不同体位腹膜后大血管及腰大肌的MRI影像解剖学差异

doi:10.13418/j.issn.1001-165x.2023.5.02

中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (5): 511-515.doi: 10.13418/j.issn.1001-165x.2023.5.02

不同体位腹膜后大血管及腰大肌的MRI影像解剖学差异

易红蕾^1,2，陈虎^1,2，王昕辉³，朱昌荣^1,2，练沛荣^1,2，夏虹^1,2*

1.中国人民解放军南部战区总医院骨科，广州 510062； 2.南方医科大学研究生院，广州 510515；
3.中国人民解放军南部战区总医院麻醉科，广州 510062

收稿日期:2022-05-21 出版日期:2023-09-25 发布日期:2023-10-16
通讯作者: 夏虹，博士，博士生导师，主任医师，E-mail：gzxiahong2@126.com
作者简介:易红蕾（1981-），男，湖南邵阳人，博士，副主任医师，主要从事脊柱外科相关研究，E-mail：hongleiyimd@qq.com
基金资助:
国自然科学基金（81972080）；广东省自然科学基金（2015A030312004）

MRI anatomical differences of retroperitoneal blood vessels and psoas muscle in different body positions

Yi Honglei^1,2, Chen Hu ^1,2, Wang Xinhui ³, Zhu Changrong ^1,2, Lian Peirong ^1,2, Xia Hong ^1,2*

1.Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou 510062, Guangdong Province, China; 2.Graduate School, Southern Medical University, Guangzhou 510515, Guangdong Province, China; 3.Department of Anesthesiology, General Hospital of Southern Theatre Command, Guangzhou 510062, Guangdong Province, China

Received:2022-05-21 Online:2023-09-25 Published:2023-10-16

摘要/Abstract

摘要： 目的比较仰卧位、俯卧位及侧卧位时，腹主动脉和下腔静脉在腰椎各椎间隙水平的位移变化和腰大肌厚度及位移变化，确定经侧路进行腰椎融合术的安全工作区。方法 15名志愿者在3种体位接受腰椎磁共振检查，记录L1/2~L4/5椎间隙水平腹主动脉和下腔静脉的位置、腰大肌的厚度及位移情况并进行比较。结果相同节段不同体位下腔静脉分布相似。而在L1/2~L3/4水平，相较于仰卧位，腹主动脉在侧卧位和俯卧位部分向前方移动至椎体前缘。相同节段不同体位腰大肌厚度存在差异（L2/3 A区，L3/4 A区、IV区和P区，L4/5 II区和IV区）（P<0.05）。不同节段腰大肌前移距离存在差异，在L1/2水平，俯卧位（-7.53±3.30）mm及侧卧位（-7.25±3.96）mm的前移距离大于仰卧位（-10.90±3.31）mm，P=0.012；在L2/3水平，侧卧位的前移距离（-0.12±5.59）mm明显大于仰卧位（-5.03±2.49）mm和俯卧位（-3.38±3.99）mm，P=0.009；在L3/4和L4/5水平未见明显差异。结论右侧卧位在L1/2、L2/3选择I、II区穿刺是安全可行的；L3/4、L4/5水平可以选择II区穿刺。

关键词: 血管； , , 腰大肌； , , 体位； , , 腰椎侧方入路

Abstract: Objective To explore the changes of the abdominal aorta and vena cava in different lumbar intervertebral space levels in supine, prone, and lateral positions, and the thickness and displacement of the psoas muscle were noted as well to define the safe working zone for lateral lumbar interbody fusion. Methods Fifteen volunteers underwent lumbar magnetic resonance imaging (MRI) examinations in different positions (supine, prone and lateral positions). The position of the abdominal aorta and inferior vena cava, the thickness, and displacement of the psoas major muscle at each intervertebral space level (L1/2~L4/5) on MRI were recorded and compared as well. Results In the same segment, the distribution of the inferior vena cava in different positions was similar. However, compared with the supine position, the abdominal aorta moved anteriorly to the anterior edge of the vertebral body in the lateral and prone positions at L1/2~L3/4 levels. There were differences in the thickness of the psoas muscle between different body positions in the same segment (L2/3 A zone, L3/4 A zone, IV zone and P zone, L4/5 II zone and IV zone) (P<0.05). In addition, there were differences in the anterior displacement of the psoas muscle between different segments. At the L1/2 level, the forward movement distances of the prone (-7.53±3.30 mm) and lateral positions (-7.25±3.96 mm) were significantly greater than that of the supine position（-10.90±3.31 mm) (P=0.012). At the L2/3 level, the forward displacement of the lateral position （-0.12±5.59 mm）was significantly greater than that of supine (-5.03±2.49 mm) and prone (-3.38±3.99 mm) positions (P=0.009). There was no significant difference in the L3/4 and L4/5 levels. Conclusions For right lateral position, it is safe and feasible to select zone I and II for puncture in the L1/2 and L2/3 levels. And zone II is suitable to puncture in L3/4 and L4/5 levels.

Key words: Blood vessels; , , Psoas muscle; , , Body positions; , , Lumbar lateral approach

中图分类号:

R323.43

易红蕾, 陈虎, 王昕辉, 朱昌荣, 练沛荣, 夏虹. 不同体位腹膜后大血管及腰大肌的MRI影像解剖学差异[J]. 中国临床解剖学杂志, 2023, 41(5): 511-515.

Yi Honglei, Chen Hu, Wang Xinhui, Zhu Changrong, Lian Peirong, Xia Hong. MRI anatomical differences of retroperitoneal blood vessels and psoas muscle in different body positions[J]. Chinese Journal of Clinical Anatomy, 2023, 41(5): 511-515.

参考文献 18

[1]	Chiarotto A, Koes BW. Nonspecific low back pain[J]. N Engl J Med, 2022, 386(18): 1732-1740. DOI: 10.1056/NEJMcp2032396.
[2]	Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009[J]. Spine J, 2015, 15(2): 265-271. DOI: 10.1016/j.spinee.2014.09.026.
[3]	易红蕾, 廖嘉炜, Oheneba Boahie-Adjei, 等. 开放前后路手术与混杂手术治疗成人脊柱侧凸的并发症及临床疗效比较[J]. 中国骨科临床与基础研究杂志, 2017, 9(6): 331-343. DOI: 10.3969/j.issn.1674-666X.2017.06.002.
[4]	Yang Y, Hong Y, Liu H , et al. Comparison of clinical and radiographic results between isobar posterior dynamic stabilization and posterior lumbar inter-body fusion for lumbar degenerative disease: a four-year retrospective study[J]. Clin Neurol Neurosurg, 2015, 136: 100-106. DOI: 10.1016/j.clineuro.2015.06.003.
[5]	易红蕾, 许俊杰, 陈虎, 等. LLIF与TLIF对腰椎矢状面序列影响的比较[J]. 中国矫形外科杂志, 2020, 28(14): 1278-1282. DOI: 10.3977/j.issn.1005-8478.2020.14.07.
[6]	Agarwal N, Faramand A, Alan N, et al. Lateral lumbar interbody fusion in the elderly: a 10-year experience[J]. J Neurosurg Spine, 2018, 29(5): 525-529. DOI: 10.3171/2018.3.SPINE171147.
[7]	易红蕾, 陈虎, 许俊杰, 等. 微创侧路胸腰椎融合术治疗特发性脊柱侧弯[J]. 中国矫形外科杂志, 2020, 28(13): 1235-1238. DOI: 10.3977/j.issn.1005-8478.2020.13.19.
[8]	Hiyama A, Katoh H, Sakai D, et al. Comparison of radiological changes after single- position versus dual- position for lateral interbody fusion and pedicle screw fixation[J]. BMC Musculoskelet Disord, 2019, 20(1): 601. DOI: 10.1186/s12891-019-2992-3.
[9]	Hiyama A, Sakai D, Sato M, et al. The analysis of percutaneous pedicle screw technique with guide wire-less in lateral decubitus position following extreme lateral interbody fusion[J]. J Orthop Surg Res, 2019, 14(1): 304. DOI: 10.1186/s13018-019-1354-z.
[10]	杨斌, 郑明辉, 凌杜华, 等. 腰椎退行性侧凸患者椎旁肌的形态学改变[J]. 中国临床解剖学杂志, 2021, 39(3): 263-268. DOI: 10.13418/j.issn.1001-165x.2021.03.004.
[11]	陈卿安, 钟涛, 赵博厚, 等. 腹主动脉分叉解剖位置的影响因素[J]. 中国临床解剖学杂志, 2022, 40(2): 138-142. DOI: 10.13418/j.issn.1001-165x.2022.2.04.
[12]	Moro T, Kikuchi S, Konno S, et al. An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery[J]. Spine (Phila Pa 1976), 2003, 28(5):423-428. DOI:10.1097/01.BRS.0000049226.87064.3B.
[13]	Kueper J, Fantini GA, Walker BR, et al. Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique[J]. Eur Spine J, 2015, 24(4): 800-809. DOI: 10.1007/s00586-015-3796-2.
[14]	Fujibayashi S, Kawakami N, Asazuma T, et al. Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first 2 years of its use in Japan[J]. Spine (Phila Pa 1976), 2017,42(19): 1478-1484. DOI: 10.1097/BRS. 000000000000 2139.
[15]	Ebata S, Ohba T, Haro H. Integrated anatomy of the neuromuscular, visceral, vascular, and urinary tissues determined by MRI for a surgical approach to lateral lumbar interbody fusion in the presence or absence of spinal deformity[J]. Spine Surg Relat Res, 2018, 2(2): 140-147. DOI: 10.22603/ssrr.2017-0036.
[16]	Nalbandian MM, Hoashi JS, Errico TJ, Variations in the iliolumbar vein during the anterior approach for spinal procedures[J]. Spine (Phila Pa 1976), 2013, 38(8): E445-E450. DOI: 10.1097/BRS.0b013e31828972ac.
[17]	Alkadhim M, Zoccali C, Abbasifard S, et al. The surgical vascular anatomy of the minimally invasive lateral lumbar interbody approach: a cadaveric and radiographic analysis[J]. Eur Spine J, 2015, 24 Suppl 7: 906-911. DOI: 10.1007/s00586-015-4267-5.
[18]	Yang H, Liu J, Hai Y. Is instrumented lateral lumbar interbody fusion superior to stand-alone lateral lumbar interbody fusion for the treatment of lumbar degenerative disease? A meta-analysis[J]. J Clin Neurosci, 2021, 92: 136-146. DOI: 10.1016/j.jocn.2021.08.002.

不同体位腹膜后大血管及腰大肌的MRI影像解剖学差异

MRI anatomical differences of retroperitoneal blood vessels and psoas muscle in different body positions

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 18

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	江剑宏, 段仁鹏, 李晓锋. 国人胆道三维重建解剖变异应用研究[J]. 中国临床解剖学杂志, 2024, 42(1): 1-4.
[2]	郭红志, 王瑜, 张加琪, 梁海彬, 马梓玮, 冯伟, 吴忧, 司子燚. 血管铸型结合CT三维模型评估先兆子痫胎盘血管结构[J]. 中国临床解剖学杂志, 2024, 42(1): 5-10.
[3]	李佳伟, 张静, 李灿然, 兰文杰, 籍庆余, 郭志勇, 张云凤, 刘启, 陈清威, 李筱贺. 蒙古族人群股骨近端解剖参数X线测量[J]. 中国临床解剖学杂志, 2024, 42(1): 11-16.
[4]	李琨, 张燕, 郭冉, 郝咪咪, 吴轩宇, 徐艺芳, 王超群, 马文童, 张灵淇, 杨宏宇, 李志军, 张少杰, 王星. 儿童及青少年枕颈角与后枕颈角数字化测量及其临床意义[J]. 中国临床解剖学杂志, 2024, 42(1): 17-20.
[5]	李文, 杨思艺, 黄蕾, 卿霁雯, 蒋松涛, 张磊. 基于MRI探讨Lisfranc韧带的形态学特点及临床意义[J]. 中国临床解剖学杂志, 2024, 42(1): 21-25.
[6]	李凡凡, 徐阳, 王晓旭. 紫草素调节Nrf2/HO-1信号通路对实验性大鼠肉芽肿性小叶性乳腺炎的治疗作用研究[J]. 中国临床解剖学杂志, 2024, 42(1): 26-32.
[7]	王兴航, 丁佳媛, 李放, 包翠芬, 阎丽菁. 人参皂苷Rg1通过抑制NLRP3炎症小体途径减轻氧糖剥夺/复供后小胶质细胞炎症反应[J]. 中国临床解剖学杂志, 2024, 42(1): 33-41.
[8]	程莹莹, 武建军, 蔡海燕, 焦旭文, 马江波, 丁银秀. 体外炎性诱导星形胶质细胞激活及功能分析[J]. 中国临床解剖学杂志, 2024, 42(1): 42-46.
[9]	祁志, 杨力, 贾秋叶, 陈浩伦, 段兆达, 吴春云. 依达拉奉经MAPKs通路对脂多糖激活的小胶质细胞Sirt3表达调控[J]. 中国临床解剖学杂志, 2024, 42(1): 47-53.
[10]	张晶晶, 王洪新. 黄芩苷通过PDGF/P38 MAPK信号通路对肺动脉高压大鼠的保护作用[J]. 中国临床解剖学杂志, 2024, 42(1): 54-58.
[11]	乐钦, 陈荣丽, 熊婧熙, 王婷怡, 蔡志恒, 易秋实, 曾心怡. 白芨多糖对大鼠跨区皮瓣choke区的影响[J]. 中国临床解剖学杂志, 2024, 42(1): 59-64.
[12]	李笑予, 张磊, 付磊, 李东波, 汪国友. 三步接骨法治疗Sanders Ⅱ型跟骨骨折的有限元研究[J]. 中国临床解剖学杂志, 2024, 42(1): 65-70.
[13]	吴研飞, 马剑雄, 卢斌, 王颖, 柏豪豪, 靳洪震, 马信龙. CT后处理技术重建CT值与终板抗压强度的相关性研究[J]. 中国临床解剖学杂志, 2024, 42(1): 71-76.
[14]	庄万强, 唐毅, 骆勇刚, 张辉. 关节镜联合胫骨高位截骨术对髌骨位置及髌股关节功能影响的早中期回顾性研究[J]. 中国临床解剖学杂志, 2024, 42(1): 77-82.
[15]	罗鹰, 窦伟誉, 吴小杭, 陈璟昆, 彭昌贵, 潘剑英 . 微创海马钢板内固定治疗跟骨骨折并发症的影响因素[J]. 中国临床解剖学杂志, 2024, 42(1): 83-88.