本文選題：腰骶椎 + 應(yīng)用解剖　； 參考：《中南大學(xué)》2008年碩士論文

【摘要】： 目的:測(cè)量成人腰5骶1腹側(cè)區(qū)域尸體標(biāo)本相應(yīng)的解剖學(xué)與影像學(xué)數(shù)據(jù),為研制腰5骶1前路內(nèi)固定器械提供參考。 方法:(1)40套成人腰5骶1椎體干標(biāo)本,測(cè)量腰5骶1椎體高度、寬度、弧度,椎弓根寬高,骨-螺釘通道長(zhǎng)度(BSPL),椎弓根與水平面角度(TSA)以及與矢狀面角度(SSA)。 (2)20套脊柱正中縱切面濕標(biāo)本,測(cè)量腰5骶1椎體及其椎間盤(pán)高度,腰骶關(guān)節(jié)角(LJA)。 (3)40例正常成人的腰椎X線(xiàn)片和CT片,測(cè)量指標(biāo)同解剖學(xué)。 (4)20具腰椎及其前面附屬結(jié)構(gòu)完整的尸體標(biāo)本,觀測(cè)主動(dòng)脈分叉(AB)與髂總靜脈匯合點(diǎn)(CCIV)至腰5椎體下緣的距離,骶正中動(dòng)靜脈(MSA,MSV)的發(fā)出點(diǎn)與走行、數(shù)量與缺失、伴行情況及腰骶椎前方交感神經(jīng)叢(SHP)的走行與分布。 (5)測(cè)量L5/S1前方可供手術(shù)操作區(qū)域。 結(jié)果:(1)L5椎體高30.27±2.52mm,寬51.03±3.20mm,椎弓根高11.88±2.35mm,椎弓根寬14.53±2.20mm,骨-螺釘通道長(zhǎng)49.16±3.36mm,椎體前緣弧度133.74±13.59°。 (2)骶1椎體高31.57±3.37mm,弧長(zhǎng)34.03±3.14mm,弧度77.25±7.12°,椎弓根高16.25±1.90mm,椎弓根寬11.17±2.15mm,骨-螺釘通道長(zhǎng)43.94±4.60 mm。腰骶角為137.4±6.7°,腰5骶1椎間盤(pán)厚度為17.23±3.21mm。 (3)L5椎體螺釘進(jìn)釘點(diǎn)為L(zhǎng)5椎體下緣水平線(xiàn)向上12±2mm,椎體中線(xiàn)旁開(kāi)5-6mm垂直線(xiàn)交點(diǎn)處,進(jìn)釘角度為尾偏7.2±1.9°、外偏25.5±3.0°。S1椎體螺釘進(jìn)釘點(diǎn)為S1椎體上緣水平線(xiàn)向下12±2mm,中線(xiàn)旁開(kāi)6-7mm垂線(xiàn)交點(diǎn)處,進(jìn)釘角度為尾偏9.0±1.1°、外偏26±2.3°。 (4)L5螺釘長(zhǎng)度以不超過(guò)45mm、S1螺釘長(zhǎng)度以不超過(guò)40mm為宜,螺釘直徑不超過(guò)8mm為宜。 (5)L5/S1內(nèi)固定手術(shù)有一可供操作區(qū)域,為一雙底邊重疊之梯形區(qū),上梯形上邊寬30mm,距L5椎體下緣20mm,中間底邊為平腰5骶1椎間盤(pán)中點(diǎn)水平線(xiàn),寬38mm,下梯形下底邊寬25mm,距S1椎體上緣23mm,總面積約18.60cm~2。 (6)主動(dòng)脈分叉到L5椎體下緣距離男性為43.86±12.24mm,女性為36.81±12.93mm,在L4/5椎間盤(pán)水平最為集中。 (7)髂總靜脈匯合點(diǎn)到L5椎體下緣距離男性為26.85±14.72mm、女性為24.77±12.33mm,集中分布在L5椎體上分,在L4椎體中分及其以上沒(méi)有分布。 (8)骶正中動(dòng)脈的發(fā)出點(diǎn)和位置相對(duì)固定,無(wú)多支與缺失。而骶正中靜脈多支的現(xiàn)象非常常見(jiàn),82.8%由左髂總靜脈發(fā)出。 (9)輸尿管與髂動(dòng)脈相交的位置距主動(dòng)脈分叉點(diǎn)的距離左側(cè)為53.35±7.48mm,右側(cè)為45.95±2.41mm。 (10)上腹下叢在髂間三角內(nèi)約85%位于偏左側(cè)區(qū),右側(cè)區(qū)只占(15%),多干多見(jiàn)。 結(jié)論:1在設(shè)計(jì)腰5骶1前路內(nèi)固定系統(tǒng)時(shí)應(yīng)考慮腰5骶1椎體相關(guān)解剖參數(shù)如LJA,SSA,TSA,BSPL等。 2腰5骶1骨-螺釘通道長(zhǎng)度以椎前中線(xiàn)旁開(kāi)6mm至椎弓根后緣的距離最長(zhǎng)。 3腰5骶1前方存在一可供植入鋼板的手術(shù)操作區(qū),其形狀為雙底邊重疊的梯形區(qū)域“(?)”形,面積約18.60cm~2。
[Abstract]:Objective: to measure the anatomical and imaging data of cadavers in the ventral region of lumbar 5 sacral 1, and to provide a reference for the development of anterior lumbar 5 sacral 1 internal fixation apparatus.Methods 40 adult lumbar 5 sacral 1 vertebral stem specimens were collected. The height, width, arc, pedicle width, length of bone-screw passage (BSPLN), pedicle and horizontal plane angle (TSA) and sagittal angle (SSA) of lumbar 5 sacral vertebrae were measured.Twenty sets of wet specimens were collected from the median longitudinal section of the spine to measure the height of the lumbar 5 sacral vertebrae and their intervertebral disc, and to measure the LJAA of the lumbosacral joint angle.Lumbar vertebrae X-ray films and CT films of 40 normal adults were measured with the same anatomical parameters.From 20 cadavers with intact lumbar vertebrae and their anterior accessory structures, the distance between the aortic bifurcation (ABV) and the confluence point of the common iliac vein (CCIV) and the lower margin of the lumbar 5 vertebrae, the origin and route, the quantity and the absence of MSAMSV of the median sacral artery and vein were observed.The concomitant status and the pattern and distribution of sympathetic plexus in anterior lumbosacral plexus.5) to measure the area available for operation in front of L5/S1.Results the vertebral body height was 30.27 鹵2.52mm, the width was 51.03 鹵3.20mm, the pedicle height was 11.88 鹵2.35mm, the pedicle width was 14.53 鹵2.20mm, the length of bone-screw passage was 49.16 鹵3.36mm, the curvature of the anterior edge of vertebral body was 133.74 鹵13.59 擄.2) the height of sacral vertebrae was 31.57 鹵3.37mm, the arc length was 34.03 鹵3.14mm, the arc was 77.25 鹵7.12 擄, the pedicle height was 16.25 鹵1.90mm, the pedicle width was 11.17 鹵2.15mm, the length of bone-screw passage was 43.94 鹵4.60mm.The lumbosacral angle was 137.4 鹵6.7 擄and the lumbar 5 sacral disc thickness was 17.23 鹵3.21 mm.The angle of entry nail was 9.0 鹵1.1 擄and 26 鹵2.3 擄respectively.The suitable length of L5 screw is not more than 45 mm and S1 screw length is not more than 40mm and the diameter of screw is not more than 8mm.L5 / S1 internal fixation has an operational area, which is a trapezoid area with overlapping bottom edges, 30 mm wide of the upper trapezoid, 20 mm from the lower edge of the L5 vertebra, and a horizontal horizontal line at the middle point of the horizontal lumbar 5 sac1 intervertebral disc.The width is 38 mm, the bottom edge of the lower trapezoid is 25 mm wide, and is 23 mm from the upper edge of the S1 vertebra, with a total area of 18.60 cm / 2.(6) the distance from aortic bifurcation to the lower edge of L5 vertebra was 43.86 鹵12.24mm in males and 36.81 鹵12.93mm in females, which was the most concentrated at L4 / 5 intervertebral disc level.The distance from the common iliac vein confluence to the lower margin of the L5 vertebra was 26.85 鹵14.72mm in males and 24.77 鹵12.33mm in females.The origin and location of the median sacral artery were relatively fixed, without multiple branches or deletions.The multiple branches of the median sacral vein were very common in 82.8% of the cases from the left common iliac vein.The distance between the intersection of the ureter and the iliac artery was 53.35 鹵7.48 mm on the left side and 45.95 鹵2.41 mm on the right side.(10) about 85% of the upper and lower ventral plexus were located in the left-sided region in the interiliac triangle, and the right region accounted for only 15%, and the trunk was more common.Conclusion the anatomical parameters of lumbar 5 sacral 1 vertebral body should be considered in the design of W5 sacral 1 anterior internal fixation system, such as LJASSAA TSAA BSPL and so on.2 the length of bone-screw passage in lumbar 5 sacral 1 was the longest between 6mm and posterior margin of pedicle.3There is a surgical operation area in front of lumbar 5 sacral 1, which can be implanted with steel plate. Its shape is a trapezoid area with double bottom edges overlapping.Shape, with an area of about 18.60 cm-2.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類(lèi)號(hào)】：R687.3;R322

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