Manjatika Arthur Tsalani, Mazengenya Pedzisai, Davimes Joshua Gabriel
Anatomy Division, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi.
School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Asian Spine J. 2023 Jun;17(3):451-460. doi: 10.31616/asj.2022.0078. Epub 2023 Jan 20.
A descriptive cross-sectional study of the anatomical variations, morphometry, and histology of the iliolumbar veins (ILVs).
This study aimed to describe the anatomical variations of the ILVs and determine their tissue composition in South African cadavers of European descent.
A safe anterior surgical approach to the L4/L5 intervertebral disc space requires understanding the anatomy of the ILVs. Limited understanding of ILVs and their variations may lead to inadvertent avulsion of veins with subsequent hemorrhage and damage to the adjacent nerves intraoperatively. Variations in ILVs are population specific, but such reports are limited in the South African population.
Eighty-nine adult cadavers were dissected to reveal ILV patterns. The variations (origin, course, and drainage pattern), morphometries, and topography of the ILVs were studied. A total of 19 (10 proximal, nine distal) ILVs were processed for hematoxylin and eosin, Masson's trichrome, and Verhoeff's histological staining to determine the tissue composition.
The ILVs were identified in 100% of the cases, and 45% of the ILVs were anastomosed to each other bilaterally. The rightside ILVs terminated into the posterior surfaces of the iliac vessels (p =0.001), whereas the left-side ILVs terminated into the lateral surfaces (p =0.001). The left-side proximal ILVs had higher elastic fiber composition (p =0.030). The ratio of the ILVs' elastic fibers to collagen fibers was 1:9, and 61% of the cadavers exhibited type 1 ILV pattern. Moreover, 42% of the ILVs were at the S1 vertebral level with 31% lying between L4 and L5 spinal nerve roots. The obturator nerve coursed anteriorly to the ILVs in 96% of cases.
The ILV variations described for South Africans present new additional patterns, such as bilateral anastomosis and laterality of the terminal drainage. The ILVs have more collagen fibers than elastic fibers, predisposing them to avulsion during surgical retraction. The identification of all the ILVs is crucial to minimize inadvertent hemorrhage and damage to adjacent structures.
一项关于髂腰静脉（ILV）的解剖变异、形态测量和组织学的描述性横断面研究。
本研究旨在描述欧洲裔南非尸体中ILV的解剖变异，并确定其组织构成。
安全的L4/L5椎间盘间隙前路手术方法需要了解ILV的解剖结构。对ILV及其变异的了解有限可能导致术中意外撕裂静脉，继而出血并损伤相邻神经。ILV的变异具有人群特异性，但此类报告在南非人群中有限。
解剖89具成年尸体以揭示ILV模式。研究ILV的变异（起源、走行和引流模式）、形态测量和局部解剖。共对19条（10条近端，9条远端）ILV进行苏木精-伊红染色、Masson三色染色和Verhoeff组织学染色以确定组织构成。
100%的病例中识别出ILV，45%的ILV双侧相互吻合。右侧ILV汇入髂血管后表面（p =0.001），而左侧ILV汇入侧面（p =0.001）。左侧近端ILV的弹性纤维成分更高（p =0.030）。ILV的弹性纤维与胶原纤维比例为1:9，61%的尸体呈现1型ILV模式。此外，42%的ILV位于S1椎体水平，31%位于L4和L5神经根之间。96%的病例中闭孔神经走行于ILV前方。
所描述的南非人ILV变异呈现出新的额外模式，如双侧吻合和终末引流的侧别。ILV的胶原纤维多于弹性纤维，使其在手术牵开过程中易发生撕裂。识别所有ILV对于将术中意外出血和对相邻结构的损伤降至最低至关重要。
