Observations and measurements of Wiltse paraspinal sacrospinalis splitting approach in Chinese people

doi:10.3969/j.issn.2095-4344.2014.22.011

Abstract

Abstract:

BACKGROUND: Application of Wiltse paraspinal sacrospinalis splitting approach can reduce paraspinal muscle injuries caused by operations, but there are still no precise criteria to determine anatomic locations of longissimus-multifidus cleavage planes.

OBJECTIVE: To have an intimate knowledge of structural characteristics of Wiltse paraspinal sacrospinalis splitting approach, to determine specific locations of longissimus-multifidus cleavage planes in different lumbar segments, and to provide experiences and references for its clinical applications by observations and measurements of autopsies and magnetic resonance images in Chinese people.

METHODS: Ten embalmed adult cadavers were used for anatomical observations. The natural cleavage planes between longissimus and multifidus were noted and bluntly dissected bilaterally. Measurements were done between these planes and the midline at levels of spinous processes of L₂ and L₄. 400 patients’ images of lumbar spines were also used for observations. Measurements were taken bilaterally between longissimus-multifidus cleavage planes and the midline at levels of discs from L₂/L₃ to L₅/S₁. The correlations between these distances and sex or age were analyzed.

RESULTS AND CONCLUSION: No important vessels or nerves were found in the longissimus-multifidus cleavage planes of all 10 cadavers. Superior facets and roots of transverse processes could be exposed at the bottom of the planes. At L₂, the mean distance was (2.3±0.3) cm; at L₄, (3.4±0.6) cm. Of all 400 images, the mean distances from L₂/L₃ to L₅/S₁ were respectively (19.71±1.93) mm, (23.49±2.49) mm, (27.49±2.84) mm and (31.36±3.15) mm. No strong correlation was discovered between sex or age with respect to measured distances. This study provides valuable references for clinical application of Wiltse paraspinal sacrospinalis splitting approach. We suggest routine measurements of magnetic resonance imaging before surgeries to reduce iatrogenic injuries.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: spinal injuries, lumbar vertebrae, magnetic resonance imaging, models, anatomic, intervertebral disk

CLC Number:

R318

Gui Ke-ke, Yu Yong-lin, Zhao Ming-dong, Tan De-yan, Yin Wang-ping. Observations and measurements of Wiltse paraspinal sacrospinalis splitting approach in Chinese people[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(22): 3504-3509.

Figures/Tables 4

2.1 解剖学观察测量采用腰椎后路正中切口切开皮肤，分开皮下组织后，可见胸腰筋膜浅层在L1-L2平面由浅入深依次由斜方肌、背阔肌和后锯肌构成，但此三层肌纤维相互交错，不易分离，胸腰筋膜浅层在L3-S1平面由背阔肌从两侧倾斜向下构成。胸腰筋膜浅层在腰骶交界以上处与深面的竖脊肌腱膜之间存在间隙，内含神经及结缔组织，而在腰骶交界以下处则与竖脊肌腱膜产生粘连，不易分离。胸腰筋膜中层的内侧附着于腰椎横突和横突间韧带，并与胸腰筋膜浅层在竖脊肌外侧融合形成竖脊肌鞘。竖脊肌纵向排列于脊柱两侧，由3列构成，最外侧为髂肋肌，中间为最长肌，内侧为棘肌(起于L2以上棘突)。竖脊肌腱膜分为内、外侧2部分，内侧由胸段最长肌肌束斜向下行以腱性成分为主附着于腰椎至S1棘突，外侧则由胸段髂肋肌肌束以腱性成分为主附着于髂嵴。竖脊肌腱膜内侧部覆于腰段最长肌，与多裂肌之间无明显粘连，这一肌间隙即为Wiltse椎旁肌间隙。钝性分离最长肌与多裂肌之间的肌间隙，其表面未见重要血管、神经分布，间隙底部可见上关节突及横突根部，即可暴露椎弓根的置钉处，见图3。测量所得d1、d2分别经双侧比较，差异有显著性意义(P > 0.05)，故对d1、d2进行双侧合并处理。L2棘突水平最长肌与多裂肌间隙距后正中线的距离d1为(2.3± 0.3) cm，L4棘突水平最长肌与多裂肌间隙距后正中线的距离d2为(3.4±0.6) cm，主要解剖学数据，见表1。 2.2 MRI观察测量在400例接受腰椎MRI检查的患者中，男性177例，年龄(47.9±13.4)岁(19-74岁)，女性223例，年龄(47.0±12.7)岁(22-75岁)，年龄的性别间比较，差异无显著性意义(P > 0.05)。测量所得dw分别经双侧比较差异无显著性意义(P > 0.05)，故对dw进行双侧合并处理。同一平面dw的性别间比较差异无显著性意义(P > 0.05)，同性别不同平面间dw的比较差异有显著性意义(P < 0.05)。将同一平面不同性别的dw合并处理，从L2/L3-L5/S1，最长肌与多裂肌间隙至后正中线的距离dw分别为(19.71±1.93) mm、(23.49±2.49) mm、(27.49±2.84) mm和(31.36±3.15) mm，呈现逐渐增加趋势，不同平面间dw的比较差异有显著性意义(P < 0.05)，各平面的dw与患者年龄均无高度相关性(r < 0.500)，主要MRI数据见表2，图4。"

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