Creze Maud, Soubeyrand Marc, Nyangoh Timoh Krystel, Gagey Olivier
Radiology Department, Bicêtre Hospital, APHP, 78 avenue du Général Leclerc, 94270, Le Kremlin-Bicetre, France.
Laboratory "Complexité, Innovations, Activités Motrices et Sportives", CIAMS (EA4532), University Paris-Sud, University Paris-Saclay, Orsay, France.
Surg Radiol Anat. 2018 Nov;40(11):1231-1242. doi: 10.1007/s00276-018-2087-0. Epub 2018 Aug 31.
The thoracolumbar fascia (TLF) and the erector spinae aponeurosis (ESA) play significant roles in the biomechanics of the spine and could be a source of low back pain. Attachment, collagen fiber direction, size and biomechanical properties of the TLF have been well documented. However, questions remain about the attachment of the TLF and ESA in relation to adjoining tissues in the lumbosacral region. Moreover, quantitative data in relation to the ESA have rarely been examined. The aim of this study was to further investigate the anatomical features of the TLF and ESA and to determine the attachments and sliding areas of the paraspinal compartment through dissection.
In 10 fresh cadavers (6 females, 4 males, mean age: 77 ± 10 years), we determined (1) the gross anatomy of the ESA and the TLF (attachments and sliding areas) and (2) the structure of the ESA and the TLF (thickness, width, orientation of collagen fibers). The pennation angle between the axis of the ES muscle fibers and the axis of the collagen fibers of the ESA were also measured.
The TLF is an irregular dense connective tissue with a mean thickness of 0.95 mm. The distance between the spinous processes line and the site where the neurovascular bundles pierced the TLF, depending on the vertebral level, ranged from 29 mm at L1 to 75 mm at L3. The ESA constituted a band of regular longitudinally oriented connective fibers (mean thickness: 1.85 mm). Muscles fibers of the ES were strongly diagonally attached to the ESA (mean pennation angle 8° for the iliocostalis and 14° for the longissimus). To a lesser extent, the superficial multifidi were attached to the ESA at the lumbar level close to the midline and at the sacral level.
The ESA, at twice the thickness of the pTLF, was the thickest dense connective tissue of the paraspinal compartment. The ESA and the TLF circumscribed subcompartments and sliding areas between the TFL and the lumbar paraspinal muscles, between the ES and the multifidus, and between the longissimus and the iliocostalis.
胸腰筋膜（TLF）和竖脊肌腱膜（ESA）在脊柱生物力学中发挥着重要作用，可能是下腰痛的一个来源。TLF的附着、胶原纤维方向、大小和生物力学特性已有充分记录。然而，关于TLF和ESA在腰骶部与相邻组织的附着情况仍存在疑问。此外，关于ESA的定量数据很少被研究。本研究的目的是进一步研究TLF和ESA的解剖特征，并通过解剖确定椎旁间隙的附着和滑动区域。
在10具新鲜尸体（6名女性，4名男性，平均年龄：77±10岁）中，我们确定了（1）ESA和TLF的大体解剖结构（附着和滑动区域）以及（2）ESA和TLF的结构（厚度、宽度、胶原纤维方向）。还测量了竖脊肌纤维轴与ESA胶原纤维轴之间的羽状角。
TLF是一种不规则的致密结缔组织，平均厚度为0.95毫米。棘突连线与神经血管束穿过TLF的部位之间的距离，根据椎体水平不同，在L1处为29毫米，在L3处为75毫米。ESA由规则的纵向排列的结缔组织纤维带组成（平均厚度：1.85毫米）。竖脊肌的肌纤维强烈地以对角方式附着于ESA（髂肋肌的平均羽状角为8°，最长肌为14°）。在较小程度上，浅层多裂肌在靠近中线的腰椎水平和骶骨水平附着于ESA。
ESA的厚度是胸腰筋膜后层（pTLF）的两倍，是椎旁间隙中最厚的致密结缔组织。ESA和TLF界定了胸腰筋膜（TFL）与腰段椎旁肌之间、竖脊肌与多裂肌之间以及最长肌与髂肋肌之间的子间隙和滑动区域。
