目的 研究腰椎椎间静脉的解剖结构及其临床意义。 方法 观察12具防腐的腰椎标本两侧椎间静脉属支的走行、分布及其与神经根的关系，并测量其外径以及长度。其静脉外径以及长度由观察者反复采用游标卡尺（精确度0.01 mm）测量所得。 结果 腰椎椎间静脉在12具标本中120个椎间孔内均存在。根据其属支在椎间孔内的走行、分布及其与神经根的关系，大致可以分4种类型。199条腰椎椎间静脉的外径平均为（2.13±0.58）mm，最大外径为4.16 mm。 结论 腰椎椎间静脉是腰椎比较重要的解剖结构，当椎间孔镜技术在安全三角操作时，可能会导致椎间静脉的破裂。应注意椎间静脉的存在，提前结扎或者术中充分止血，有可能会降低术后神经感觉迟钝等相应并发症的发生。对于脊柱微创手术医生，充分了解掌握腰椎椎间静脉的解剖结构有一定的临床辅导意义。
Objective To study the anatomy and clinical significance of lumbar intervertebral veins. Methods 12 embalmed cadavers were dissected to observe the tributaries and distribution of the lumbar intervertebral vein, and their relationship with nerve roots in the intervertebral foramina. The diameter and length of branches of the lumbar intervertebral vein were measured by the Vernier caliper (accuracy 0.01 mm). Results The branches of the intervertebral veins could be observed in all the 120 intervertebral foramina of 12 embalmed cadavers. According to the distribution and distribution of tributaries of the lumbar intervertebral vein, and their relationship with nerve roots can be divided into four types. The average diameter of 199 branches of the lumbar intervertebral veins was （2.13±0.58） mm and the maximum outer diameter was 4.16 mm. Conclusions The lumbar intervertebral veins are an important anatomical structure of the lumbar spine. When percutaneous transforaminal endoscopic disscectomy is performed in the safe triangle area, it may lead to the rupture of the intervertebral veins. Attention should be paid to the presence of the intervertebral veins, and early ligation or adequate hemostasis should be performed during operation, which may reduce postoperative complications such as nerve insensitivity. For minimally invasive spine surgeons, understanding of the anatomy of the lumbar intervertebral veins adequately may have some clinical implications.
[1] 徐仲林, 蒋赞利. 经皮椎间孔镜技术的发展、治疗范围、并发症及特点[J]. 东南大学学报(医学版), 2015(3): 452-455.
[2] 赵伟, 李长青, 周跃, 等. 经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症 [J]. 中国矫形外科杂志, 2012, 20(13): 1192-1195.
[3] Lee JH, Lee SH. Which clinical and radiological variables could predict clinical outcomes of percutaneous endoscopic lumbar discectomy for treatment of patients with lumbosacral disc herniation[J]. Spine J, 2018, 18(8): 1338-1346.
[4] Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation[J]. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
[5] 刘盾, 胡冰. PTED手术治疗腰椎间盘突出症的并发症分析[J]. 中国骨与关节损伤杂志, 2018, 33(5): 474-477.
[6] Yuan SG, Wen YL, Zhang P, et al. Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina[J]. Int Orthop, 2015, 39(11): 2135-2141.
[7] Nojiri H, Miyagawa K, Banno S, et al. Lumbar artery branches coursing vertically over the intervertebral discs of the lower lumbar spine: an anatomic study[J]. Eur Spine J, 2016, 25(12): 4195-4198.
[8] Zhong E, Zhao Q, Shi B, et al. Morphology and possible clinical significance of the radiating extraforaminal ligaments at the L1-L5 levels[J]. SPINE, 2017, 42(18): 1355-1361.
[9] Chaynes P, Verdié JC, Moscovici J, et al. Microsurgical anatomy of the internal vertebral venous plexuses[J]. Surg Radiol Anat, 1998, 20(1): 47-51.
[10]Demondion X, Delfaut EM, Drizenko A, et al. Radio-anatomic demonstration of the vertebral lumbar venous plexuses: an MRI experimental study[J]. Surg Radiol Anat, 2000, 22(3-4): 151-156.
[11] 侯海涛. 下腰椎侧面结构相关应用解剖与影像学研究[D]. 大连: 大连医科大学, 2013.
[12] 陆声, 钟世镇, 徐永清，等. 下腰椎侧前方静脉的解剖及其在腹腔镜腰椎手术中的临床意义[J]. 中国临床解剖学杂志, 2006, 24(2): 125-127.
[13]马春明，鞠晓华，王孝文，等. 腰椎椎基静脉孔的解剖学观测及其临床意义[J]. 中国临床解剖学杂志, 2014(4): 405-408.
[14]孙兆忠，李瑞，房清敏，等. 腰椎关节突关节区域静脉临床解剖学研究[J]. 滨州医学院学报, 2015(1): 4-6.
[15]潘力，李忠华，马廉亭，等. 椎管内静脉丛的应用解剖学研究[J]. 中国临床神经外科杂志, 2006, 11(11): 664-666.
[16]金晓锋, 刘礼锋, 王涵广, 等. TESSYS椎间孔镜术中止血措施探讨[J]. 浙江创伤外科, 2015, 20(2): 279-280.
京ICP备08002354号-3
