目的：通过对胸腰移行部椎旁肌间隙( Wiltse间隙)的解剖学研究,为该区微创椎弓根螺钉固定术的开展提供形态学依据。方法选取9具(18侧)成人尸体湿性标本,局部解剖观察胸腰移行部的Wiltse间隙及其毗邻结构；选取4例(8侧)成人尸体湿性标本,模拟椎弓根螺钉固定术。结果Wiltse间隙表面由最长肌肌腱构成的竖脊肌腱膜覆盖,钝性分离最长肌内侧第1根肌腱和胸半棘肌肌腱(83%,15侧)或同时分离最长肌第1、2根肌腱(17%,3侧)即可清晰暴露胸腰移行部全部节段的Wiltse间隙。通过肌间隙可显露多裂肌、T11~T12横突和L1~L2关节突等结构,定位进钉点,模拟椎弓根螺钉固定术,将螺钉顺利置入椎弓根及椎体,术后CT示螺钉位置良好,多裂肌保持完整。结论对胸腰移行部Wiltse间隙解剖的深入认识有助于该区微创椎弓根螺钉固定术的开展。%Objective To evaluate the anatomy of paraspinal intermuscular space ( Wiltse space ) in the thoraco-lumbar spine, in order to provide a morphological basis for the minimally invasive pedicle screw fixation surgery. Methods The Wiltse space in thoracolumbar spine and its adjacent structures were observed in 9 (18 sides) cada-vers with regional anatomy. Another 4 (8 sides) cadavers were selected to simulate pedicle screw fixation. Results The surface of Wiltse space was covered by the erector spinae aponeurosis, which was constituted by the tendons of longissimus pars thoracis. After the potential space was separated bluntly between the thoracic semispinalis tendons and the first medial tendon of longissimus (83%, 15 sides) , or between the first and the second tendon of longissi-mus additionally (17%, 3 sides) . The Wiltse space in all the thoracolumbar spine was exposed clearly. Through the Wiltse space, the multifidus, T11-T12 transverse process, L1-L2 articular process were exposed. After the accurate entry points of pedicle screw were shown, the pedicle screw fixation was simulated, and the pedicle screws were inserted into pedicle and vertebral body successfully. The location of the pedicle screws were assured by posto-peration CT, and the multifidus remained intact. Conclusion In-depth understanding of the anatomy of Wiltse space in the thoracolumbar spine will contribute to the improvement of the minimally invasive pedicle screw fixation in this area.
展开▼
