骶正中动、静脉解剖变异对脊柱腰骶椎前路手术的临床意义

【】　目的　对骶正中动静脉的位置分布及变异进行解剖观察及实际测量其与周围重要结构的位置关系，为临床医师提高腰骶椎前路手术安全性提供必要的参考信息。　方法　收集2008年5月-2011年1月期间因疾病及意外死亡者新鲜人体尸体标本30例，对其进行解剖学研究，观察并测量骶正中动、静脉的发出点与走行，骶正中动、静脉的数量与缺失情况，以及骶正中动、静脉间的相互走行关系。　结果　①骶正中动脉在主动脉发出以及走行的位置相对固定，无明显多支与缺失情况；骶正中动脉均为腹主动脉根部背侧发出，未见发出点位于左右髂总动脉。发出后行于左侧髂总静脉后方，跨过腰5/骶1椎间盘下行。骶正中静脉与骶正中动脉伴行的情况占总数的60.0%；②骶正中静脉多支常见，没有发现有骶正中静脉的缺失。1支的占总标本数的66.7%，2支的占30.0%，3支的占3.3%。　结论　当选择分叉下入路，应该特别注意骶正中动静脉的解剖位置。动脉的变异相对较小，而静脉的变异程度非常大，发出点变异，多支的情况多见，这些原因都造成了静脉容易损伤的原因，在手术中应该特别注意。【Abstract】　Objective　Toinvestigatetheclinicalsignificanceofanatomicalfeaturesofmiddlesacralarteryandveinforlumbar-sacralspinalsurgery.　Methods　Wecarriedoutanatomicalresearchon30cadaverscausedbydiseasesoraccidentscollectedbetweenMay2008andJanuary2011.Wedissectedthevascularsystemanteriortolumbarvertebraetolearntheircharacteristics.Theinitialpointofmiddlesacralarteryandconfluentpointofveins,andthenumbersof,andthecompanionrelationshipbetweenmiddlesacralarteriesandveinswerechosenastheindexestobemeasured.　Results　Themiddlesacralarteriesstartedfromtheaorta,andtheirlocationswererelativelyfixedwithoutabsenceormulti-branches.Allthemiddlesacralarteriesderivedfromthedorsalsideofabdominalarteryroot,andwerenotstartedfromthecommoniliacartery.Then,thesacralarterieswentatthebackofleftcommoniliacvein,andwentdownaftertraversingtheinter-vertebraldiskbetweenthefifthlumbarandfirstsacralvertebra.About60%ofthemiddlesacralveinswereaccompaniedwiththearteries.Multi-branchesofthemiddlesacralveinswerefrequentlyseen,andnoabsencewasobserved.One-branch,two-branchandthree-branchmiddlesacralveinsoccupied66.7%,30.0%and3.3%respectivelyoutofthetotal.　Conclusions　Whenchoosingdownwardbranchapproachduringtheoperation,weshouldpayspecialattentiontotheanatomicallocationsofthemiddlesacralarteriesandveins.Comparedwiththearteries,therearegreatervariationsoftheveinsincludingvariationsoftheconfluentpointandbrancheswhichcancausetheveinstobequitevulnerable.