本文選題：腰椎 + 微創(chuàng)　； 參考：《第一軍醫(yī)大學》2006年博士論文

【摘要】：目的和意義： 1．通過大體解剖和斷層解剖的方法了解椎前血管的變異性及手術(shù)時椎前血管和輸尿管可能損傷的部位，為經(jīng)腹膜腰椎前路微創(chuàng)手術(shù)提供腰椎前方血管的解剖學依據(jù)；對腰椎前方的自主神經(jīng)進行詳細的解剖和組織學觀察，結(jié)合手術(shù)中暴露的要求，提出避免腰椎微創(chuàng)前路手術(shù)損傷自主神經(jīng)叢的手術(shù)方式及其解剖學依據(jù)。 2．觀察腰椎側(cè)方節(jié)段血管、腰升靜脈及髂腰靜脈的解剖，為腹膜后腰椎微創(chuàng)手術(shù)避免側(cè)方血管的損傷提供解剖學依據(jù)；通過大體解剖和斷層解剖了解腰叢在腰椎前路微創(chuàng)手術(shù)中的應用解剖學特點，，并提出減少腰叢損傷的解剖學依據(jù)及手術(shù)中的標志點。對腰叢及其周圍的組織結(jié)構(gòu)進行可視化的研究，為微創(chuàng)手術(shù)提供更精確的數(shù)據(jù)和解剖學資料。 3．成功的建立前路椎體間融合的后路和前路固定的有限元模型，分析比較微創(chuàng)前路融合后不同固定方式的生物力學特性。利用骨質(zhì)疏松腰椎三維有限元模型的方法，探討在椎體成形術(shù)中骨水泥的量、不同分布及骨水泥向椎間隙滲漏等狀態(tài)下，對鄰近椎體生物力學的影響。 4．通過動物實驗研究探討不同方式的腹腔鏡腰椎手術(shù)可行性和安全性，確定不同腰椎節(jié)段安全有效的腹腔鏡手術(shù)入路及學習曲線；初步觀察后腹腔鏡技術(shù)在腰椎結(jié)核手術(shù)中的應用價值。 材料與方法： 1．選擇30例防腐固定腰段尸體標本及120例腰椎MRI斷層數(shù)據(jù)，觀察下腰椎區(qū)域椎前大血管的解剖學特點，并根據(jù)手術(shù)暴露的需要做相應的解剖學測量；觀察與進入下腰椎前方輸尿管的應用解剖關(guān)系；觀察椎前大血管分權(quán)前、分杈及分杈后的斷層影像學特點，根據(jù)腰椎前方血管的斷層圖片判斷腹主動脈的分杈點(AoB)和髂靜脈匯合點(CCIV)對應椎體的位置；不同性別AoB和CCIV分杈點對應椎體位置上的差異；L5～S1前方左髂總靜脈對應椎間盤的位置；經(jīng)腹膜暴露L4～L5椎
[Abstract]:Purpose and significance: 1. By means of gross anatomy and sectional anatomy, the variation of anterior vertebral vessels and the location of possible injuries to the anterior vertebral vessels and ureter during operation were studied. The anatomical basis of anterior lumbar artery was provided for minimally invasive operation of anterior approach of retroperitoneal lumbar vertebrae. The anatomical and histological observation of the anterior autonomic nerve of lumbar vertebrae was carried out. Combined with the requirements of surgical exposure, the surgical methods and anatomical basis of avoiding the injury of autonomic plexus in anterior lumbar spine minimally invasive operation were put forward. 2. The anatomy of lumbar lateral segmental vessels, ascending lumbar veins and iliolumbar veins was observed to provide anatomic basis for minimally invasive operation of retroperitoneal lumbar vertebrae to avoid lateral vascular injury. The applied anatomical characteristics of lumbar plexus in lumbar anterior minimally invasive surgery were studied by gross anatomy and sectional anatomy. The anatomical basis for reducing injury of lumbar plexus and the mark points in operation were put forward. To provide more accurate data and anatomical data for minimally invasive surgery by visualizing the structure of the lumbar plexus and its surrounding tissues. 3. The finite element models of posterior and anterior fixation of anterior interbody fusion were established successfully, and the biomechanical characteristics of different fixation methods after minimally invasive anterior fusion were analyzed and compared. By using the three-dimensional finite element model of osteoporotic lumbar vertebrae, the effects of bone cement content, different distribution of bone cement and leakage of bone cement into intervertebral space on biomechanics of adjacent vertebrae in vertebroplasty were studied. 4. The feasibility and safety of different types of laparoscopic lumbar surgery were discussed through animal experiments, and the safe and effective laparoscopic approach and learning curve of different lumbar segments were determined. To observe the application value of retroperitoneal laparoscopy in lumbar tuberculosis surgery. Materials and methods: 1. The anatomical characteristics of anterior great vertebral vessels in the lower lumbar vertebrae were observed with 30 cadavers and 120 lumbar MRI sections, and the anatomical measurements were made according to the need of surgical exposure. To observe the applied anatomical relationship with the anterior ureter entering the lower lumbar vertebrae, and to observe the features of the tomographic features before, after, and after the separation of the anterior great vessels of vertebrae. According to the sectional images of the anterior lumbar artery, the position of the branches of the abdominal aorta (AoB) and the confluence point of iliac vein (CCIV) corresponds to the position of the vertebral body, and the bifurcation points of AoB and CCIV of different genders correspond to the position of the vertebral body, and the position of the left common iliac vein corresponding to the intervertebral disc in front of L _ (5) and S _ (1). Transperitoneal exposure of L4~L5 vertebrae
【學位授予單位】：第一軍醫(yī)大學
【學位級別】：博士
【學位授予年份】：2006
【分類號】：R687.3;R322

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