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目的通过标本解剖和影像学研究,找出生殖股神经(genitofemoral nerve,GFN)在各腰椎间隙的走行位置,结合腰椎前大血管和腰神经根的位置,得出极外侧人路腰椎椎体间融合术(extreme lateral interbody fusion,XLIF)在各腰椎间隙的安全入路范围。方法解剖16例成人尸体标本,暴露GFN并观察其与腰大肌的位置关系。在36例腰椎磁共振扫描影像上观察腰大肌和腹部大血管的位置并测量相关解剖数据,通过分析计算得出各腰椎间隙GFN的走行位置和XLIF入路的安全范围。结果生殖股神经在腰大肌内段走行于GFN出椎间孔处与腰大肌穿出点连线上方,呈向前的抛物线或近似直线。GFN在L_(3/4)椎间隙或以上位置穿出腰大肌的样本,GFN距椎体后缘的距离为(34.0±6.02)mm,位置分布在Moro分区位于A区和Ⅰ区。GFN在L_(3/4)椎间隙以下位置穿出腰大肌的样本,GFN距椎体后缘的距离不小于(16.0±2.16)mm,位置分布在Ⅰ区、Ⅱ区和Ⅲ区。结论XLIF入路的安全区域在L_(2/3)。椎间隙为Ⅱ区、Ⅲ区,在L_(4/5)椎间隙为Ⅱ区。GFN穿出腰大肌的位置在L_(3/4)椎间隙或以上者,L_(3/4)椎间隙的安全区为Ⅱ区;在L_(3/4)椎间隙以下者,在L_(3/4)椎间隙从任何分区进入都有损伤血管或神经的可能。
Objective To find out the location of the genital tract (GFN) in the lumbar intervertebral space through the anatomy and imaging studies of the specimens and to find the location of the anterior lumbar vertebral body The scope of the safe approach of XLIF in the lumbar intervertebral space. Methods Sixteen adult cadavers were dissected and their GFNs were exposed and their relationship with psoas muscle was observed. The locations of the psoas and abdominal large vessels were observed in 36 cases of lumbar magnetic resonance imaging and the related anatomical data were measured. The location of the glomerular GFN and the safety range of the XLIF approach were obtained through the analysis and calculation. Results Reproductive nerve in the psoas muscle segment walking in GFN out of the foramen and psoas point above the line of attachment, was a forward parabola or approximate straight line. GFN was found to be a sample of the psoas muscle at the L_ (3/4) intervertebral space or above. The distance of GFN from the posterior edge of the vertebral body was (34.0 ± 6.02) mm. The location of the GFN was located in the A and I regions. The GFN passed through the psoas below L_ (3/4) intervertebral space. The distance from GFNS to the posterior edge of the vertebral body was not less than (16.0 ± 2.16) mm. The location of GFN was located in area Ⅰ, Ⅱ and Ⅲ. Conclusion The safe area of XLIF approach is L_ (2/3). Intervertebral space Ⅱ, Ⅲ area, L_ (4/5) in the intervertebral space Ⅱ area. The location of GFN out of the psoas muscle was in the L_ (3/4) intervertebral space or above, and the safety zone of the L_ (3/4) intervertebral space was in the Ⅱ area. Under the L_ (3/4) intervertebral space, (3/4) Intervertebral space from any partition into the damage of blood vessels or nerves may be.