3 research outputs found

    Anatomic variations of the lumbar plexus and its nerves in Korean adults

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    ์˜๊ณผํ•™๊ณผ/์„์‚ฌ[ํ•œ๊ธ€] ํ•œ๊ตญ์ธ ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์˜ ๊ตฌ์„ฑ๊ณผ ๊ทธ ๊ฐ€์ง€์˜ ๊ตญ์†Œํ•ด๋ถ€ํ•™ ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ๋Š” ๋Œ€๋ถ€๋ถ„ ๊ต๊ณผ์„œ์— L1-L4์˜ ์•ž๊ฐ€์ง€๊ฐ€ ์ด๋ฃจ๋ฉฐ, T12๋„ ์ผ๋ถ€๊ฐ€ ์ฐธ์—ฌํ•œ๋‹ค๊ณ  ํ•˜์˜€๋‹ค. ๋งŽ์€ ์—ฐ๊ตฌ์—์„œ๋Š” ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ๋Š” T12-L5 ์‚ฌ์ด์—์„œ ๋‹ค์–‘ํ•˜๊ฒŒ ํ˜•์„ฑ๋˜๊ณ , ๊ทธ ๊ฐ€์ง€๋ฅผ ์ด๋ฃจ๋Š” ์ฒ™์ˆ˜์‹ ๊ฒฝ์˜ ๊ตฌ์„ฑ๋„ ๋‹ค์–‘ํ•˜๊ฒŒ ๋ณด๊ณ ๋˜์—ˆ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์—์„œ ์ผ์–ด๋‚˜๋Š” ์‹ ๊ฒฝ์„ ์ด๋ฃจ๋Š” ์ฒ™์ˆ˜์‹ ๊ฒฝ์˜ ๊ตฌ์„ฑ์— ๋Œ€ํ•œ ํ˜•ํƒœ๊ณ„์ธก์— ๊ด€ํ•œ ์—ฐ๊ตฌ๋Š” ์ฐพ์•„ ๋ณผ ์ˆ˜๊ฐ€ ์—†์—ˆ๋‹ค. ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์™€ ํฐํ—ˆ๋ฆฌ๊ทผ ๊ทธ๋ฆฌ๊ณ  ์ƒ…๊ณ ๋ž‘์ธ๋Œ€ ๋ถ€์œ„์—์„œ ๊ฐ ์‹ ๊ฒฝ์˜ ๊ตญ์†Œํ•ด๋ถ€ํ•™์  ๊ด€๊ณ„๋Š” ๋ถ€์œ„๋งˆ์ทจ ๋•Œ ์ž„์ƒ์ ์œผ๋กœ ์ค‘์š”ํ•˜๋‹ค. ์ด ์—ฐ๊ตฌ๋Š” ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์™€ ๊ทธ ๊ฐ€์ง€๋ฅผ ์ด๋ฃจ๋Š” ์ฒ™์ˆ˜์‹ ๊ฒฝ์˜ ํ˜•์„ฑ๋ณ€์ด๋ฅผ ์กฐ์‚ฌํ•˜๊ณ , ๊ฐ ์‹ ๊ฒฝ์„ ์ด๋ฃจ๋Š” ์ฒ™์ˆ˜์‹ ๊ฒฝ์˜ ๊ตฌ์„ฑ์— ๋Œ€ํ•œ ํ˜•ํƒœ๋ฅผ ๊ณ„์ธกํ•˜๊ณ , ๋ถ€์œ„๋งˆ์ทจ์‹œ ๋„์›€์ด ๋˜๋Š” ์ž๋ฃŒ๋ฅผ ์–ป๊ธฐ ์œ„ํ•ด ์‹œ๋„ํ•˜์˜€๋‹ค. ์žฌ๋ฃŒ๋กœ๋Š” ํ•œ๊ตญ์„ฑ์ธ์‹œ์‹  86๊ตฌ(172์ชฝ)๋ฅผ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ๊ทธ ์ค‘ 15๊ตฌ(30์ชฝ)์—์„œ๋Š” ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์™€ ๊ทธ ๊ฐ€์ง€๋ฅผ ํ•œ ๋ฉ์–ด๋ฆฌ๋กœ ๋–ผ์–ด๋‚ด์–ด 0.04M guanidine ์šฉ์•ก์— ๋‹ด๊ทผ ํ›„, ์ดˆ์ŒํŒŒ์„ธ์ฒ™๊ธฐ๋กœ ์ฒ˜๋ฆฌํ•˜์—ฌ ๊ฒฐํ•ฉ์กฐ์ง์„ ๋ถ€๋“œ๋Ÿฝ๊ฒŒ ํ•œ ํ›„, ์ˆ˜์ˆ ํ˜„๋ฏธ๊ฒฝ ์•„๋ž˜์—์„œ ์‹ ๊ฒฝ๋‹ค๋ฐœ์„ ๋ถ„๋ฆฌํ•˜์˜€๋‹ค. ๊ธด์ง€๋ฆ„๊ณผ ์งง์€์ง€๋ฆ„์„ ๊ณ„์ธกํ•˜์—ฌ ๊ทธ ํ‰๊ท ๊ฐ’์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์˜ ๋ฟŒ๋ฆฌ๋Š” T12-L4๊ฐ€ 33.7%, L1-L4๊ฐ€ 56.6%, L1-L5๊ฐ€ 9.6%์˜€๋‹ค. ์—‰๋ฉ์•„๋žซ๋ฐฐ์‹ ๊ฒฝ์€ T12์—์„œ 25.3%, L1์—์„œ 67.5%๊ฐ€ ์ผ์–ด๋‚ฌ๋‹ค. ์—‰๋ฉ์ƒ…๊ตด์‹ ๊ฒฝ์€ L1์—์„œ 83.3%, L2์—์„œ 7.1%๊ฐ€ ์ผ์–ด๋‚ฌ๋‹ค. ์Œ๋ถ€๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ์€ 7๊ฐ€์ง€ ์œ ํ˜•์ด ์žˆ์—ˆ๋Š”๋ฐ, ๊ทธ ์ค‘ L1์—์„œ 14.1%, L1-L2์—์„œ 28.2%, L2์—์„œ 42.3%๊ฐ€ ์ผ์–ด๋‚ฌ๋‹ค. ๊ฐ€์ชฝ๋„™๋‹ค๋ฆฌํ”ผ๋ถ€์‹ ๊ฒฝ์€ 8๊ฐ€์ง€ ์œ ํ˜•์ด ์žˆ์—ˆ๊ณ , L2์—์„œ 35.9%, L2-L3์—์„œ 29.3%๊ฐ€ ์ผ์–ด๋‚ฌ๋‹ค. ๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ์€ 7๊ฐ€์ง€ ์œ ํ˜•์ด์—ˆ๋Š”๋ฐ, L1-L4์—์„œ 24.2%, L2-L4์—์„œ 65.7%๊ฐ€ ์ผ์–ด๋‚ฌ๋‹ค. ํ์‡„์‹ ๊ฒฝ์€ 8๊ฐ€์ง€ ์œ ํ˜•์ด์—ˆ๊ณ , L2-L4์—์„œ 40.0%, L3-L4์—์„œ 40.0%๊ฐ€ ์ผ์–ด๋‚ฌ๋‹ค. ์—‰๋ฉ์•„๋žซ๋ฐฐ์‹ ๊ฒฝ์„ ์ด๋ฃจ๋Š” ์ฒ™์ˆ˜์‹ ๊ฒฝ์˜ ๊ตต๊ธฐ๋Š” T12๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 2.38mm, L1์ด ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 1.18mm์˜€๋‹ค. ์—‰๋ฉ์ƒ…๊ตด์‹ ๊ฒฝ์€ L1์ด ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 0.61mm, L2๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 0.40mm์˜€๋‹ค. ์Œ๋ถ€๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ์€ L1์ด ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 0.56mm, L1-L2๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L1์€ 0.57mm, L2๋Š” 1.02mm์˜€๊ณ , L2๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 0.60mm, L2-L3๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L2๋Š” 0.38mm, L3๋Š” 0.28mm, ๊ทธ๋ฆฌ๊ณ  L3๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 0.98mm์˜€๋‹ค. ๊ฐ€์ชฝ๋„™๋‹ค๋ฆฌํ”ผ๋ถ€์‹ ๊ฒฝ์€ L2๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ 0.73mm, L2-L3๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L2๋Š” 0.77mm, L3๋Š” 0.73mm์˜€๋‹ค. ๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ์€ L2-L4๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L2๋Š” 1.48mm, L3๋Š” 2.91mm, L4๋Š” 2.19mm, L2-L5๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L2๋Š” 0.48mm, L3๋Š” 2.47mm, L4๋Š” 2.87mm, L5๋Š” 0.51mm์˜€๊ณ , L3-L5๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L3๋Š” 2.11mm, L4๋Š” 3.30mm, L5๋Š” 1.00mm์˜€๋‹ค. ํ์‡„์‹ ๊ฒฝ์€ L2-L3๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L2๋Š” 0.56mm, L3๋Š” 1.79mm์˜€๊ณ , L2-L4๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L2๋Š” 0.53mm, L3๋Š” 1.45mm, L4๋Š” 0.64mm์˜€์œผ๋ฉฐ, L3-L4๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ L3๋Š” 1.31mm, L4๋Š” 1.09mm, ๊ทธ๋ฆฌ๊ณ  L3-L5๊ฐ€ ์ด๋ฃจ๋Š” ๊ฒฝ์šฐ๋Š” L3๋Š” 0.91mm, L4๋Š” 1.38mm, L5๋Š” 0.30mm์˜€๋‹ค. ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์˜ ๊ฐ ๊ฐ€์ง€ ์ค‘ ์Œ๋ถ€๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ๊ณผ ํ์‡„์‹ ๊ฒฝ์„ ์ œ์™ธํ•œ ๋ชจ๋“  ์‹ ๊ฒฝ๋“ค์€ ํฐํ—ˆ๋ฆฌ๊ทผ์˜ ๊ฐ€์ชฝ๋ชจ์„œ๋ฆฌ๋ฅผ ๋น ์ ธ๋‚˜์™”๊ณ , ํ์‡„์‹ ๊ฒฝ์€ ํฐํ—ˆ๋ฆฌ๊ทผ์˜ ์•ˆ์ชฝ๋ชจ์„œ๋ฆฌ๋ฅผ ๋น ์ ธ๋‚˜์™€ ๋‹ค๋ฆฌ๋กœ ๋‚ด๋ ค๊ฐ”๋‹ค. ์Œ๋ถ€๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ์€ 1-3๊ฐœ์˜ ๊ฐ€์ง€๊ฐ€ ํฐํ—ˆ๋ฆฌ๊ทผ์„ ๋šซ๊ณ  ๋‚˜์™”๋‹ค. ์ƒ…๊ณ ๋ž‘์ธ๋Œ€์˜ ๊ธธ์ด๋Š” 119.9mm์˜€๋‹ค. ์œ„์•ž์—‰๋ฉ๋ผˆ๊ฐ€์‹œ์—์„œ ๊ฐ€์ชฝ๋„™๋‹ค๋ฆฌํ”ผ๋ถ€์‹ ๊ฒฝ๊ณผ ๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ๊นŒ์ง€์˜ ๊ฑฐ๋ฆฌ๋Š” ๊ฐ๊ฐ 17.6mm, 54.0mm, ๋‘๋ฉ๋ผˆ๊ฒฐ์ ˆ์—์„œ ์Œ๋ถ€๋„™๋‹ค๋ฆฌ์‹ ๊ฒฝ ์ค‘ ์Œ๋ถ€๊ฐ€์ง€์™€ ๋„™๋‹ค๋ฆฌ๊ฐ€์ง€๊นŒ์ง€์˜ ๊ฑฐ๋ฆฌ๋Š” ๊ฐ๊ฐ 66.9mm, 68.6mm, ๋‘๋ฉ๋ผˆ๊ฒฐ์ ˆ์—์„œ ํ์‡„์‹ ๊ฒฝ๊นŒ์ง€์˜ ๊ฑฐ๋ฆฌ๋Š” 27.6mm์˜€๋‹ค. ์ด์ƒ์˜ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋Š” ํ—ˆ๋ฆฌ์‹ ๊ฒฝ์–ผ๊ธฐ์™€ ์ด๊ฒƒ์—์„œ ์ผ์–ด๋‚œ ์‹ ๊ฒฝ๋“ค์˜ ํ˜•ํƒœ๋ณ€์ด๋ฅผ ๊ด€์ฐฐํ•˜์—ฌ ํ•œ๊ตญ์ธ์˜ ํŠน์ง•์„ ๋ฐํ˜”๊ณ , ๊ทธ ๊ฒฐ๊ณผ๋ฅผ ๋‹ค๋ฅธ ์—ฐ๊ตฌ์ž๋“ค์˜ ๊ฒฐ๊ณผ์™€ ๋น„๊ตํ•˜์˜€์œผ๋ฉฐ, ๊ฐ ์‹ ๊ฒฝ์„ ์ด๋ฃจ๋Š” ์ฒ™์ˆ˜์‹ ๊ฒฝ์„ ๊ณ„์ธกํ•˜์—ฌ ๊ทธ ๊ตฌ์„ฑ๋น„์œจ์„ ๋ฐํ˜”๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์ƒ…๊ณ ๋ž‘์ธ๋Œ€ ๋ถ€์œ„์—์„œ ๊ฐ ์‹ ๊ฒฝ์ด ์ง€๋‚˜๊ฐ€๋Š” ์œ„์น˜๋ฅผ ๊ณ„์ธกํ•˜์—ฌ ๋ถ€์œ„๋งˆ์ทจ์™€ ๊ด€๋ จ๋œ ์ž„์ƒ์  ์˜์˜์— ๋Œ€ํ•˜์—ฌ ๊ณ ์ฐฐํ•˜์˜€๋‹ค. [์˜๋ฌธ]The lumbar plexus and its nerves have been described to be formed diversely by the spinal nerves from T12 to L5. However the detailed anatomy of the nerves and the topographic relationship with the surrounding structures have not been clarified. Accordingly, this study was performed to clarify the diverse constituent of the lumbar plexus, the detailed anatomy of the nerves from the lumbar plexus, and its topographic relationship with the medial and lateral border of the psoas major muscle, the anterior superior iliac spine, and the pubic tubercle. One hundred-seventy two sides of 86 Korean adult cadavers were used in this study. The lumbar plexus and its nerves were dissected under the surgical microscope, after being separated from the body. The lumbar plexus was formed by the spinal nerves of the T12-L4 in 33.7%, the L1-L4 in 56.6%, and the L1-L5 in 9.6%. The iliohypogastric nerve mostly arised from T12(25.3%, thickness 2.38mm) or L1(67.5%, thickness 1.18mm). The ilioinguinal nerve mainly arised from L1(83.3%, thickness 0.61mm) or L2(7.1%, thickness 0.40mm). The formation of the genitofemoral nerve could be classified into 7 types, and the type in which L2 comprised the nerve, was the most common(42.3%, thickness 0.60mm). The lateral femoral cutaneous nerve could be classified into 8 types, and the most common type was L2(35.9%, thickness 0.73mm). The femoral nerve could be classified into 7 types, and the type in which L2-L4 comprised the nerve, was the most common(65.7%, thickness L2 1.48mm, L3 2.91mm, L4 2.19mm). The obturator nerve could be classifed into 8 types, and the common type was L2-L4(40.0%, thickness L2 0.53mm, L3 1.45mm, L4 0.64mm) or L3-L4(40.0%, thickness L3 1.31mm, L4 1.09mm). While the obturator nerve and the other nerves emerged from the medial and lateral border of the psoas major muscle, respectively, the genitofemoral nerve pierced the muscle by 1-3 branches. The mean distance from the anterior superior iliac spine to the lateral femoral cutaneous and the femoral nerve was 17.6mm, and 54.0mm, respectively. The mean distance from the pubic tubercle to the genital and femoral branch of the genitofemoral nerve was 66.9mm, and 68.6mm, respectively. The mean distance from the pubic tubercle to the obturator nerve was 27.6mm.ope
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