收稿日期: 2015-09-24
网络出版日期: 2016-06-17
基金资助
国家自然科学基金（31271286）；漯河市2014年度青年拔尖人才支持项目
Applied anatomy of the rectosacral fasia for axial lumbar interbody fusion
Received date: 2015-09-24
Online published: 2016-06-17
目的 观察骶直肠筋膜在轴向腰骶椎椎间融合术中的应用解剖。 方法 10具(20侧)男女骨盆标本，观察骶直肠筋膜的位置，并进行相关解剖学测量。 结果 ①骶直肠筋膜起自S3者较多，为44.4%，将骶前间隙分为上下两部分；②男性骶直肠筋膜跨越直肠两侧连于骨盆腔壁腹膜，女性的则两侧跨越直肠后连于直肠子宫襞；③骶直肠筋膜长度（23.14±1.41）mm、厚度（1.25±0.13）mm，距离手术切口（66.10±7.03）mm、距离S1/S2横线中点（23.09±1.87）mm。 结论 ①骶直肠筋膜在骶前间隙内普遍存在，术中应对其进行锐性分离以避免骶前静脉丛撕裂伤；②女性骶直肠筋膜可能为子宫骶韧带的一部分。
王江栓 , 丁冉 , 赵庆豪 , 王丰刚 , 王建中 , 丁自海 , 王福青 . 骶直肠筋膜在轴向腰椎椎间融合术中的应用解剖[J]. 中国临床解剖学杂志, 2016 , 34(3) : 260 -262 . DOI: 10.13418/j.issn.1001-165x.2016.03.005
Objective To observe the applied anatomy of the rectosacral fasia (RSF) for axial lumbar interbody fusion(Axial LIF). Methods The pelvic region of 10 human specimens were divided into 20 halves in the median sagittal plane. Related anatomical data of the RSF were collected from all specimens. Results (1) The RSF mostly originated from the level of the S2 in 44.4% which divided the presacral space into superior and inferior portions. (2) The RSF of men were across both sides of the rectum and connected to the parietal peritoneum of the pelvic, and the RSF of women were connected to the rectouterine fold. (3) The average length of the RSF was (23.14±1.41) mm, the average thickness was (1.25±0.13) mm, the average distance to surgical incision (66.10±7.03) mm, the average distance to the midpoint of S1/S2 cable(23.09±1.87) mm. Conclusion (1) The RSF existed universally in the presacral space which should be dissected sharply in surgery to avoid the injury to the presacral venous plexus. (2)The RSF of women may be a part of the uterosacral ligament.
[1] 王华峰, 郑召民. 经骶前间隙轴向腰椎间融合术的研究进展[J].中国脊柱脊髓杂志, 2013, 23(3): 275-278.
[2] Kinugasa Y, Murakami G, Suzuki D, et al. Histological identification of fascial structures posterolateral to the rectum[J]. Br J Surg, 2007,94(5): 620-626.
[3] Diop M, Parratte B, Tatu L, et al. "Mesorectum": the surgical value of an anatomical approach[J]. Surg Radiol Anat, 2003, 25(3-4): 290-304.
[4] Zhang C, Ding ZH, Li GX, et al. Perirectal fascia and spaces: annular distribution pattern around the Mesorectum[J]. Dis Colon Rectum, 2010, 53(9):1315-1322.
[5] Cragg A1, Carl A, Casteneda F, et al. New percutaneous access method for minimally invasive anterior lumbosacral surgery[J]. J Spinal Disord Tech, 2004, 17(1): 21-28.
[6] Hong X, Wu XT, Zhuang SY, et al. New cage for posterior minimally invasive lumbar interbody fusion: a study in vitro and in vivo[J]. Orthop Surg, 2014, 6(1): 47-53.
[7] Fleischer GD, Hart D, Ferrara LA, et al. Biomechanical effect of transforaminal lumbar interbody fusion and axial interbody threaded rod on range of motion and S1 screw loading in a destabilized L5-S1 spondylolisthesis model[J]. Spine (Phila Pa 1976), 2014, 39(2): E82-88.
[8] Li X, Zhang Y, Hou Z, et al. The relevant anatomy of the approach for axial lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2012, 37(4): 266-271.
[9] Crapp AR, Cuthbertson AM.William Waldeyer and the rectosacral fascia[J]. Surg Gynecol Obstet, 1974, 138(2): 252-256.
[10]Muntean V.The surgical anatomy of the fasciae and the fascial spaces related to the rectum[J]. Surg Radiol Anat, 1999, 21(5):319-324.
[11]Sato K, Sato T. The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia [J]. Surg Radiol Anat,1991, 13(1):17-22.
[12]Havenga K, Grossmann I, Deruiter M, et al. Definition of total mesorectal excision, including the perineal phase: technical considerations [J]. Dig Dis, 2007, 25(1):44-50.
[13]孙喜太, 苏磊, 李强, 等. 腹腔镜直肠癌根治术的相关解剖要点分析[J]. 中国微创外科杂志, 2009, 9(7):589-591.
[14]柏树令. 系统解剖学[M]. 第7版. 北京: 人民卫生出版社,2008:173.
[15]周秀华, 欧阳四新. 子宫骶韧带的应用解剖[J]. 解剖学杂志, 2007, 30( 4): 480-482.
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