Application Of Lower Lumbar Lateral Anatomy And Imaging Research

Objective: To explore the feasiblity of study lower lumbar lateral surgicalapproach by study the anatomy of lower lumbar lateral structure and MSCTperformance of vessels in relevant section, so as to provide the basis of detailedguidance on clinical surgical approach.Methods: This study was divided into two parts:First: Anatomy study of lower lumbar structure.25adult corpses was dissected,the important blood vessels and nerves of front, laterial and back of the lower lumbarspine was showed, the relative position relation of each structure were noted; theemergence, line and into point of lumbar segmental vein were observed and recorded,the vein diameter were measured. Observed and recorded the lumbar nerve rootcourse and lumbar sympathetic trunk anatomical structure. Through the simulation ofsurgical approach, On the basis of anatomical study selection, incision size, surgicalincision of the position each organization and vulnerability of the blood vessels,nerves, so as to choose the best surgical approach.Second: Imaging Anatomy study of lower lumbar vessel. By MSCT angiographytechnology to understand the living tissue of the lumbar veins, lumbar segmental vein,with iliac vein blood vessel diameter and compared them with part one,so as to judgewhether MSCT angiography techniques can provide useful information for surgery.Results:First, the lower lumbar spine anatomical study.Lumbar veins starts from the vertebral venous plexus, through the inside edge ofpsoas major muscle, then within central vertebral bodies among the ventral groove,join in the inferior vena cava, in the distance the left side is longer than the right side.Lumbar segmental vein located above the accompanying arteries in the middle of thevertebral groove, connected the ascending lumbar vein In the intervertebral foramen,running in front of the transverse process of the root in the lumbar plexus within remitted common iliac vein and iliolumbar vein. This study showed the frequency ofL3、L4segment veins, iliolumbar veins and ascending lumbar veins were92﹪、84﹪、64﹪and60﹪. Measuring blood vessel diameter difference increased; ascendinglumbar vein and low waist iliac vein display course and morphological variation.Lumbar spinal nerve anterior branch from the corresponding level of theintervertebral foramen the partial upper part of a hole(expenditure before the lumbarnerve root hole locations partial intervertebral foramen below), trench traveling in thedeep surface of the psoas muscle, nerve next to the spine. Traffic branch connectedbetween the lumbar sympathetic trunk and the lumbar plexus. We measured thevertical distance from bilateral lumbar sympathetic trunk to the intervertebral foramen,the distance of L3/4、L4/5、L5/S1was26.16±1.96mm、26.31±1.90mm、25.79±2.01mmrespectively.Second, MSCT enhanced contrast examination.MSCT angiography can show segmental vein, the diameter of the ascendinglumbar vein and iliolumbar vein, the measurement results and the autopsy results arebasically the same.Conclusion:1. There were less study about laterial lumbar vascular anatomy, but someanatomical studies have shown a high frequency of appearance of segments veinsunder the lumbar spine, varied greatly. Therefore, in the surgical procedure ofrevealed the side of the vertebral body or intervertebral, you must to pay attention toavoid damage the vascular structures.2．Iliolumbar vein and ascending lumbar vein have low display rate, and thecourse and morphology variated significantly. During he surgery exposed of thelaterial vertebral body, especially exposed the structure below the level of L5vertebra,more attention should be payed to observe the presence or absence of the veinstructure and the traffic branch.3. Lumbar anterior branch of spinal nerve from the level of the correspondingintervertebral foramen through the intervertebral foramen, walking in the psoas deepsurface, paravertebral nerve sulcus. The L5spinal nerve anterior branch and the iliacwing closely, this site operation, can choose the hip flexion posture, to increase nerveroot branches outside distraction shift, expand the operation space, to avoid or reducethe injury of nerve root. The traffic branch is connected between the lumbarsympathetic trunk and the lumbar plexus. L3-5vertebral lateral operation, observe the traffic situation, to avoid injury.4. Lower lumbar vertebrae blood vessels and nerves can display operation safetyarea without important neurovascular structures, its scope is relatively large,conducive to the implementation of the operation, reduce the incidence ofcomplications.5. Dual-phase enhanced MSCT scan can display the lower lumbar lateralvascular structure, to avoid operation has important clinical significance of vascularinjury.