The Clinical Anatomy Research Of Sacral Tumor Resection

ObjectiveIn order to avoid the tissue injury aroud the Sacral when resectting Sacral tumor and provide anatomy reference , this study was designed to research the structural feature of the Sacral and the tissue around of Sacral .MethodsObserving the structural features of Lumbosacral and tissue that around it, if there is a clinical signification , an anonatomy measurement is required . With using SPSS 13.0 for windows, all statistics are analysed .Results1 The location of Aortic Bifurcation is following as : 40%of total in the front of L4(4/10),40%of total in the front of the disc of L4/L5(4/10), 20%of total in the front of L5(2/10), the angle of Aortic bifurcation is (54.6±7.7)°,the distance between the Aortic bifurcation and the edge of Sacral Promontory is (50.7±7.8)mm. The point of Right Common Iliac Vein and Left Common Iliac Vein converge Inferior Vena Cava is 60%of total in the front of the disc of L4～L5(6/10), 40%of total in the front of the L5 (4/10).The distance between the point of Right Common Iliac Vein and Left Common Iliac Vein converge inferior vena cava and the superior border of Sacral Promontory is (32.3±9.2)mm.2 The length of Common Iliac artery: Left (45.7±17.8)mm;Right (40.0±13.6)mm,The width of Common Iliac artery: Left (10.1±2.7)mm,Right(10.4±2.7)mm. The length of Common Iliac Vein : Left (57.2±24.0)mm;Right (43.4±15.2)mm, The width of Common Iliac Vein:Left (15.4±4.3)mm;Right (11.8±2.4)mm。3 The constitute,height,width and area of"Vascular Trigone"before the Sacral Promontory.An imaginary"Vascular Ttrigone"was constitute with its apex at the intersection of the Right Common Artery and the Left Common Iliac Vein and its base at Sacral Promontory. The height of trigone : (28.4±8.1)mm,the width of trigone : (40.7±5.8)mm,the area of trigone:(587.5±211.2)mm2,the width of the uncovered Left Commom Iliac Vein :(9.0±2.3)mm。4 Middle Sacral Artery was present in 100﹪of the cadavers(10/10)and its starting point is on the cephalic of Aortic Bifurcation. The distance between the Middle Sacral Artery starting point and Aortic Bifurcation: (8.3±3.0)mm. The Middle Sacral Vein import to Left Commom Iiliac Vein in nine cadavers(9/10), it import to Left Internal Iiliac Vein in one cadavers(1/10), The distance between the converge point of Middle Sacral Vein and the starting point of inferior Vena Cava: (19.6±7.1)mm.5 The distance between the Sacral Sympathetic Trunk and the midline at the superior border of Sacral Promontory: Left (21.9±4.0)mm;Right (22.7±3.8)mm.6 The distance between the L4 nerve branch and the Sacroiliac Joint at the Sacral ala level: Left (23.8±4.6)mm;Right (24.8±5.1)mm,The distance between the point of L5 nerve as it exits the intervertebral foramen and the Sacroiliac Joint: Left (20.3±4.0)mm ; Right (20.8±4.0)mm. After observing 10 adults specimen , it is found that two sides of the sixth specimen do not have converged Lumbosacral Trunk ,the rest 9 specimen have converged Lumbosacral Trunk . The length of Lumbosacral Trunk: Left (32.2±13.3)mm ; Right (32.1±11.3)mm,the width of Lumbosacral Trunk:Left (9.1±2.4)mm;Right (9.6±2.8)mm. After observing 10 adults specimen , it is found that in bilateral sides of the sixth specimen there is not converged Lumbosacral Trunk, and in the fifth specimen , the converging point of bilateral Lumbosacral Trunk is below the Pelvic brim ; In the other 8 specimen , the distance between Lumbosacral Trunk and the Sacroiliac Joint at the level of Pelvic brim is : Left (7.4±2.7)mm ; Right (7.8±3.6)mm。7 The length of Sacral Nerve between the Anterior Sacral Foramina and the Sacral Plexus: S1 Left (35.7±8.4)mm, Right (31.6±5.6)mm; S2 Left (32.3±9.8)mm, Right (30.5±9.7)mm; S3 Left(21.5±4.7)mm, Right (20.3±4.9)mm; S4 Left (15.9±2.9)mm, Right (15.1±2.9)mm. The distance between the both of the Sacral Nerve medial margin at the Anterior Sacral Foramina: S1 (31.6±3.8)mm; S2 (29.6±3.1)mm; S3 (27.8±2.9)mm; S4 (25.7±2.2)mm. the distance between the line of both Anterior Sacral Foramina and the superior border of Sacral Promontory: S1 (31.5±3.3)mm; S2 (56. 8±5.9)mm; S3 (77.7±5.2)mm;S4 (92.2±5.1)mm.8 The distance between the medial margin of Gluteus Superior Vascular Nerve Bundle and the Sacral lateral margin at the same level: Left (25.1±7.1)mm; Right (24.8±7.5)mm. The distance between the Sciatic nerve at the inferior margin of Piriformis and Sacral lateral margin at the same level: Left (41.8±11.6)mm;Right (40.7±10.7)mm. The distance between the Internal Pudendal Vascular Nerve Bundle at the inferior margin of Piriformis and Sacral lateral margin at the same level: Left (20.5±4.0)mm;Right (20.6±3.6)mm. The distance between the Internal Pudendal Vascular Nerve Bundle at the inferior margin of Sacrotuberous Ligament and Sacral lateral margin at the same level: Left (31.2±4.4)mm;Right (31.2±4.4)mm. Conclusion1 The sacral promontory and sacroiliac joint have a stable relation with the vessel in the front of sacral and lumbosacral trunk; the Sacral lateral margin have a stable relation with the Vascular nerve bundle of back side of hip; The sacroiliac joint have a stable relation with the second sacral nerve; the superior border of Crista sacralis mediana have a stable relation with the terminal point of Hard film . It is suggested that all the refered structure can be anatomic landmarks for protecting vessels and nerves in the operation of sacral tumor resection.2 The results of experiment display: the area of"Vascular trigone"before the sacral promontory: (587.5±211.2)mm2, this space can provide operation space in the operation of sacral tumor resection through the anterior approach .3 the Right Common Iliac Artory can be the anatomic landmarks in the operation of sacral tumor resection through the anterior approach , and then the injury of Iliac Vein and the autonomic nerver can be avoided .4 The Vascular nerve bundle arounding the sacral may have variation , so an additional attention should be required .5 At the level of gluteal region , the branch of Sacral plexus that exit from the pelvic cavity have a stable relation with the piriformis and sacrotuberous ligament . Meanwhile there is a certain distance between the branch of Sacral plexus and the Sacral lateral margin . So , for avoiding its injury all operation should be done follow the Sacral lateral margin when resecting the sacral tumor through the back way .