腰骶干及其周围结构的应用解剖学研究
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摘要
目的:为腰骶干损害的诊治及相邻区域的手术操作提供解剖学资料。万法:对31具(33例)成人尸体腰骶干及周围血管、神经的分布,走行特点进行观察,对具有临床意义的数据进行解剖学测量。结果:1、腰骶干本身变异极大,它的有无、长短、粗线、走行、组成都有很大变异。在无腰骶干形成的标本中的L5神经前支的起止点都较恒定,走行方向和大部分毗邻关系与腰骶干相同。2、腰骶干最易损伤的部位是在骶骨翼上缘。Denis Ⅰ型骶骨骨折、骶髂关节脱位、Tile C型骨盆骨折和局部的肿瘤等都有损伤腰骶干的可能。3、腰骶干大部分位于腰大肌内缘、髂血管后方,探察可在此二者间进行。左侧腰骶干距髂腰动脉较近,探查时注意辨认和处理。4、L4神经前支、股神经、闭孔神经和交通支在髂腰韧带前方易损伤。探查可沿髂嵴上缘外侧,经腰大肌后方进入,也可经腰5椎体旁与腰大肌内侧进入。5、腰4横突距腰骶干和L5神经前支起始部较远,骨折后对其造成损害的可能不大,易损伤的是位于其下方的L4神经前支、股神经、闭孔神经和交通支。结论:1、腰骶干本身变异太大,在无典型腰骶干形成的标本中L5神经前支的起止点较恒定,其走行方向和大部分毗邻关系也与腰骶干相同,故在探查腰骶干而又不了解其变异的情况下应以L5神经前支的解剖走行为准。2、腰骶干、股神经、闭孔神经都有其易损伤部位,探查时应首先探查这些部位。
Purpose: To provide anatomy data for the diagnosis and treatment of the injured lumbosacral trunk and for the operation technique of its adjacent areas. Methods: By observing the lumbosacral trunks of 31 adult bodies (33 examples), the distributions and runs of the blood vessels and the nerves around them, and by measuring anatomically the data significant to the clinic. Results: 1.there 're great variations in the lumbosacral trunk itself, so do its presence and absence, length, linea aspera fermoris, runs and compositions. The start-stop point of the nerve preramus L5 in the specimen without forming the lumbosacral trunk is relatively constant and its runs and most adjacent relations are similar to the lumbosacral trunk.2. The most vunable part of the lumbosacral trunk lies in the upper fringe of the alae sacri.3.The lumbosacral truks are mostly located in the inter fringe of the musculus psoas major and the rear of the iliac blood vessels, so exploration can be made between them. The left lumbosacral trunk is near to the small iliac artery and attention should be focused on the identification and treatment of it while exploring. 4. The nerve preramus L4 , the femoral nerve, the obturator nerve and the communicating branch are liable to injury in the front of the ligamentum iliolumbale. Exploration can be made along the external side of the upper fringe of the crista iliaca before passing the rear of the musculus psoas major, it can also be made through the side of lumber 5 vertebra and the internal side of the musculus psoas major. 5. Musculi 4 intertransversarii is far from the initiation part of the nerve preramus L5 and there is
no great possibility to create damage to it after the fracture, the venerable parts are the nerve preramus L4, the femoral nerve , the obturator nerve and the communicating branch under it. Conclusions: 1. The variations in the lumbosacral trunk itself are great , the start-stop point of the nerve preramus L5 in the specimen without forming the typical lumbosacral trunk is relatively constant and its runs and most adjacent relations are similar to the lumbosacral trunk, so exploring the lumbosacral trunk without knowing its variations should be subject to the anatomy of the lumber 5 nerve preramus. 2. The lumbosacral trunk, the femoral nerve and the obturator nerve all have their vulnerable parts, so priority should be given to them while exploring.
Purpose: To provide anatomy data for the diagnosis and treatment of the injured lumbosacral trunk and for the operation technique of its adjacent areas. Methods: By observing the lumbosacral trunks of 31 adult bodies (33 examples), the distributions and runs of the blood vessels and the nerves around them, and by measuring anatomically the data significant to the clinic. Results: 1.there 're great variations in the lumbosacral trunk itself, so do its presence and absence, length, linea aspera fermoris, runs and compositions. The start-stop point of the nerve preramus L5 in the specimen without forming the lumbosacral trunk is relatively constant and its runs and most adjacent relations are similar to the lumbosacral trunk.2. The most vunable part of the lumbosacral trunk lies in the upper fringe of the alae sacri.3.The lumbosacral truks are mostly located in the inter fringe of the musculus psoas major and the rear of the iliac blood vessels, so exploration can be made between them. The left lumbosacral trunk is near to the small iliac artery and attention should be focused on the identification and treatment of it while exploring. 4. The nerve preramus L4 , the femoral nerve, the obturator nerve and the communicating branch are liable to injury in the front of the ligamentum iliolumbale. Exploration can be made along the external side of the upper fringe of the crista iliaca before passing the rear of the musculus psoas major, it can also be made through the side of lumber 5 vertebra and the internal side of the musculus psoas major. 5. Musculi 4 intertransversarii is far from the initiation part of the nerve preramus L5 and there is
no great possibility to create damage to it after the fracture, the venerable parts are the nerve preramus L4, the femoral nerve , the obturator nerve and the communicating branch under it. Conclusions: 1. The variations in the lumbosacral trunk itself are great , the start-stop point of the nerve preramus L5 in the specimen without forming the typical lumbosacral trunk is relatively constant and its runs and most adjacent relations are similar to the lumbosacral trunk, so exploring the lumbosacral trunk without knowing its variations should be subject to the anatomy of the lumber 5 nerve preramus. 2. The lumbosacral trunk, the femoral nerve and the obturator nerve all have their vulnerable parts, so priority should be given to them while exploring.
引文
[1] 人体解剖学,河北新医大学《人体解剖学》编写组,人民卫生出版社出版.1439-1440
[2] 郭世钹著.临床骨科解剖学.天津:天津科学技术出版社,1988;261
[3] 刘建丰,杜心如,王文质,张一模,孙祥玉.腰4.5神经根交通支的基础研究.中国骨伤,1994,7(1):30-31
[4] Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis: a postmortem radiographic and patho-anatomical study. Acta Chir Scand Suppl. 1972; 429: 3-43
[5] Huittinen VM, Slatis P: Nerve injury in double vertical pelvic fractures. Acta Chir Scand 138: 571-575, 1972
[6] Huittinen VM, Slatis P: Fractures of the pelvis: Trauma mechanism, types of injury and principles of treatment. Acta Chir Scand 138: 563-569, 1972
[7] Ebraheim NA, Lu J, Yang H, Huntoon M, Yeasting RA. Lumbosacral plexus: a histological study. Acta Anat (Basel). 1997; 158(4): 274-8
[8] Lundberg G. Nerve regeneration and repair: A review. Acta Orthopaedica Scandinavica. Vol. 58(2)(pp 145-169), 1987
[9] 顾立强,张景僚,王钢,裴国献.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志,2002,4(3):174-177
[10] Slatis P, Huittinen VM: Double vertical fractures of the pelvis. Acta Chir Scand 138: 799-807, 1972
[11] Ward E, Tomasin J, Vander Griend R: Open reduction and internal fixation of verticalshear pelvic fractures. J Trauma 27: 291-295, 1987
[12] FP Patterson and KS Morton. The cause of death in fractures of the pelvis: with a note on treatment by ligation of the hypogastric (internal iliac) artery. Trauma, Oct 1973; 13(10): 849-56
[13] Weis Jr EB. Subtle neurological injuries in pelvic fractures. Journal of Trauma-Injury Infection & Critical Care. Vol. 24(11)(pp 983-985), 1984
[14] Atlihan, Dogan MD;Tekdemir, Ibrahim MD;Ates, Yalim MD;Elhan, Alaittin MD. Anatomy of the Anterior Sacroiliac Joint With Reference to Lumbosacral Nerves. Clinical Orthopaedics & Related Research. (376).2000. 236-241
[15] Rageth JCh. Saurenmann E. Waespe W. Postpartal footdrop due to compression of the lumbosacral trunk.Gynakologisch- Geburtshilfliche Rundschau. Vol. 40(2)(pp 68-70),2000
[16] Katirji B, Wilbourn AJ, Scarberry SL, Preston DC. Intrapartum maternal lumbosacral plexopathy. Muscle Nerve 2002 Dec;26(6):858
[17] Graesslin O, Elaerts M, Palot M, Bednarczyk L, Quereux C.Maternal paralysis of obstetrical origin. Two case reports . J Gynecol Obstet Biol Reprod (Paris). 1996;25 (8):858-61
[18] FRANCIC DENIS, MD., STEVEN DAVIS, B. S. , AND THOMAS COMFORT, M. D. Sacral Fractures:An Important Problem.Retrospective Analysis of 236 Cases. Clinical Orthopaedics & Related Research.1988, (227):67-81
[19] Bonnin JG. Sacral fractures and injuries to the cauda equina. J Bone Joint Surg Am. 1945; 27: 113-127
[20] Duverney JG. The classic Duverney' s fracture. Reprinted from: Duverney JG. Traite des Maladies des 0s. Vol. 1.Paris: Bure, 1' Aine, 1751:285. Clin. Orthop. 1996; 329:4-5
[21] Patterson FP, Morton KS. Neurologic complications of fractures and dislocations of the pelvis. Surg Gynecol Obstet. 1961; 112: 702-706
[22] VM Huittinen and P Slatis. Nerve injury in double vertical pelvic fractures. Acta Chir Scand, Jan 1972; 138(6): 571-5
[23] Huittinen VM, Slatis P: Nerve injury in double vertical pelvic fractures. Acta Chir Scand 138: 571-575, 1972
[24] Huittinen VM, Slatis P: Fractures of the pelvis: Trauma mechanism, types of injury and principles of treatment. Acta Chir Scand 138: 563-569, 1972
[25] 李书奎,李建博.第四腰椎横涂骨折压迫腰骶干一例.中华创伤杂志,1995,11(1):27
[26] 李传夫,李家明.腰大肌损伤性腰腿痛解剖学分析 中国骨伤2003年03月第16卷第03期
[2] 郭世钹著.临床骨科解剖学.天津:天津科学技术出版社,1988;261
[3] 刘建丰,杜心如,王文质,张一模,孙祥玉.腰4.5神经根交通支的基础研究.中国骨伤,1994,7(1):30-31
[4] Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis: a postmortem radiographic and patho-anatomical study. Acta Chir Scand Suppl. 1972; 429: 3-43
[5] Huittinen VM, Slatis P: Nerve injury in double vertical pelvic fractures. Acta Chir Scand 138: 571-575, 1972
[6] Huittinen VM, Slatis P: Fractures of the pelvis: Trauma mechanism, types of injury and principles of treatment. Acta Chir Scand 138: 563-569, 1972
[7] Ebraheim NA, Lu J, Yang H, Huntoon M, Yeasting RA. Lumbosacral plexus: a histological study. Acta Anat (Basel). 1997; 158(4): 274-8
[8] Lundberg G. Nerve regeneration and repair: A review. Acta Orthopaedica Scandinavica. Vol. 58(2)(pp 145-169), 1987
[9] 顾立强,张景僚,王钢,裴国献.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志,2002,4(3):174-177
[10] Slatis P, Huittinen VM: Double vertical fractures of the pelvis. Acta Chir Scand 138: 799-807, 1972
[11] Ward E, Tomasin J, Vander Griend R: Open reduction and internal fixation of verticalshear pelvic fractures. J Trauma 27: 291-295, 1987
[12] FP Patterson and KS Morton. The cause of death in fractures of the pelvis: with a note on treatment by ligation of the hypogastric (internal iliac) artery. Trauma, Oct 1973; 13(10): 849-56
[13] Weis Jr EB. Subtle neurological injuries in pelvic fractures. Journal of Trauma-Injury Infection & Critical Care. Vol. 24(11)(pp 983-985), 1984
[14] Atlihan, Dogan MD;Tekdemir, Ibrahim MD;Ates, Yalim MD;Elhan, Alaittin MD. Anatomy of the Anterior Sacroiliac Joint With Reference to Lumbosacral Nerves. Clinical Orthopaedics & Related Research. (376).2000. 236-241
[15] Rageth JCh. Saurenmann E. Waespe W. Postpartal footdrop due to compression of the lumbosacral trunk.Gynakologisch- Geburtshilfliche Rundschau. Vol. 40(2)(pp 68-70),2000
[16] Katirji B, Wilbourn AJ, Scarberry SL, Preston DC. Intrapartum maternal lumbosacral plexopathy. Muscle Nerve 2002 Dec;26(6):858
[17] Graesslin O, Elaerts M, Palot M, Bednarczyk L, Quereux C.Maternal paralysis of obstetrical origin. Two case reports . J Gynecol Obstet Biol Reprod (Paris). 1996;25 (8):858-61
[18] FRANCIC DENIS, MD., STEVEN DAVIS, B. S. , AND THOMAS COMFORT, M. D. Sacral Fractures:An Important Problem.Retrospective Analysis of 236 Cases. Clinical Orthopaedics & Related Research.1988, (227):67-81
[19] Bonnin JG. Sacral fractures and injuries to the cauda equina. J Bone Joint Surg Am. 1945; 27: 113-127
[20] Duverney JG. The classic Duverney' s fracture. Reprinted from: Duverney JG. Traite des Maladies des 0s. Vol. 1.Paris: Bure, 1' Aine, 1751:285. Clin. Orthop. 1996; 329:4-5
[21] Patterson FP, Morton KS. Neurologic complications of fractures and dislocations of the pelvis. Surg Gynecol Obstet. 1961; 112: 702-706
[22] VM Huittinen and P Slatis. Nerve injury in double vertical pelvic fractures. Acta Chir Scand, Jan 1972; 138(6): 571-5
[23] Huittinen VM, Slatis P: Nerve injury in double vertical pelvic fractures. Acta Chir Scand 138: 571-575, 1972
[24] Huittinen VM, Slatis P: Fractures of the pelvis: Trauma mechanism, types of injury and principles of treatment. Acta Chir Scand 138: 563-569, 1972
[25] 李书奎,李建博.第四腰椎横涂骨折压迫腰骶干一例.中华创伤杂志,1995,11(1):27
[26] 李传夫,李家明.腰大肌损伤性腰腿痛解剖学分析 中国骨伤2003年03月第16卷第03期