| 邓尚希,赵庆豪,江 剑,彭 睿,马润洵,谭雪梅,刘则征,黎庆初.腰段自主神经的解剖学研究及临床意义[J].中国脊柱脊髓杂志,2020,(7):644-651. |
| 腰段自主神经的解剖学研究及临床意义 |
| 中文关键词: 腰段自主神经 解剖 |
| 中文摘要: |
| 【摘要】 目的：描述腰段自主神经的解剖学特征，为前路腰椎手术提供详实的神经解剖学资料。方法：取10具防腐男性胸腰骶部标本（年龄36~78岁，平均56岁）。仔细剔除腹腔器官及双侧腰大肌，找出腰段自主神经并去除周围软组织。观察腰段自主神经的走行、起始位置和分布特点。使用游标卡尺测量各腰内脏神经发出点与对应节段腰椎体下终板之间的距离，同侧相邻腰内脏神经发出点之间的距离，腰椎椎间孔前缘以及各腰椎间盘平面上左、右两侧腰交感干后缘分别与腰椎椎体前缘在矢状面上的距离，以及上腹下丛右侧缘在L5椎体下终板和S1椎体上终板平面上与中线的距离。使用量角器测量各腰内脏神经与水平面所成的夹角。结果：在10具标本上共发现72条腰内脏神经，其中58条起源于L3椎体下终板颅侧的腰交感干。第1、2、3、4腰内脏神经的发出点分别位于L1椎体下终板尾侧9.35±10.62mm，L2椎体下终板尾侧5.23±7.08mm，L3椎体下终板颅侧9.34±6.36mm及L4椎体下终板尾侧9.21±8.55mm。第3腰内脏神经与第1、2、4腰内脏神经发出点位置分布有差别（H=32.227，P=0.000），其余腰内脏神经发出点位置分布及左侧与相应的右侧腰内脏神经发出点位置分布均无统计学差异（P>0.05）。第1与第2腰内脏神经、第2与第3腰内脏神经以及第3与第4腰内脏神经发出点之间的距离分别为24.25±6.27mm、21.96±8.13mm、54.54±11.41mm。在L2/3、L3/4及L4/5椎间盘平面上，双侧腰交感干有95%（57/60）位于矢状面上的前1/3内。在L5椎体下终板及S1椎体上终板平面上，上腹下丛的右侧缘分别位于中线左侧3.92±3.35mm及右侧5.25±2.98mm。左侧与相应的右侧腰内脏神经分别与水平面所成夹角（P>0.05）及各腰内脏神经与水平面所成夹角（H=4.921，P=0.178）均无统计学差异，大小约为41°±6°。结论：80.6%腰内脏神经起源于L3椎体下终板颅侧的腰交感干，第3与第4腰内脏神经发出点之间的距离远大于其他两相邻的腰内脏神经发出点之间的距离；在L5/S1椎间盘平面上，腹中线的右外侧存在非常少的上腹下丛神经纤维。了解腰段自主神经的这些解剖学特征对减少手术并发症、提高手术安全性具有重要意义。 |
Anatomical study and clinical significance of lumbar autonomic nerves |
| 英文关键词:Lumbar autonomic nerves Anatomy |
| 英文摘要: |
| 【Abstract】 Objectives: The purpose of this study was to describe the anatomical characteristics of lumbar autonomic nervesand to provide betterneural anatomy data for anterior lumbar surgery. Methods: Lumbar autonomic nerves from 10 embalmed men cadavers (aged 36-78 years, mean 56 years) were studied. Abdominal organs and bilateral psoas major muscles were carefully removed to identify the lumbar autonomic nerves, and the surrounding soft tissues were also removed. The course, initial position and distribution of the lumbar autonomic nerves were observed. Distances between the initial site of each lumbar splanchnic nerve and the corresponding lumbar vertebral inferior endplate, between the initial site of adjacent lumbar splanchnic nerves on the same side, between anterior margin of the lumbar intervertebral foramen and anterior margin of lumbar intervertebral disc in the sagittal plane, between the posterior margin of the lumbar sympathetic trunk and the anterior margin of the vertebral body in the sagittal plane, and between the right margin of the superior hypogastric plexus and the median line at the L5/S1 level were measured. The angle formed by the lumbar splanchnic nerve and horizontal plane was also measured. Results: A total of 72 lumbar splanchnic nerves were found in 10 specimens, of which the initial sites of 58 lumbar splanchnic nerves were superior to the inferior endplate of the L3 vertebra. On average, the initial sites of the 1st, 2nd, 3rd, and 4th lumbar splanchnic nerves were 9.35±10.62mm distal, 5.23±7.08mm distal, 9.34±6.36mm proximal, and 9.21±8.55mm distal to the inferior endplates of the L1, L2, L3, and L4 vertebrae, respectively. For the distribution of initial sites locations, except differences between the 3rd and the 1st, 2nd and 4th lumbar splanchnic nerves(H=32.227, P=0.000), there′s no statistical difference between other lumbar splanchnic nerves, norbetween left lumbar splanchnic nerve and itsassociated right lumbar splanchnic nerve(P>0.05). The distances between the initial sites of the 1st and the 2nd, the 2nd and the 3rd, or the 3rd and the 4th lumbar splanchnic nerves were 24.25±6.27mm, 21.96±8.13mm, and 54.54±11.41mm, respectively. Bilateral lumbar sympathetic trunks (n=57) were more likely to be located in the first 1/3 of the sagittal plane at the level of L2/3, L3/4 and L4/5 intervertebral discs. In the plane containing the inferior endplate of the L5 vertebra, the right margin of the superior hypogastric plexus was located 3.92±3.35mm to the left of the median line; in the plane containing the superior endplate of the S1 vertebra, the right margin of the superior hypogastric plexus was 5.25±2.98mm to the right of the median line. The angle formed by a left lumbar splanchnic nerve and the horizontal plane was no different from the associated right lumbar splanchnic nerve′s(P>0.05). There was also no significant difference in the angles betweeneach lumbar splanchnic nerve and the horizontal plane(H=4.921, P=0.178), with the size of about 41°±6°. Conclusions: The initial sites of 80.6% lumbar splanchnic nerves were superior to the inferior endplate of the L3 vertebra. The distances betweenthe initial site of the 3rd and the 4th lumbar splanchnic nerves were much larger than that between the other two adjacent lumbar splanchnic nerves. And at the right-extra side of the L5/S1 levels, very thin nerve fiber of the superior hypogastric plexus could be distinguished. It was of great significance to understand the anatomical characteristics of lumbar autonomic nerves in order to reduce thecomplications and improve the safety of operation. |
| 投稿时间：2020-04-09 修订日期：2020-05-31 |
| DOI： |
| 基金项目:广州市科技计划（批准号：2017B020210010） |
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