合或固定术提供一定的 操作空间，且左、右侧安全区面积无显著性差异，都有足够的空间以完成腰椎侧 面的操作。 3 ：根据AAP 、IMP 和 SHP 等自主神经丛的解剖学特点，为术中较少干扰椎前自 主神经丛，行下腰椎前入路手术时：对于L -L 节段椎体，可以考虑采用从椎体右 2 5 侧进行显露，将自主神经同血管作为一个整体，自右向左沿椎间盘边缘推开，而 不必单独分离解剖神经丛；对于L -S 椎间隙，从右髂血管内侧钝性分离SHP 神经 5 1 丛，将其自右沿椎间盘表面轻柔的向左推开，从而达到最大限度的避免神经的损 伤。 关键词：下腰椎; 前入路; 上腹下丛; 逆行性射精; 应用解剖 2 Clinical anatomy study of autonomic nerves and vascular of the anterior approach lumbar surgery Abstract Objective: To understand the location characteristics and the anatomical relationship between lumbosacral autonomic nerve plexus and vascular,the morphological changes were observed in the lumbosacral autonomic nerve plexus and vascular.The purpose of this study is to provide anatomic theoretical basis for the protection of autonomic nerve and vessel on the lower lumbar anterior approach operation. Methods:1. A random investigation on 19 formalin-treated adult cadavers (15 male and 4 female).2. Cutting rectal on the level of peritoneal invagination and remove intestine,Open the parietal peritoneum ,Complete exposure spinal region below the level of L2.Dissection the following organizational structure:abdominal aortic plexus(AAP) 、 Lumbar splanchnic nerve(LSN) 、Inferior mesenteric plexus(IMP) 、Superior hypogastric plexus(SHP) 、Sympathetic trunk(SC).3.Exposure of lumbar side:remove the psoas muscle and exposure of lumbar side to intervertebral foramen.Exposure Intervertebral disc and the segmental artery and vein of the lateral face of low lumbar,from