轴向腰椎椎间融合术入路的应用解剖
Applied anatomy of presacral approach for axial lumbar interbody fusion
目的 探讨经骶前间隙轴向腰椎椎间融合术入路的安全性。 方法 (1) 12具（24侧）防腐固定成人骨盆段标本，解剖骶前间隙，观察骶前的筋膜层次，骶直肠筋膜，盆内脏神经等，测量骶直肠筋膜和盆内脏神经的相关解剖数据。(2) 参照Marotta方法，模拟手术置入导针，测量导针在骶前间隙中的相关解剖学数据。 结果 (1)骶前的筋膜可分为5层；(2)骶直肠筋膜的出现率是91.7%，在骶前壁层筋膜的起始部位：S2为16.7%，S3为41.7%，S4为33.3%，它将骶前间隙分为上、下两部分； (3)盆内脏神经限制直肠下段的解剖分离，可作为骶前间隙“矢状安全区域”的指标，其长度是（22.9±3.2）mm； (4)模拟手术时，导针到盆内脏神经的最短距离是（7.8±1.9）mm，到S3/4横线的垂直距离是（15.0±3.6）mm。 结论 经骶前间隙轴向腰椎椎间融合术入路的安全性是相对的，由于骶直肠筋膜、骶前静脉丛横干和骶前血管变异的存在，手术入路面临着较大的风险。
Objective The aim of this study was to evaluate the safety of the presacral approach for axial lumbar interbody fusion. Methods (1) The pelvic region of 12 adult cadavers was dissected and analyzed. All specimens were divided in the median sagittal plane. The main goal of these dissection was to understand the fascial structures of the presacral space and measure some data correlated with the rectosacral fascia and pelvic splanchnic nerves. (2) The blunt guide pin was inserted using the technique described by Marotta into 24 pelvic-halves, the distance from the trocar to important structures in the presacral space was measured. Results (1) The fascial structures of the presacral space was multilaminar, it could be divided into five levels. (2) The rectosacral fascia was found in 11 out of 12 specimens（91.7%），it originated from the parietal presacral fascia at the level of S2 in16.7% ,S3 in 41.7% and S4 in 33.3%. The presacral space was divided into superior and inferior portions by the rectosacral fascia. (3) Pelvic splanchnic nerves confined the dissection of the lower rectum, its length which could be used as a measure of the'sagittal safe zone' for presacral space was（22.9±3.2）mm. (4) In this study, the shortest distance from the guide pin to pelvic splanchnic nerves was （7.8±1.9）mm, the vertical distance to the S3/4 junction was（15.0±3.6）mm. Conclusion It is risky to perform the presacral approach for axial lumbar interbody fusion because of the presence of the rectosacral fascia, presacral venous plexus and the vascular variations.
椎间融合 / 骶前间隙 / 外科平面 / 盆内脏神经 / 应用解剖
Interbody fusion / Presacral space / Surgical plane / Pelvic splanchinc nerves / Applied anatomy
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