Abdominal Puncture Lumbar <sub> 5 </ Sub> The Sacral <sub> 1 </ Sub> Discectomy Applied Anatomy And Clinical Research

Objective To meet the needs of the clinical application, We intend to explore a new entrance route to puncture the Li/S1 intervertebral disc ?translaparopuncture, providing a new approach to the interventional treanient of Li/S1 intervertebral disc herniation. Meanwhile, through applied anatomic study, we contribute the topographic anatomic data and information concerning the level of Li/S1 intervertebral disc to increasing the success of operation and preventing complications during translaparopucture disc on the basis of these data and information. Materials and Methods 1. 30 adult cadavers (male 19, female 11) were selected randomly.After topography,the position, together with the included angle, of the origin of inferior vena cava and the terminal of abdominal aorta were measured, we also observed and measured the orientation, morphology,distribution and outer梔iameters of median sacral vessels.The data were measured statistically by ?? the SPSS software. 2. The images of several randomized cases were selected, including CT, angiogram and degistive contrast films in L5/S1 intervertebral disc areas.To evaluate the orientation and distribution of local vessels, the sphere of activities of intestines and their positions related with LIS1 intervertebral disc, and then further analyzed these comparing with data obtained from cadavers. 3.Through the contrast study of applied anatomy and radiography, so as to self梞anufacture the pressing梐nd梖ixing apparatus, introduce digestive contrast, pressure on hypogastria and puncture using hollow needle, translaparopuncture the anterior fibrous ring of L5/S1 intervertebral disc to create a passage for the intervertebral disc dissecting and aspirating technique. Results 1.The study of applied anatomy indicated:O The terminal of the abdominal aorta was located in the area of L4 upper 1/3 vertabral body to L5 middle 1/3 vertabral body, 60. 0 ?8. 94% of them were present on the L4 lower 1/3 vertabral body and L4.5 disc level, all the abdominal aorta ended above the level of Li S1 disc. 0 The location of the origin of inferior vena cava varied from L4 lower 1/3 vertabral body to L5/ S~ disc level, among them, 76. 67 ?. 72% converged on the L5 middle or upper 1/3 vertabral body level; 3.33?.28%onthe L5/S1 disc level; 6.67?.56% left common iliac veins slant to the left and reveal their courses left anteriorly on the Li S~ disc level.?The outer梔iameter of median sacral artery was 1.61?.24mm, it ran down leftly ?? paralleling the median of the spine, its distribution was very regular. 0 The median sacral vein had a lot of variatoins, it ran left superiorly along the median of the spine and drained into the left common iliac vein, its outer梔iameter was2. 25?1. 43mm, 10.0?.48% exceeded 5mm; 26. 67?. 07% 2挆3 branches ran horizontally and joined the left common iliac vein separately; 3. 33?. 28% it may be absent. ?The intestines and their vessels had a big sphere of activities, it is certain that they can move to the areas outside the L5/ S~ disc when the abdomen was pressed on.2. Clinical application:102 cases of this group have turned out to be successful, one case ended with injury of the small intestine ,average efficiency was 90.2%.