Kirchmair Lukas, Lirk Philipp, Colvin Joshua, Mitterschiffthaler Gottfried, Moriggl Bernhard
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
Reg Anesth Pain Med. 2008 Mar-Apr;33(2):109-14. doi: 10.1016/j.rapm.2007.07.016.
Conflicting definitions concerning the exact location of the lumbar plexus have been proposed. The present study was carried out to detect anatomical variants regarding the topographical relation between the lumbar plexus and the psoas major muscle as well as lumbar plexus anatomy at the L4-L5 level.
Sixty-three lumbar plexuses from 32 embalmed cadavers were dissected to determine the topographical relation between lumbar plexus and psoas major muscle. At the L4-L5 levels variability in the course of the femoral as well as obturator nerve were described.
The lumbar plexus was situated within the psoas major muscle in 61 of 63 cases. In 2 of 63 cases the entire plexus was localized posterior to the psoas major muscle. In the 61 of 63 cases in which the lumbar plexus was situated within the psoas major muscle, emergence of the individual nerves most often occurred on the posterior or posterolateral surface.
Our results synthesize contrasting assumptions in previous literature, by demonstrating that both locations of the lumbar plexus may be encountered in clinical practice: within and posterior to the psoas major muscle. However, the latter situation represents a minor variant. At the level of L4-L5 the femoral nerve, showing a remarkable degree of branching, as well as the obturator nerve, were found within the psoas major muscle in the vast majority of specimens.
关于腰丛的确切位置，已提出了相互矛盾的定义。本研究旨在检测腰丛与腰大肌之间的局部解剖变异以及L4 - L5水平的腰丛解剖结构。
对32具防腐尸体的63个腰丛进行解剖，以确定腰丛与腰大肌之间的局部解剖关系。描述了L4 - L5水平股神经和闭孔神经走行的变异情况。
63例中有61例腰丛位于腰大肌内。63例中有2例整个腰丛位于腰大肌后方。在腰丛位于腰大肌内的61例中，各神经最常从后表面或后外侧表面穿出。
我们的结果综合了以往文献中相互矛盾的假设，表明在临床实践中可能会遇到腰丛的两种位置：腰大肌内和腰大肌后方。然而，后一种情况是一种少见的变异。在L4 - L5水平，绝大多数标本中，股神经（显示出显著的分支程度）以及闭孔神经位于腰大肌内。
