旁肌间隙手术入路的解剖与临床研究

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1、腰椎椎旁肌间隙手术入路的解剖与临床研究陈宣煌许卫红胡建伟陈荣生李贵双张怀志郑祖高[摘要]目的观测腰背部椎旁肌间隙入路局部解剖结构，指导临床应用并评价疗效。方法解剖研究采用10具成人尸体脊柱标本进行胸腰筋膜、竖脊肌腱膜、最长肌、多裂肌及其支配的神经血管束等结构的观测，分别测量第3～4腰椎、第4～5腰椎、第5腰椎～第1骶椎椎间隙中点水平多裂肌最外缘、多裂肌与椎板汇合点及小关节突外缘至后正中线的距离。临床应用传统开放式入路（A组）和椎旁肌间隙入路（B组）分别行下腰椎后路融合术，每组100例，以临床疗效及腰椎椎旁肌MRI为评判标准。结果①竖脊肌腱膜与最长肌及多裂肌表面无粘连，

2、下腰段最长肌与多裂肌间隙的接触面未见神经血管，钝性分离即可顺利暴露上关节突及横突根部，第3～4腰椎、第4～5腰椎、第5腰椎～第1骶椎椎间隙中点水平小关节突外缘、多裂肌最外缘及多裂肌与椎板汇合点至后正中线距离约为2.5～3.0cm；②按Nakai标准B组临床疗效优于A组，MRI显示多裂肌面积B组较A组无明显萎缩。结论椎旁肌间隙入路操作简便，可减少椎旁肌的损伤，临床应用效果良好。腰椎椎旁肌间隙；手术入路；解剖学；临床应用AnatomicalandclinicalstudyoftheWiltseapproachtothelumbarspineCHENXuan-huang*X

3、UWei-hongHUJian-weiCHENRong-shengLIGui-shuangZHANGHuai-zhiZHENGZu-gao*DepartmentofOrthopedics,AffiliatedHospitalofPutianUniversity,Putian351100,China[Abstract]ObjectiveToobservetherelevantsurgicalanatomyfortheWiltseapproachtothelumbarspineandprovideatheoreticalbasisforclinicalapplicatio

4、n.MethodsTenadultcadaverspecimenswereappliedintheanatomystudy,thethoracolumbarfascia,erectorspinaeaponeurosis,longissimus,multifidusmuscleandtheneurovascularbundleandotherdisposablewereobserved,makingtheappropriatemeasurement.Applicationoftraditionalopenapproach(groupA)andtheparaspinala

5、pproach(groupB)wereperformedundertheposteriorfusionofthe100patientsseparately,andtheclinicalefficacyandlumbarparaspinalmnuscleMRIshowwerecompared.ResultsTherewasnoadhesionbetweenthemultifidus,longissimusanderectorspinaeaponeurosis.Specialanatomicalstructureofmultifidusandlongissimusmake

6、sthesmoothmusclegapbluntdissectionwhichcanbeexposedtofacetandtransverseprocess.Measuringfollow:L3-4,L4-5,L5-S1intervertebral-gappointsandtheouteredgeofasmallfacet,themostouteredgeofthemultifidusmuscleandmultifidustotheconfluencewiththelaminaafterthemidlinedistance,fluctuationsinthevalue

7、ofthethree2.5-3.0cm.AccordingtothestandardclinicalevaluationofNakai,theclinicaleffectingroupBwassuperiortothatingroupA,andtherewasnosignificantdifferenceinmultifidusmuscleareabetweenthetwogroups.ConclusionsParaspinalapproachissimple,itcanreducethedamageofthemultifidusandtheclin