XLIF入路相关的生殖股神经应用解剖及影像学研究
Applied anatomy and imaging study on genitofemoral nerve with respect to the XLIF approach
目的 通过标本解剖和影像学研究，找出生殖股神经（genitofemoral nerve，GFN）在各腰椎间隙的走行位置, 结合腰椎前大血管和腰神经根的位置，得出极外侧入路腰椎椎体间融合术（extreme lateral interbody fusion，XLIF）在各腰椎间隙的安全入路范围。 方法 解剖16例成人尸体标本，暴露GFN并观察其与腰大肌的位置关系。在36例腰椎磁共振扫描影像上观察腰大肌和腹部大血管的位置并测量相关解剖数据，通过分析计算得出各腰椎间隙GFN的走行位置和XLIF入路的安全范围。 结果 生殖股神经在腰大肌内段走行于GFN出椎间孔处与腰大肌穿出点连线上方，呈向前的抛物线或近似直线。GFN在L3/4椎间隙或以上位置穿出腰大肌的样本，GFN距椎体后缘的距离为（34.0±6.02）mm，位置分布在Moro分区位于A区和I区。GFN在L3/4椎间隙以下位置穿出腰大肌的样本，GFN距椎体后缘的距离不小于（16.0±2.16）mm，位置分布在I区、II区和III区。 结论 XLIF入路的安全区域在L2/3椎间隙为II区、III区，在L4/5椎间隙为II区。GFN穿出腰大肌的位置在L3/4椎间隙或以上者，L3/4椎间隙的安全区为II区；在L3/4椎间隙以下者，在L3/4椎间隙从任何分区进入都有损伤血管或神经的可能。
Objective To investigate the position of genitofemoral nerve (GFN) in each vertebral space by dissection, then measure and calculate the data on lumbar magnetic resonance image to investigate GFN’s traveling position in the lumbar intervertebral space. Combined with the position of the great vessels and lumbar spinal nerve roots, the secure zone of each vertebral space in extreme lateral interbody fusion(XLIF) was located. Methods 16 cases of adult cadavers were dissected, GFN’s position in the psoas major muscle and out the psoas major muscle was observed. The position of psoas major muscle and abdominal great vessels in 36 cases of lumbar magnetic resonance image was measured, the secure zone of XLIF approach in each vertebral space was analyzedand calculated. Results GFN was parabolic or nearly straight forward in the psoas major muscle, its position was above the line from its origin point in foramen to the point where it pierced out of the psoas major muscle. In samples that GFN pierce out of the psoas muscle at intervertebral space L3/4 or above, the distance from the posterior edge to GFN was (34.0±6.02)mm, and GFN was located in Zone A and I by Moro’s method. In samples that GFN exited the psoas muscle below intervertebral space L3/4, the distance from the posterior edge to GFN was not less than (16.0±2.16)mm, and GFN might be located in Zone I、II and III. Conclusion The security zone of XLIF approach at intervertebral space L2/3 is zone II and III, at intervertebral space L4/5 is Zone II. When GFN exitspsoas major muscle at intervertebral space L3/4 or above, the secure zone of XLIF approach at intervertebral space L3/4 is zone II. When GFN exits the psoas muscle below intervertebral space L3/4, approach from any zone at intervertebral space L3/4 has a chance to damage the blood vessels or nerve.
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广东省医学科研基金项目（A2013039）；广东省科技计划项目（201301）
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