Anatomic Study For Radiofrequency Thermosetting Lumbar Sympathectomy

Background:Diabetic foot is aslo called acromegaly necrosis diabetes. It is one of the most serious complications of diabetes. According to the WHO definition in1999, diabetic foot is the lower limbs deep infection, ulcer and tissue destruction resulting from a chronic neuropathy and peripheral vascular lesions. Clinically, it is characterized by nutrition loss, peripheral neuropathy, ischemia, foot deformity and infection, severe pain; and if it continue to development, it will lead to foot ulcer or gangrene. Previous medication, which is difficult to control the further development of lower limb ischemia, usually adopts blood vessel dilators and nerve nutrition therapy, but the effect is poor, and also difficult to achieve the purpose of continuing to vessels expand and alleviating the pain. Surgery in lumbar sympathetic nerve resection can be used for the treatment of lower limb ischemia based on the automatic nerve function, and many operations have been applied. With the development of science and technology, the surgical derogations of sympathetic nerve emerged. In1999, Dominkus M for the first time reports the radiofrequency thermosetting lumbar sympathectomy. During the past ten years, the lumbar sympathetic ganglion radiofrequency thermal coagulation technique gradually expand. The treatment of diabetic foot was confirmed as an effective method. When lumbar sympathetic ganglion was heated with radiofrequency needle, the neural coagulation necrosis was achieved, though puncture target choice was more difficult. Accurate puncturing to nerve can achieve satisfactory surgical results. According to the principle of physics, the needle end working scope expands with the rising of temperature; and when radiofrequency needle temperature is up to80℃above, the C neural axon dissolution necrosis can be made. Meanwhile, the injuries of spinal nerve, reproductive femoral nerve, and ureter increased. At times, the partial derogations would occur with too low temperature. So the anatomy study of lumbar sympathetic nerve was very necessary, and the understanding of the anatomy could provide the base for the clinical treatment of diabetes foot with heat coagulation technique.21cases of diabetic foot were investigated in the lumbar sympathetic ganglion radiofrequency thermal coagulation in order that the lumbar sympathetic nerve anatomy could been applied as the treatment of diabetic foot.Objective:To investigated the sympathetic nerve local anatomy in order to provide the anatomical data of the lumbar sympathetic ganglion radiofrequency thermosetting technique.Methods:The local anatomy of lumbar sympathetic nerve to20adult corpses was studied, while21cases of lumbar sympathetic nerve radiofrequency thermal coagulation with diabetic foot were performed.Results:(1) The number and distribution of lumbar sympathetic ganglion is different individually, ranging from2to6on each side, most concentrating between the L2and L5vertebral bodies.(2) The lumbar sympathetic trunk lies on the two side of spinal, anterior lateral, parallel distance to the edge of being about4.02±1.34mm.(3) Vertical distance of sympathetic ganglion to sagittal plaine as follows:on the left side,3.79±0.83cm; on the right side,3.68±0.68cm.(4) The distance on the front of the abdominal aorta and inferior vena cava is0.93+0.52cm,1.12±0.94cm respectively.(5) The reproductive femoral nerve is derived from between L2and L4vertebral body through the psoas major, and the distance to lateral edge of the psoas major is 0.72±0.36cm.(6) The junctions of iliac blood vessels and ureter lie beteen L4and L5vertebral bodies, and the distance to lateral edge of the psoas major, the left:3.37±0.56cm; the right:3.52±0.56cm.(7) The successful clinical experiences for40cases of lumbar sympathetic nerve radiofrequency thermal coagulation were reported.Conclusion:Lumbar sympathetic ganglion anatomy varies, the important vessels and nerves lying around. The lumbar sympathetic ganglion local anatomy and agile application is critical to the success of lumbar sympathetic ganglion radiofrequency thermosetting operation.