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目的:为腰椎前路手术中避免或减少生殖股神经(GFN)损伤提供解剖学依据。方法:选择15具30侧成年男性尸体标本,研究GFN在腰大肌内的走行及分支形态特点,选择术中易于触及的骨性结构或突起作为标志,测量数据,进行统计学处理。结果:GFN腰大肌内段可分为由L1脊神经前支发出(Ⅰ型,6侧,占20%),L1～2前支联合发出(Ⅱ型,17侧,占56.7%)及从发出点分为生殖支和股支(Ⅲ型,7侧,占23.3%)3种类型。Ⅰ型、Ⅱ型GFN纤维及Ⅲ型的生殖支向前内下方穿越腰大肌,在L3/4椎间盘上或下方经腰大肌前腱膜穿出,Ⅲ型的股支从腰大肌腹穿出。GFN腰大肌出口毗邻腹主动脉、下腔静脉、输尿管及交感神经链等重要结构。结论:在显露L2～4椎体侧前方时容易损伤GFN。在注意避免损伤GFN时,经由腰大肌显露腰椎侧前方可减少大血管、输尿管、交感神经损伤等并发症。
Objective: To provide anatomic evidence for the prevention or reduction of reproductive nerve injury (GFN) in anterior lumbar surgery. Methods: Fifteen cadavers of 30 adult male were selected to study the characteristics of GFN in the psoas muscle. The skeletal structures or protuberances that were easy to reach in the operation were selected as the markers and measurement data for statistical analysis. Results: The anterior segment of the GF psoas muscle could be divided into two groups (type Ⅰ and type 6, 20%). The L1 ~ 2 anterior commissures were combined (type Ⅱ and type 17, accounting for 56.7% Point is divided into genital branch and branch (type Ⅲ, 7 sides, accounting for 23.3%) 3 types. Type Ⅰ, Ⅱ GFN fibers and genital type Ⅲ reproductive branches forward and down through the psoas muscle, L3 / 4 disc below or through the anterior psoas of the psoas muscle wear out, type III of the femoral leg from the psoas major Piercing GFN psoas exports adjacent to the abdominal aorta, inferior vena cava, ureter and sympathetic chain and other important structures. Conclusion: It is easy to damage GFN when L2 ~ 4 anterior vertebral body is revealed. In the attention to avoid damage to GFN, revealed by the psoas muscle anterior lumbar side can reduce macrovascular, ureteral, sympathetic injury and other complications.