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目的:测量与经骶前间隙轴向腰骶椎间融合(AxiaLIF)入路相关的解剖学和影像学数据,探讨国人该入路的安全性。方法:(1)成人尸体标本20具,男8具,女12具,年龄26～86岁,平均56岁,在S1/2间隙水平线上测量骶骨中线至髂内动、静脉和骶中动脉的距离及直肠系膜的厚度,计算最靠近中线的左右髂血管间的距离。(2)120例腰痛患者,男46例,女74例,年龄18～90岁,平均53岁,在其腰骶椎MRI正中矢状面上测量骶骨前缘至直肠系膜的最短距离。骶前间隙的前后向最短距离和最靠近中线的左右髂血管间距离构成AxiaLIF工作通道的“操作空间”。结果:同一性别左、右侧同名血管到骶骨中线的距离均无显著性差异(P>0.05),最靠近骶骨中线的髂血管均为髂内静脉,左右髂内静脉间的距离即“操作空间”横径男性为5.8±0.5(5.1～6.4)cm,女性为6.3±0.4(5.6～7.0)cm,男性与女性比较有显著性差异(P<0.05);骶中动脉位置有变异;直肠系膜厚度为0.3￣0.5cm。在MRI上测量,男性骶骨前缘到直肠系膜的最短距离的中位数为1.0(0.3～2.3)cm,女性为0.6(0.3～1.8)cm,男性与女性比较有显著性差异(P<0.01)。结论:国人在经骶前间隙AxiaLIF入路中放置直径1.2cm的工作套管是安全的。
OBJECTIVE: To measure the anatomic and radiographic data related to the Axial LIF approach through the presacral space, and to explore the safety of the approach. Methods: (1) 20 adult male cadavers, including 8 males and 12 females, aged 26 to 86 years with an average of 56 years. The midline of the sacrum to the internal iliac arteries, veins and the middle of the sacral artery Distance and mesorectal thickness, calculate the distance between the left and right iliac vessels closest to the midline. (2) 120 patients with low back pain, 46 males and 74 females, aged from 18 to 90 years old with an average of 53 years old. The shortest distance between the anterior sacrum and the mesorectum was measured on the mid-sagittal plane of lumbosacral MRI. The shortest distance between the presacral space and the left and right iliac vessels closest to the midline constitutes the “operating space” of the AxiaLIF working channel. Results: There were no significant differences in the distances from the vessels of the same name to the sacral midline on the left and right sides of the same sex (P> 0.05). The iliac vessels closest to the sacral midline were both internal iliac vein and the distance between the internal and external iliac veins was There was a significant difference between males and females (P <0.05); there was variation in the position of sacral artery; Rectal mesangial thickness of 0.3 ~ 0.5cm. In MRI, the shortest distance from the anterior sacrum to the mesorectum was 1.0 (0.3-2.3) cm in women and 0.6 (0.3-1.8) cm in women. There was a significant difference between men and women (P <0.01) ). CONCLUSIONS: It is safe for people in China to place a working cannula 1.2 cm in diameter through the presacral space AxiaLIF approach.