| Background and Objective:Lumbosacral plexus(LSP)injury is a nerve invasion by outside factors and injury of the disease,along with raising the level of treatment,patients with nerve injury on the functional recovery after a higher demand.LSP injury causes more traffic accidents for high-speed,high falling,leading to landslides,such as pelvic fracture, pelvic ring caused by the rupture.LSP normal activities within the pelvis in a very small degree,LSP injury mechanism for regular pelvic fracture displacement after the Central or the merger dislo-cation caused by traction injury,for the oppression of minorities injury.Trauma,oppression machinery,chemical stimulation,and other reasons leading to nerve damage after ischemia of the internal organization of the changes in nerve function is difficult to restore the main,causing the normal conduction of nerve root dysfunction.Foreign scholars through animal and human anatomy,histology and hemodynamics the observation,causing nerve root obstacles to the normal function of the causes for the con-duction of the study,but the LSP blood for the study is not perfect.LSP injury after the repair of the clinical effects affected by many factors, including nerve on the blood supply plays a very important role.In neural defect,the nerve of vascular graft(VNG) than conventional non-vascular nerve graft with the superiority theory.The peripheral nerves of the blood supply has been 200 years of history,as early as the 18th century,the 1960s,Isenflamm and Doerffler with the first infusion methods on peripheral nerve supply vessels were studied,after the scholars on peripheral nerve of the blood supply Due to lack of research and clinical application has been staying in basic theoretical research stage.Taylor 1976 since the successful conduct of the vascularized nerve transplant,the people on the study of the blood supply from purely on the basis of the clinical application to the study, and research methods have improved.2003 Suami,Sidney,2006年Hong, Tian-Hong Peng,respectively use of radiation vascular enhancement technology to lower limb nerve,the nerve and brachial plexus of blood vessels were studied. Suami,such as lower extremity vascular study of the region,a vascular radiology enhancement technology,focused mainly on the lower extremities of the nutrient vessels to discuss the scope of distribution,but also the lack of LSP of the blood supply system,LSP and the distribution of blood supply Features also failed radiation from the image on unsubstantiated.To this end,the issue of the first part of a LSP anatomical observation,using microscopic anatomy of vascular technology and gelatin-lead oxide radiation microvascular enhancement technology to LSP blood supply to conduct research, provide lumbosacral nerve root out vertebral Around the hole between the anatomy, spinal nerve root in the running angle,lumbar sacral nerve root of the anatomy data, defined the LSP of the blood supply,nerve and vascular anatomy and the location and characteristics of relations between the segments of blood vessels Regional,LSP injury provide anatomical basis for the repair surgery.Minimally invasive treatment technology and the continuous improvement of the rapid development of imaging technology,the blood vessels and nerve visualization of clinical diagnosis has become an integral part of the evidence.At this stage clinical application of conventional CT,ultrasound,MRI and other imaging method is not enough to clearly show LSP structure,LSP injury affect the accuracy of diagnosis.1992,Howe tried to applications such as magnetic resonance(magnetic resonance,MR) combined with fat suppression shows that the rabbits forelimb nerve cross-section images,for peripheral nerve imaging provides a new viable solution, due to the restrictions MR hardware and software,The resolution shows that nerve is not high,artifacts Clearly,in the clinical application is limited.In recent years,due to the rapid development of MRI technology to improve the image of the time and spatial resolution,better pressure resin technology,MRN become a clinical application of new technologies.So the second part of this topic on the use of technology MRN imaging for LSP, shows that the integrity of the LSP MR imaging and to make it three-dimensional imaging.LSP for the clinical diagnosis of the injury imaging data for the LSP injury to provide treatment based on imaging.Many scholars continue to improve in the clinic on the basis of technology,is also committed to exploring different ways to restore the operation of motor function. Aramburo(1986) reports on LSP exploration surgical approach,through extraperitoneal and peritoneal within two approaches can reveal LSP,often flanking abdominal muscle incision,the retroperitoneal separation revealed lumbar plexus; abdominal incision separation revealed Sacral plexus.Linarte and Gilbert(1986) reported the sacral approach revealed sacral plexus.LSP repair the current exploration not reported in the literature,and a reasonable surgical approach to repair the damage and to protect their vessels and around the psoas major muscle(PM) structure,the spine of the normal structure and function of great importance.Clinical on the road retroperitoneal approach of more concern is spinal surgery,ARP approach can be led by the great vessels to the medial more fully exposed vertebra, or more lateral incision through the lumbar vertebrae exposed muscle.But cut lumbar vertebrae easily exposed the lumbar plexus in PM and affect the function of the spine.Lumbar spine surgery in iatrogenic LSP injury is also reported,mainly in equipment exposed in the process of implantation.In order to better surgery to repair the damage LSP,restore its function and reduce the secondary trauma surgery and the protection of spinal function,the choice of topics in the third part of the bodies were fresh,with the morphology and imaging results to explore the way forward LSP ARP approach of the anatomical structure characteristics,with a view to surgical repair of the LSP to provide morphological basis.Method:1.(1) 15 cases of red latex perfusion preservation of the adult specimens following spinal T9 specimens,and the naked eye surgery microscope LSP root canal inside and outside the shape and characteristics of the spinal canal and,epidural and spinal cord,and other organizations around the,(2) Observation with Naked eyes and under a surgery microscope,the sources of the blood supply for anterior roots and posterior roots of LSP,and the relationship between anterior roots and posterior roots nutrition artery with spinal cord.(3) Three fresh adult cadaveric specimens, infuse 5%gelatin-lead oxide suspension in the abdominal aorta and angiography, then anatomical separate LSP with nutritional blood vessels and source blood vessels, remove the spine then take the LSP to X-ray observation.(4) Use the Canon A650 digital camera photographed the entire process,then use photoshop software to process the images.The images of the South Centre Hospital PACS system will be X-ray film into personal computers,can be clear for the observation of LSP blood supply of angiography picture. 2.Healthy volunteers three cases,GE company 3.0 T HD signa superconducting magnetic resonance imaging system,spine surface coil(CTL456).Routine sagittal T1WI,cross-sectional imaging T2WI,parameter::FRFSE sequence T2WI fat suppression,TR/TE/NEX:4000/85/2,Matrix:352×256,slice thickness/floor space:1.0/0 mm,Floors 40 to 44,scan time:4 min17s.Dicom format of the original image to import GE company AW4.3 image workstations,complete the maximum intensity projection(MIP),multi-volume reorganization(MPVR),volume reproduction(VR) image reconstruction.3.Three fresh specimens,use the front-line of axillary opening,left and into the posterior peritoneal cavity,PM after stripping,separation revealed lumbar plexus, with LSP and nutrition of the vascular anatomy,MRN positioning observation,To simulate the road retroperitoneal nerve repair,exploratory surgery to observe the psoas muscle and LSP,the location of relations between the blood vessels.Results:1.(1) LSP roots of the microscopic anatomy:LSP AR and PR followed by the small beam-nerve-beam-bundle of nerves and nerve on the beam since the corresponding segments of the spinal cord LS anterior and posterior the lateral ditch,lateral ditch parallel with the issue or to enter,ramps outside the bottom course,from top to bottom before beginning the root of its distance from the center line and the spinal cord after the first small,L1 maximum 2.21±0.49mm,down gradually decreased root and spinal cord of the longitudinal axis angle gradually become smaller,L1 up to 25.07°±5.37;AR and PR canal running the length of the gradually increasing,L1 to 66.74±10.77mm,65.61±9.87mm,by L5 to the big 129.99±16.27mm,137.64±11.37mm;before and after the diameter of the root L5 crude for the 1.70±0.36mm, 1.75±0.56mm,the corresponding root root rough than before;separation of lumbar nerve root Kok better than the first-separation angle,LN and the angle between the dural sac gradually decreased,L1 from 56.64°±7.67,to S3's 7.80°±1.94;before and after the nerve root gradually formed the medial wide,lateral Narrow fan-shaped structure,its surface roots artery with nerve root out dural sac.(2)LSP and AR and PR of the blood supply:from 1st to 4ed LA,iliolumbar artery,Sperior gluteal artery, sacral lateral artery,the artery root and spinal cord artery before and after the match in many ways.(3) LSP blood for the distribution:from the lumbar artery system, sacroiliac lumbar artery system,Sperior gluteal artery,the artery buttocks,perineum, the artery segmental artery and adjacent muscle muscle branch.Segmental artery in addition to the branch of vertebra,External arch,all to the medial branch of the lumbar sacral ganglion,LSP,accompanied by extending to the ganglion inside epidural or across the epidural,Cobweb Membrane,along the pre-and post-Gen-walking,a branch of spinal nerve root and spinal cord and nerve before and after the match artery,anastomosis true form.Section arteries to "Y"-type into the nerve membrane,and then divided into movements sticks,branches and sections of the artery between the anastomosis,true form anastomosis and occlusion of the anastomosis to the main anastomosis true.LSP stem,stock,in addition to beam the blood supply from the artery segment,but also from the nearby artery,including accompanied artery and its branches,close to the muscular branches.Red latex and gelatin infusion specimens-lead oxide radiation image shows the law are clear LSP of the blood supply.2.MRN LSP imaging:MRN can clearly show that lumbar intervertebral foramen nerve(nerve root),lumbar ganglion(nerve),LN sections,the LST and the femoral nerve,the nerve obturator,Lateral femoral nerve,Iliohypogastric nerve,ilioinguinal nerve.Ganglion signal higher than the nerve root and neural stem,and neural stem ganglion no signal around the stove.Femoral nerve in the lumbar vertebra level from four to five lumbar muscle to the surface transitional iliopsoas surface,shape shifting from a long strip of oval-shaped cross section,the signal slightly higher than the psoas muscle,a clear edge.Traveling sacral plexus due to different point of view can not be at the same time,oblique sagittal imaging and positioning of the best oblique coronal shown in the short strip of running the same direction,this can increase the S1 and adjacent to show the sciatic nerve,the use of MPR technology can be the raw data collected on any of the reconstruction,clearly shows that the rate of increase.3.Simulation lumbosacral plexus repair the road retroperitoneal surgical approach: the left side of the road axillary front-line incision,exposed L1～L3 lumbar nerve,to achieve a good exposure and open heart operation under the purpose.Lumbar plexus in different sections,the lumbar plexus in the lumbar muscle or deep muscle quality, in front of the transverse process spinal,here for the psoas muscle gap,the lumbar plexus in the composition of the lateral lumbar have a certain regularity,Lumbar artery in the lumbar muscles to walk,there is no specific muscle gap.Conclusion:1.LSP blood supply from 1 to 4 lumbar artery,sacroiliac lumbar artery system, Sperior gluteal artery,hip artery,the artery and the neighbouring perineal muscles of the muscular branches.Nutrition in the artery between the true nerve anastomosis in the pathological state,may provide collateral circulation,the blood vessels between regions compensate for each other.LSP familiar with the roots of the microanatomy of the LSP injury to the diagnosis and treatment.2.Latex perfusion of external blood supply for the observation,angiography law for the overall distribution of nerves and blood vessels observation,latex and vascular perfusion imaging method used in conjunction,can clearly show LSP nerves and blood vessels and nerve and the distribution of blood vessels Relations. 3.MRN completed a comprehensive technical LSP of the imaging,because of their non-invasive,it should be carried out for clinical LSP injury check the preferred means of imaging.4.LSP injury rehabilitation and detectors before the surgery more appropriate approach road,the road retroperitoneal approach can be used as non-injury LS function under the premise of the lumbar plexus repair the surgical approach,lumbar muscle is the first lateral lumbar muscle cut the security zone.Approach to direct, simple,clear exposure,can be dealt with under the open-nerve root and prominent disc;trauma small,less bleeding into the space from the muscle,nerve and muscle damage is not the normal structure,with no part of the spinal bones and ligaments, Impact of spinal stability.
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