NYU Langone Medical Center, Divisions of Vascular, New York, NY 10010, USA.
Spine (Phila Pa 1976). 2013 Apr 15;38(8):E445-50. doi: 10.1097/BRS.0b013e31828972ac.
Retrospective study from data from a single access surgeon at 2 hospitals.
To increase the surgeon's awareness of iliolumbar vein (ILV) variants during the anterior approach to the lumbar spine.
Although there are many advantages to using the anterior approach, serious risks are involved, namely, vascular injury. The ILV is especially vulnerable when exposing the L4 and L5 vertebrae, and its ligature is recommended to avoid massive hemorrhage from its disruption. Cadaver studies on ILV variants have mainly analyzed drainage patterns. To our knowledge, however, no studies on ILV variants have been conducted on live humans during anterior spinal surgical procedures.
A total of 159 patients who underwent anterior spinal surgery of at least the L4-L5 levels were included. Cases not involving the L4-L5 level were excluded. Frequency of anomalous ILVs and their possible association with diagnosis (spondylolisthesis, herniated nucleus pulposus, degenerative disc disease, and stenosis), sex, comorbidities, and pelvic history was evaluated. ILV was classified into 5 types: type 0 (missing ILV), type 1 (single ILV), type 2 (2 ILVs), type 3 (3 ILVs), and type 4 (>3 ILVs).
Most patients had a single ILV (73%, N = 116). Multiple ILVs were found in 25.8% of cases: 27 cases (17%) for type 2, 11 cases (6.9%) for type 3, and 3 cases (1.9%) for type 4. A higher frequency of multiple ILVs was found in males (32%) than in females (19.2%) (P = 0.034). Diagnosis, comorbidity, and pelvic surgical history were not associated with the number of ILVs.
The high frequency of multiple ILVs found during the anterior approach is crucial knowledge for access surgeons, as it will help them anticipate such anomalies and thus avoid the potentially catastrophic complications of an avulsion of an unexpected extra vein.
来自 2 家医院同一位单通道外科医生的数据的回顾性研究。
提高外科医生在腰椎前路手术中对髂腰静脉（ILV）变异的认识。
尽管前路方法有许多优点，但也存在严重的风险，即血管损伤。当暴露 L4 和 L5 椎体时，ILV 特别容易受到影响，建议结扎以避免其破裂引起的大量出血。关于 ILV 变异的尸体研究主要分析了引流模式。但是，据我们所知，在进行前路脊柱手术期间，尚未对活体人类的 ILV 变异进行过研究。
共纳入 159 例至少行 L4-L5 水平前路脊柱手术的患者。排除不涉及 L4-L5 水平的病例。评估异常 ILV 的频率及其与诊断（脊椎滑脱、椎间盘突出、退行性椎间盘疾病和狭窄）、性别、合并症和骨盆史的可能关联。ILV 分为 5 型：0 型（缺失 ILV）、1 型（单 ILV）、2 型（2 个 ILV）、3 型（3 个 ILV）和 4 型（>3 个 ILV）。
大多数患者仅有 1 条 ILV（73%，N=116）。25.8%的病例发现有多条 ILV：27 例（17%）为 2 型，11 例（6.9%）为 3 型，3 例（1.9%）为 4 型。男性（32%）比女性（19.2%）多发现多条 ILV（P=0.034）。诊断、合并症和骨盆手术史与 ILV 的数量无关。
在前路入路中发现的多条 ILV 频率较高，这对于通道外科医生来说是至关重要的知识，因为这将帮助他们预测到这种异常，从而避免意外额外静脉撕脱的潜在灾难性并发症。
