Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
J Urol. 2011 Aug;186(2):579-83. doi: 10.1016/j.juro.2011.03.120. Epub 2011 Jun 16.
In a descriptive, inventorial anatomical study we mapped the course of the 10th and 11th intercostal nerves, and the subcostal nerve in the abdominal wall to determine a safe zone for lumbotomy.
We dissected 11 embalmed cadavers, of which 10 were analyzed. The 10th and 11th intercostal nerves, and the subcostal nerve were dissected from the intercostal space to the rectus sheath. Analysis was done using computer assisted surgical anatomy mapping. A safe zone and an incision line with a minimum of nerve crossings were determined.
The 10th and 11th intercostal nerves were invariably positioned subcostally. The subcostal nerve lay subcostally but caudal to the rib in 4 specimens. The main branches were located between the internal oblique and transverse abdominal muscles. The nerves branched and extensively varied in the abdominal wall. A straight line extended from the superior surface of the 11th and 12th ribs indicated a zone with lower nerve density. In 5 specimens the 10th and 11th intercostal nerves crossed this line from the superior surface of the 11th rib. In 5 specimens neither the 11th intercostal nerve nor the subcostal nerve crossed this extended line from the superior surface of the 12th rib up to 15 cm from the tip of the rib.
Damage is inevitable to branches of the 10th or 11th intercostal nerve, or the subcostal nerve during lumbotomy. However, an incision extending from the superior surface of the 11th or 12th rib is less prone to damage these nerves. Closing the abdominal wall in 3 layers with the transverse abdominal muscle separately might prevent damage to neighboring nerves.
在一项描述性的解剖学研究中，我们绘制了第 10 肋和第 11 肋神经以及腹侧壁的肋下神经的走行，以确定腰椎切开术的安全区域。
我们解剖了 11 具防腐尸体，其中 10 具进行了分析。从肋间隙解剖第 10 肋和第 11 肋神经以及肋下神经到腹直肌鞘。使用计算机辅助手术解剖学绘图进行分析。确定了一个安全区域和一个神经交叉最少的切口线。
第 10 肋和第 11 肋神经始终位于肋下。在 4 个标本中，肋下神经位于肋骨下方，但在肋骨后方。主要分支位于腹内斜肌和腹横肌之间。神经在腹壁分支并广泛变异。从第 11 和 12 肋的上表面延伸的直线表示神经密度较低的区域。在 5 个标本中，第 10 肋和第 11 肋神经从第 11 肋的上表面穿过这条线。在 5 个标本中，无论是第 11 肋神经还是肋下神经都没有从第 12 肋的上表面穿过这条延伸线，直到肋骨尖端 15 厘米处。
在腰椎切开术中，第 10 肋或第 11 肋神经或肋下神经的分支不可避免地会受到损伤。然而，从第 11 肋或第 12 肋的上表面延伸的切口不太容易损伤这些神经。将腹直肌单独分层缝合可以防止邻近神经受损。
