目的基于解剖学研究评估腰椎不同节段进行斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）中发生交感神经损伤的风险。
方法选择健康成人志愿者24名（男女各12名），采用Siemens磁共振MAGNETOM Verio 3.0 T进行常规腰椎扫描。于L 2，3、L 3，4、L 4，5椎间隙中央层面轴位T2加权像上辨识左侧腰交感干、腹主动脉、左侧腰大肌等解剖结构，测量OLIF手术入路相关解剖学参数和左侧交感干与毗邻结构的解剖学参数。不同性别之间对应参数比较采用成组 t检验；不同节段之间对应参数比较采用最小显著差异（LSD）单因素方差分析。
结果OLIF手术入路相关解剖学参数和左侧交感干与毗邻结构的解剖学参数自L 2，3~L 4，5节段均呈规律性变化。健康成年国人L 2，3~L 4，5左侧腰大肌前缘至腹主动脉的距离男性为（13.65±4.10）mm~（9.42±4.00）mm，女性为（13.89±3.18）mm~（8.38±3.33）mm，均呈明显下降趋势。L 2，3~L 4，5节段左侧交感干至腹主动脉的距离男性为（10.76±3.89）mm~（6.68±3.39）mm，女性为（11.52±3.02）mm~（6.12±2.95）mm，亦均呈明显递减趋势。国人不同节段之间OLIF手术操作范围存在明显差异，L 2，3节段OLIF手术操作空间相对较大，交感神经损伤风险相对较小；左侧腰交感干在L 3，4椎间隙层面走行位置更加偏前、偏内，在OLIF手术过程中存在较大的损伤风险。
结论L 2，3~L 4，5节段左侧交感干位于或紧邻OLIF手术操作通道，OLIF术中存在一定的交感神经损伤风险；但L 2，3、L 3，4、L 4，5不同节段OLIF术中发生交感神经损伤的风险亦有差异。
ObjectiveTo assess the risk of sympathetic nerve injury in oblique lumbar interbody fusion (OLIF) in different lumbar spine segments based on anatomical study.
MethodsTwenty-four healthy adult volunteers (12 male and female) were selected and routine lumbar spine scanning was performed with MAG MAGOMOM Verio 3.0 T. The anatomical structures of left lumbar sympathetic trunk, abdominal aorta and left psoas muscle were identified on T2 images of L 2, 3, L 3, 4, L 4, 5 intervertebral space. And the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and adjacent structures were measured. The t-test was used to compare the parameters between the different sexes. The comparison of the data between the different segments was performed by the least significant difference (LSD) single factor analysis of variance.
ResultsFrom the L 2, 3 to L 4, 5 segments, the anatomical parameters of the OLIF operation approach and the anatomical parameters of the left sympathetic trunk and the adjacent structures showed regular changes. The distances between the anterior margin of the left psoas muscle and the abdominal aorta from L 2, 3 to L 4, 5 were 13.65±4.10 mm to 9.42 ± 4.00 mm in adult healthy male individuals, and 13.89±3.18 mm to 8.38 ± 3.33 mm in female individuals, showing a significant downward trend. The distances between the left sympathetic trunk and the abdominal aorta from L 2, 3 to L 4, 5 were 10.76±3.89 mm to 6.68±3.39 mm in adult healthy male individuals, and 11.52±3.02 mm to 6.12±2.95 mm in female individuals, also showing a significant downward trend. There were significant differences in the operation area of OLIF surgery between different segments. The operation area of OLIF surgery was relatively large in L 2, 3 segment, and the risk of sympathetic nerve injury was relatively small. The left lumbar sympathetic trunk in the L 3, 4 intervertebral space was walking front and inside, and there was a greater risk of injury in the OLIF surgery.
ConclusionThe left lumbar sympathetic trunk located in or close to OLIF surgery operation field in L 2-L 5 segments. There was a certain risk of sympathetic nerve injury in OLIF surgery, and the risk of sympathetic nerve injury was different in L 2, 3, L 3, 4, L 4, 5 segments.
王洪立,张宇轩,马晓生,等. 斜外侧腰椎椎间融合术中交感神经损伤风险的解剖学评估[J]. 中华骨科杂志,2017,37(16)：1014-1020.
DOI:10.3760/cma.j.issn.0253-2352.2017.16.008版权归中华医学会所有。
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