实用医学杂志 ›› 2023, Vol. 39 ›› Issue (14): 1786-1792.doi: 10.3969/j.issn.1006⁃5725.2023.14.010

• 临床研究 • 上一篇    下一篇

CT 血管成像在下腰椎前髂血管解剖研究中的应用

蒲清平1 郭涛2 施向春1 田晋1    

  1. 1 黔南布依族苗族自治州人民医院创伤骨科(贵州都匀558000);2 贵州省人民医院骨科(贵阳550002)
  • 出版日期:2023-07-25 发布日期:2023-07-25
  • 通讯作者: 郭涛 E⁃mail:guotao04b@sina.com
  • 基金资助:
    贵州省科技厅基础计划项目[编号:黔科合基础⁃ZK(2022)一般 247] 

Application of CT angiography in anatomical study of anterior iliac vessels in the lower lumbar spine 

PU Qingping*,GUO Tao,SHI Xiangchun,TIAN Jin.    

  1. Trauma Orthopedics,The People′s Hospital of Qiannan,Duyun, Guizhou 558000,China 
  • Online:2023-07-25 Published:2023-07-25
  • Contact: GUO Tao E⁃mail:guotao04b@sina.com

摘要:

目的 应用 CT 血管成像探究下腰椎前方髂血管分布,为下腰椎前方入路手术提供血管解剖学参考。方法 选取贵州省人民医院 2016 年 6 月至 2018 年 11 月间行腹部 CT 血管成像男、女性患者影像资料各 100 例,进行观察、测量研究;(1)观察记录腹主动脉分叉点及髂总静脉汇合点位置分布;(2)测 量左髂总静脉与右髂总动脉夹角顶点到 L5~S1椎间隙上缘距离,左髂总静脉与右髂总动脉内侧缘之间位 于L5~S1椎间隙上缘、下缘的距离。结果 (1)腹主动脉分叉点平L4椎体男性占64%、女性占68%。髂总静 脉汇合点平 L4椎体男性占 42%、女性占 46%,平 L4⁃5椎间隙男性占 40%、女性 36%。(2)腹主动脉分叉角男 性 :(51.45 ± 9.21)° ,女 性 :(50.51 ± 7.92)° ;髂 总 静 脉 汇 合 角 男 性 :(58.82 ± 11.81)° ,女 性 :(61.88 ± 11.97)°;左髂总静脉与右髂总动脉夹角男性:(64.81 ± 11.77)°,女性:(67.21 ± 11.58)°。(3)髂总静脉汇合点 平 L4椎体、L4~5椎间隙、L5椎体时:①左髂总静脉与右髂总动脉夹角顶点到 L5~S1椎间隙上缘距离分别为: (26.51 ± 8.11)mm、(16.18 ± 6.70)mm、(7.82 ± 4.26)mm;②左髂总静脉、右髂总动脉内侧缘于L5~S1椎间隙上 缘的距离分别为:(32.52 ± 9.95)mm、(28.63 ± 11.48)mm、(16.27 ± 7.71)mm;③左髂总静脉与右髂总动脉内侧 缘于L5~S1椎间隙下缘的距离分别为:(43.88 ± 9.86)mm、(41.55 ± 11.05)mm、(33.17 ± 9.40)mm。④“髂血管 三角”面积分别为:(486.32 ± 246.26)mm2 、(263.94 ± 178.47)mm2 、(85.49 ± 71.45)mm2 。⑤L5~S1椎间隙手术窗 分别为:(496.98 ± 114.48)mm2 、(488.89 ± 127.69)mm2 、(344.32 ± 166.63)mm2 。结论 (1)腹主动脉分叉点、 髂总静脉汇合点位置存在明显解剖变化;腹主动脉分叉点多平 L4椎体,髂总静脉汇合点多平 L4椎体及 L4~5 椎间隙。(2)髂总静脉汇合点平 L4椎体时,此时下腰椎前拥有足够的血管安全区供手术操作;髂总静脉汇合点位平 L4~5椎间隙时,此时下腰椎前有一定的血管安全区供手术操作;髂总静脉汇合点平 L5椎体时,此 时下腰椎前血管安全区无法满足手术操作。(3)髂总静脉汇合点平 L4椎体、L4~5椎间隙时,前路 L5~S1椎间隙均拥有足够的手术血管安全区,但血管安全区进行性缩小。术前 CT 血管成像检查明确血管安全区有助手术安全。 

关键词: 下腰椎, 腹主动脉, 下腔静脉, 髂总动脉, 髂总静脉, CT 血管成像

Abstract:

Objective To explore the distribution of iliac vessels in the anterior lower lumbar spine using CT angiography,and to provide vascular anatomical references for anterior lower lumbar surgery. Methods Select 100 male and 100 female patients who underwent abdominal CT angiography at Guizhou Provincial People′s Hospital from June 2016 to November 2018 for observation and measurement research;(1)Observe and record the distribution of the bifurcation points of the abdominal aorta and the confluence points of the common iliac vein;(2)Measure the distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5⁃S1 intervertebral space ,and the distance between the left common iliac vein and the inner edge of the right common iliac artery at the upper and lower edges of the L5 ⁃S1 intervertebral space. Results (1)64% of the L4 vertebral body is flat at the bifurcation point of the abdominal aorta. The confluence point of the common iliac vein accounts for 42% of the L4 vertebral body and 40% of the L4⁃5 intervertebral space.(2)Abdominal aortic bifurcation angle:(51.01 ± 9.24)° for males,(50.51 ± 7.92)° for females;The confluence angle of the common iliac vein is(58.82 ± 11.81)° for males and(62.47 ± 12.46)° for females;The angle between the left common iliac vein and the right common iliac artery is(64.92 ± 12.07)° for males and(68.73 ± 13.87)° for females. (3)When the confluence point of the common iliac vein is level with the L4 vertebral body,L4 ⁃ 5 intervertebral space,and L5 vertebral body:① The distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5 ⁃S1 intervertebral space is(26.51 ± 8.11)mm,(16.18 ± 6.70)mm,and(7.82 ± 4.26)mm,respectively;② The distances between the left common iliac vein and the medial edge of the right common iliac artery from the L5⁃S1 intervertebral space are(32.52 ± 9.95)mm,(28.63 ± 11.48)mm,and(16.27 ± 7.71)mm,respectively The distance between the left common iliac vein and the inner edge of the right common iliac artery at the lower edge of the L5⁃ S1intervertebral space is(43.88 ± 9.86)mm, (41.55 ± 11.05)mm,and(33.17 ± 9.40)mm,respectively. ④ The area of the“iliac vascular triangle”is (486.32 ± 246.26)mm2 ,(263.94 ± 178.47)mm2 ,and(85.49 ± 71.45)mm2 ,respectively The surgical windows for the L5⁃S1 intervertebral space are(496.98 ± 114.48)mm2 ,(488.89 ± 127.69)mm2 ,and(344.32 ± 166.63)mm2 , respectively. Conclusion (1)There are significant anatomical changes at the bifurcation point of the abdominal aorta and the confluence point of the common iliac vein;The bifurcation point of the abdominal aorta is mostly flat on the L4 vertebral body,and the confluence point of the common iliac vein is mostly flat on the L4 vertebral body and the L4⁃5 intervertebral space.(2)When the confluence point of the common iliac vein is level with the L4 verte⁃ bral body,there is sufficient vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is located in the L4⁃5 intervertebral space,there is a certain vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is flat on the L5 vertebral body,the safety zone of the anterior blood vessels of the lower lumbar spine cannot meet the surgical requirements at this time.(3)When the confluence point of the common iliac vein is level with the L4 vertebral body and the L4⁃5 intervertebral space,there is sufficient surgical vascular safety zone in the anteri⁃ or L5⁃S1 intervertebral space,but the vascular safety zone is gradually reduced. Preoperative CT angiography exami⁃ nation to clarify the vascular safety zone is helpful for surgical safety. 

Key words: lower lumbar spine, abdominal aorta, inferior vena cava, common iliac artery, com? mon iliac vein, CT angiography