Aubert J, Koumare K, Dufrenot A
J Urol (Paris). 1981;87(5):283-9.
After a very precise anatomical review, the authors report the results of an anatomo-radiological study involving 244 urography films. The usual length of the 12th rib is 11 cm, with a width of 1 cm in the female and 1.5 cm in the male. The costo-lumbar angle was 45 degrees in 3/4 of the films. The kidney was often lower in the female than in the male. The renal artery was almost always given off at the level of the 12th rib or below, whilst at the level of the hilum, the renal artery and 12th rib having crossed, the artery was always above the 12th rib. Study of 173 usable cases of patients operated upon by lumbotomy revealed the following data: --lumbotomies on the 12th rib never opened the pleura, and gave rise to transient wall pain (7%) and one single case of abdominal wall hypotonia (1.4%) with no incisional hernias; --lumbotomies over the 11th rib were associated with 13% of cases of damage to the pleura, 16% of spontaneously resolving wall pain, 7 cases of prolonged parietal hypotonia and one incisional hernia out of 60 lumbotomies; --lumbotomies sub-jacent to the 12th rib were associated with residual abdominal wall pain in 3 cases out of 16. Lumbotomies over the 11th rib are associated with the risk of section of the superficial and deep abdominal branch of the 12th nerve and are hence those exposing to the greatest risk of abdominal wall hypotonia and neuralgia. Incision over the 12th rib would thus appear to be that associated with the least abdominal wall complications.
在进行非常精确的解剖学检查后，作者报告了一项涉及244张尿路造影X线片的解剖放射学研究结果。第12肋的通常长度为11厘米，女性宽度为1厘米，男性宽度为1.5厘米。四分之三的X线片中肋腰角为45度。女性的肾脏位置通常比男性低。肾动脉几乎总是在第12肋水平或其下方发出，而在肾门水平，肾动脉与第12肋交叉后，动脉总是在第12肋上方。对173例接受腰椎切开术的可用病例进行研究后得到以下数据：——在第12肋上进行腰椎切开术从未切开胸膜，会引起短暂的腹壁疼痛（7%）和仅1例腹壁张力减退（1.4%），无切口疝；——在第11肋上进行腰椎切开术有13%的病例损伤胸膜，16%的病例腹壁疼痛可自行缓解，7例出现持续性腹壁张力减退，60例腰椎切开术中出现1例切口疝；——在第12肋下方进行腰椎切开术，16例中有3例出现残留的腹壁疼痛。在第11肋上进行腰椎切开术有损伤第12神经腹侧浅支和深支的风险，因此是发生腹壁张力减退和神经痛风险最大的手术方式。因此，在第12肋上切开似乎是腹壁并发症最少的手术方式。
