Güvençer Mustafa, Dalbayrak Sedat, Tayefi Hamid, Tetik Süleyman, Yilmaz Mesut, Erginoğlu Ufuk, Baskan Özdil, Güran Salih, Naderi Sait
Department of Anatomy, Dokuz Eylül University, Balçova, Izmir, Turkey.
Surg Radiol Anat. 2009 Apr;31(4):251-7. doi: 10.1007/s00276-008-0435-1. Epub 2008 Nov 8.
L5-S1 instabilities can be fixated using minimally invasive presacral approach. The close relationship between the sacrum and neurovascular as well as intestinal structures may complicate the procedure during this approach. This requires knowledge regarding the normal anatomy of the presacral area to avoid the iatrogenic injuries. The aim of this study was to measure the distance between the sacrum and the structures anterior to it.
The measurements were performed on ten cadavers fixed with formaldehyde and ten MR imaging studies on individuals without any pathology in the presacral area. The distances between the sacrum and the presacral structures (i.e., middle and lateral sacral arteries, sympathetic trunks, internal iliac arteries and veins, and colon/rectum) were measured.
Cadaver study showed that the middle sacral artery was located on the right side in 55.0%, on the left side in 31.7%, and on the midline in the 13.3% of cases. The distance between the sacral midline and middle sacral artery was found to be 8.0 +/- 5.4, 9.0 +/- 4.9, 8.7 +/- 6.0, 8.6 +/- 6.4, and 4.7 +/- 5.0 mm at the levels of S1-2, S2-3, S3-4, S4-5, and S5-coccyx, respectively. The distance between the sacral midline and the sympathetic trunk ranged between 22.4 +/- 5.8 and 9.5 +/- 3.2 mm in different levels between S1 and coccygeal level. The study also showed that the distance between the posterior wall of the intestine (colon/rectum) and the ventral surface of the sacrum can be as close as 11.44 +/- 7.69 mm on MR images.
This study showed that there was close distance between the sacral midline and the structures anterior to it. The close relationships, as well as the potential for anatomical variations, require the use of sacral and presacral imaging before presacral approach.
L5 - S1节段不稳可采用微创骶前入路进行固定。骶骨与神经血管以及肠道结构的紧密关系可能会使该入路手术复杂化。这就需要了解骶前区域的正常解剖结构，以避免医源性损伤。本研究的目的是测量骶骨与其前方结构之间的距离。
对10具用甲醛固定的尸体以及10例骶前区域无任何病变的个体的磁共振成像研究进行测量。测量骶骨与骶前结构（即骶中动脉和骶外侧动脉、交感干、髂内动静脉以及结肠/直肠）之间的距离。
尸体研究表明，骶中动脉位于右侧的占55.0%，位于左侧的占31.7%，位于中线的占13.3%。在S1 - 2、S2 - 3、S3 - 4、S4 - 5和S5 - 尾骨水平，骶骨中线与骶中动脉之间的距离分别为8.0±5.4、9.0±4.9、8.7±6.0、8.6±6.4和4.7±5.0毫米。在S1至尾骨水平的不同节段，骶骨中线与交感干之间的距离在22.4±5.8至9.5±3.2毫米之间。该研究还表明，在磁共振图像上，肠壁（结肠/直肠）后壁与骶骨腹侧面之间的距离可近至11.44±7.69毫米。
本研究表明，骶骨中线与其前方结构之间距离很近。这种紧密关系以及解剖变异的可能性要求在骶前入路前使用骶骨和骶前成像技术。
