Rochester, N.Y.
From the Division of Plastic Surgery and the Department of Radiology, University of Rochester Medical Center; and the University of Rochester School of Medicine and Dentistry.
Plast Reconstr Surg. 2018 Feb;141(2):473-479. doi: 10.1097/PRS.0000000000004043.
The abdominal wall is frequently manipulated in a variety of reconstructive procedures, and its anatomy is well described. The authors' clinical observations, however, contradict the standard depiction of the components of the abdominal wall at various levels-particularly regarding the course of the transversus abdominis muscle. Therefore, the authors sought to characterize the components of the rectus sheath at various surgical landmarks to define anatomic points important to abdominal wall repair.
The authors analyzed the abdominal computed tomographic studies of 100 healthy, young (age, 18 to 35 years; body mass index, 20 to 40 kg/m) patients with suspected renal calculi. Coordinates of key landmarks were recorded at vertebral levels T12 to L5 using a specially designed computer program that scaled all values and calculated distances between various points.
All subjects had significant presence of the transversus abdominis within the rectus sheath (the overlap between the abdominis rectus and transversus abdominis muscles) at the costal margin plane (T12-L1, 4.2 cm). Ninety-nine percent had transversus abdominis presence within the rectus sheath at L1-L2 (3.2 cm), 86 percent at the level of the twelfth rib (L2-L3, 1.4 cm), 36 percent at the umbilicus (L3-L4), and 2 percent slightly above the posterosuperior iliac spine (L5-S1).
These findings contradict classic teachings of abdominal wall structure and highlight the need for a cautious revisiting of the various permutations of component separation, particularly posterior component release. Furthermore, these anatomical landmarks may help predict the development or recurrence of ventral hernias, thus guiding patient selection and informing surgical technique.
腹壁在各种重建手术中经常被操作，其解剖结构已有很好的描述。然而，作者的临床观察结果与腹壁各层标准描述的组成部分相矛盾，尤其是腹横肌的走行。因此，作者试图在各种手术标志点描述腹直肌鞘的组成部分，以确定对腹壁修复重要的解剖点。
作者分析了 100 例疑似肾结石的年轻（年龄 18 至 35 岁；体重指数 20 至 40kg/m²）健康患者的腹部 CT 研究。使用专门设计的计算机程序在 T12 至 L5 椎体水平记录关键标志点的坐标，该程序对所有值进行缩放并计算各点之间的距离。
所有患者在肋缘平面（T12-L1，4.2cm）都有明显的腹横肌位于腹直肌鞘内（腹直肌和腹横肌之间的重叠）。99%的患者在 L1-L2 水平（3.2cm）、86%的患者在第十二肋水平（L2-L3，1.4cm）、36%的患者在脐部（L3-L4）和 2%的患者在髂后上棘稍上方（L5-S1）有腹横肌位于腹直肌鞘内。
这些发现与经典的腹壁结构理论相矛盾，突出了谨慎重新审视各种成分分离的必要性，特别是后成分松解。此外，这些解剖学标志可能有助于预测腹疝的发生或复发，从而指导患者选择和告知手术技术。
