极外侧腰椎椎间融合手术入路相关的应用解剖学研究

张树芳　陈荣春　钟红发南昌大学附属赣州医院脊柱外科，江西赣州　341000

极外侧腰椎椎间融合手术入路相关的应用解剖学研究

张树芳陈荣春钟红发
南昌大学附属赣州医院脊柱外科，江西赣州341000

目的 通过标本解剖学研究，得出极外侧入路腰椎椎体间融合术（extremelateral interbody fusion，XLIF）在各腰椎间隙的安全入路范围，为XLIF技术提供详尽的应用解剖学数据。方法 自2016年3～4月行尸体解剖实验，观察18例成人尸体标本椎间盘侧方解剖结构及毗邻血管神经分布及极外侧入路的可行性。结果 腰椎间盘左侧手术窗大于右侧手术窗，左侧手术窗（39.91±5.97）mm，右侧手术窗（36.04±6.22）mm。用穿刺针进行模拟，穿刺角度为64°时安全性高，距离血管神经位置远。结论 腰椎间盘侧方区域可作为内窥镜手术治疗腰椎间盘疾患的区域，XLIF手术安全性良好。

极外侧入路腰椎椎体间融合术；微创；应用解剖；血管和神经

［Abstract］Objective To explore the safe range of surgical approach in extreme lateral interbody fusion（XLIF）by anatomy study on specimens，and to provide applied anatomy data in detail for XLIF.Methods 18 adult cadaveric specimens were dissected during March 2016 to April 2016，and the anatomical structure lateral to intervertebral disc and its adjacent neurovascular distribution were observed，and the feasibility of extreme lateral approach was analyzed. Results The left surgical window（39.91±5.97mm）of lumbar intervertebral disc was larger than the right one（36.04± 6.22 mm）.Puncture needles were used to simulate the operation.When the puncture angle was 64°，the safety was high with long distance to blood vessels and nerves.Conclusion The lateral region of lumbar intervertebral disc can be used as surgical region to treat related diseases by endoscopy，with favorable safety of XLIF operation.

［Key words］Extreme lateral interbody fusion；Microinvasive；Applied anatomy；Vessels and nerves

随着人口的老龄化，腰椎退变性疾病逐渐增多。国内外一般应用腰椎后路椎间融合术治疗腰椎退行性疾病，并且取得了良好的疗效。但是传统腰椎椎间融合手术出现了软组织损伤、邻近节段退变等并发症［1-5］。近年来，随着微创技术在脊柱外科的广泛应用，腰椎椎间融合微创技术逐渐推广应用于腰椎退行性疾病［6-8］。极外侧入路腰椎椎体间融合术（extremelateral Interbody fusion，XLIF）是目前应用较多的微创椎间融合手术，与传统腰椎后路椎间融合术相比，具有腰椎后方复合体损伤小，患者康复快等优点［9］，但XLIF也有可能出现生殖股神经损伤、腹部血管损伤等并发症［10，11］。……