Chen Rongzi, Shi Benchao, Zheng Xuefeng, Zhou Zhilai, Jin Anmin, Ding Zihai, Lv Hai, Zhang Hui
*Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China †Department of Orthopedics, The 180th Hospital of People's Liberation Army, Fujian, China ‡Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangdong, China.
Spine (Phila Pa 1976). 2015 May 15;40(10):692-8. doi: 10.1097/BRS.0000000000000860.
STUDY DESIGN: A dissection-based study of 18 embalmed thoracic specimens. OBJECTIVE: To investigate the properties and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater. SUMMARY OF BACKGROUND DATA: Previously, we performed a comprehensive anatomic study on the dorsal meningovertebral ligaments in the lumbosacral and cervical regions, whereby we concluded that the ligaments were an anatomic factor leading to dural laceration and hemorrhage during flavectomy and laminectomy. Unfortunately, thus far, no systematic anatomic study has been undertaken to examine the dorsal meningovertebral ligaments of the thoracic dura mater. METHODS: Eighteen adult embalmed cadavers were studied, and the morphology, orientation, attachment site, and distribution traits of the dorsal meningovertebal ligaments were observed. In addition, the length, width, or diameter and thickness of the ligaments were measured using a Vernier caliper. Two meningovertebal ligaments were removed for histological examination. RESULTS: In the thoracic region, the dorsal meningovertebral ligaments anchored the dura mater to the lamina or ligamentum flavum. The meningovertebral ligaments displayed a relatively even distribution along the upper thoracic region (T1-T7) and a gradual increase in frequency in the lower thoracic region from T7 to T12. The meningovertebral ligaments protrude into the dura and correspondingly become an integral part of the dura. Some ligaments are accompanied by or are attached to blood vessels. Histological examination of the meningovertebral ligaments revealed fibrous connective tissue. CONCLUSION: The dorsal meningovertebral ligaments exist between the dural sac and ligamentum flavum or lamina in the thoracic spine. Based on their anatomic features, meningovertebral ligaments may be one potential cause for dural laceration and epidural hemorrhage. We propose that, during thoracic flavectomy and laminectomy, the meningovertebral ligaments should first be identified and properly handled, thereby minimizing the occurrence of relevant complications. LEVEL OF EVIDENCE: N/A.
研究设计：对18个经防腐处理的胸部标本进行解剖学研究。 目的：探讨胸段硬脊膜背侧脊膜椎韧带的特性及临床意义。 背景资料总结：此前，我们对腰骶部和颈部的背侧脊膜椎韧带进行了全面的解剖学研究，据此得出结论，这些韧带是导致黄韧带切除术和椎板切除术中硬脊膜撕裂和出血的解剖学因素。遗憾的是，迄今为止，尚未对胸段硬脊膜的背侧脊膜椎韧带进行系统的解剖学研究。 方法：对18具成年防腐尸体进行研究，观察背侧脊膜椎韧带的形态、方向、附着部位及分布特征。此外，用游标卡尺测量韧带的长度、宽度、直径或厚度。取出两条脊膜椎韧带进行组织学检查。 结果：在胸段，背侧脊膜椎韧带将硬脊膜固定于椎板或黄韧带。脊膜椎韧带在上胸段（T1-T7）分布相对均匀，在下胸段从T7到T12频率逐渐增加。脊膜椎韧带突入硬脊膜并相应地成为硬脊膜的一个组成部分。一些韧带伴有血管或附着于血管。脊膜椎韧带的组织学检查显示为纤维结缔组织。 结论：胸段脊柱的硬脊膜囊与黄韧带或椎板之间存在背侧脊膜椎韧带。基于其解剖学特征，脊膜椎韧带可能是硬脊膜撕裂和硬膜外出血的一个潜在原因。我们建议，在胸段黄韧带切除术和椎板切除术中，应首先识别并妥善处理脊膜椎韧带，从而将相关并发症的发生率降至最低。 证据水平：无。
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