Altunrende Emre Muhittin, Ekin Elif Evrim
Department of Neurosurgery, Health Science University, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul-Turkey.
Department of Radiology, Health Science University, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2019 Mar;25(2):105-110. doi: 10.5505/tjtes.2018.49274.
Vascular injuries, which are rarely seen in all spinal area procedures, especially lumbar disc surgery, are vitally important. The relationship between the course of the iliac artery and vein and intervertebral disc distance was studied morphometrically in patients who had undergone computed tomography angiography for abdominal aorta.
This study was carried out retrospectively. A total of 100 patients who had undergone computed tomography angiography participated in the study. The aorta bifurcation, right and left common iliac artery (R/LCIA) and vein (R/LCIV), and the location of the common iliac artery bifurcation were investigated. The location of these vascular structures at the level of the spinal vertebral body and at the intervertebral disc level, determination of a fat plane between them, and the anterior longitudinal ligament (ALL) were analyzed.
At the L4-5 intertransversarius dorsalis (IDL), the RCIV was determined to be at the 12 o'clock position RCIA in 51% of cases and between the ratio of 67% ALL. The LCIA was at the 1 o'clock position in 72% and adjacent to the ALL in 47%. The RCIV was located in the 11 o'clock position and there was no fat plane between the RCIV and the ALL in 92%. In 80%, the LCIV was located at the 11-12 o'clock position and in 18% transversely along the 12-1-2 o'clock region. There was no fat plane between the LCIV and the ALL in any patient. At the L5-S1 IDL, the RCIA was observed at the 10 o'clock position in 63%, and there was no fat plane between the RCIA and the ALL. The LCIA was at the 2 o'clock position in 72% and the LCIV was between the ALL and the LCIA in 92%. The RCIV was located at the 9-10 o'clock position in 95% and no fat plane was found between the ALL and the RCIV in 60%. The LCIV was located at the 1-2 o'clock position in 96% and there was no fat plane between the LCIV and the ALL in 92%; it was located close to the ALL.
The L4-5 IDL RCIA was located at the midline and at a 30° angle position. The LCIV was located between them. The L5-S1 IDL located at LCIA left at 60° position was quite close to ALL with LCIV. When the distance from the ALL was compared and the frequency of fat planes between the ALL and the CIAs are considered, it can be noted that the RCIA in the L4-L5 IDL (p<0.001) and the LCIA in the L5-S1 IDL (p<0.001) were located remotely and in a more protected position. It should be kept in mind that the LCIV can progress along the L4-5 ID level, adjacent to the ALL, as well as transversely.
血管损伤在所有脊柱区域手术中很少见，尤其是腰椎间盘手术，但却至关重要。对接受腹部主动脉计算机断层血管造影的患者进行形态学研究，以探讨髂动脉和静脉走行与椎间盘距离之间的关系。
本研究为回顾性研究。共有100例接受计算机断层血管造影的患者参与研究。研究了主动脉分叉、左右髂总动脉（R/LCIA）和静脉（R/LCIV）以及髂总动脉分叉的位置。分析了这些血管结构在脊柱椎体水平和椎间盘水平的位置，确定它们之间的脂肪平面以及前纵韧带（ALL）。
在L4 - 5背侧横突间（IDL），51%的病例中右侧髂总静脉（RCIV）位于右侧髂总动脉（RCIA）的12点位置，在67%的ALL比例之间。72%的左侧髂总动脉（LCIA）位于1点位置，47%与ALL相邻。92%的RCIV位于11点位置，且RCIV与ALL之间无脂肪平面。80%的左侧髂总静脉（LCIV）位于11 - 12点位置，18%沿12 - 1 - 2点区域横向分布。所有患者的LCIV与ALL之间均无脂肪平面。在L5 - S1 IDL，63%的病例中观察到RCIA位于10点位置，且RCIA与ALL之间无脂肪平面。72%的LCIA位于2点位置，92%的LCIV位于ALL与LCIA之间。95%的RCIV位于9 - 10点位置，60%的ALL与RCIV之间未发现脂肪平面。96%的LCIV位于1 - 2点位置，92%的LCIV与ALL之间无脂肪平面；它靠近ALL。
L4 - 5 IDL的RCIA位于中线并呈30°角位置。LCIV位于它们之间。L5 - S1 IDL中位于左侧60°位置的LCIA与LCIV非常靠近ALL。当比较与ALL的距离并考虑ALL与髂总动脉之间脂肪平面的频率时，可以注意到L4 - L5 IDL中的RCIA（p<0.001）和L5 - S1 IDL中的LCIA（p<0.001）位置较远且处于更受保护的位置。应牢记LCIV可沿L4 - 5 ID水平在ALL附近纵向以及横向走行。
