【作者】 欧阳厚淦；

【导师】 丁自海；

【作者基本信息】 南方医科大学 ， 人体解剖与组织胚胎学， 2010， 博士

【摘要】 1研究背景通过对国内外有关文献的查阅,我们认为,针对胸腔镜下脊柱胸腰结合段(T11～L2)手术所做的基础解剖研究还不能满足临床需要。尤其是结合多种研究方法与手段来对脊柱胸腰段侧面血管神经所做的应用解剖研究更是不多,已有的研究或者是单独利用人体标本进行解剖研究,或者是只通过动物实验进行探索,而像结合人体标本与影像等手段进行综合对比研究则极为缺乏。随着传统治疗手段的一些局限或弊端,一些新兴技术、手术入路及新思维开始出现并应用于临床,而新技术就需相关理论作支持,这就需要我们专门做这方面的应用解剖研究以满足临床需要。对于T11～L2节段,由于小关节尚未完全由额状面转变为矢状面,故更易因旋转与剪切暴力而造成损伤。大约60%的胸腰段损伤发生在此特殊的解剖区域。因此有关该区域的疾病及手术占的比例较大。目前,胸腔镜下治疗胸腰段骨折手术、椎间盘摘除手术及脊柱结核清除手术等国内外已逐步推广。胸腔镜下腹膜后入路的研究国内外也已开展,有望运用于侧方融合、侧前方减压等手术。一些腹膜入路对前面的大血管容易造成损伤,而腹膜后入路因为传统的椎体后融合引发诸如术后疼痛等并发症,因此有学者提出腹膜后入路从侧面进行椎间融合的思路。可是从已有报道中我们知道,相关的节段血管损伤是其主要并发症之一,因此,要做好胸腔镜下脊柱胸腰结合段的手术就必须熟悉节段血管的解剖特点与相关入路。为了适应胸腔镜外科的发展,对该区域的血管神经进行应用解剖研究非常必要。其目的就是要总结以往经验,避免单一手段进行研究,而采用多种先进的手段进行研究才能够更全面客观地掌握相关入路特点。同时,结合过去本领域研究的一些不足(只是对尸体标本进行了观察,其研究手段单一,所得结论无法满足临床要求)做一些补充与修改。鉴于此,本研究进行了腔镜下胸腰结合段手术应用解剖与影像学研究。2目的2.1为脊柱胸腰结合段侧面的血管神经走行,变异及毗邻关系提供解剖学形态基础；为胸腔镜下脊柱胸腰结合段手术确定解剖标志并测量出两相邻节段动脉之间距离和手术操作的最大安全空间。2.2为脊柱胸腰结合段侧面的节段血管走行,变异及毗邻关系提供影像学解剖基础。2.3为使影像学应用于术前个性化方案的制定提供理论支持。2.4为胸腔镜下脊柱胸腰结合段手术入路提供胸腰段外围大体解剖基础。2.5为胸腔镜下脊柱胸腰结合段手术提供镜下解剖入路及形态基础。2.6为胸腔镜下脊柱胸腰结合段经膈手术提供膈的解剖学基础及相关标志。3方法3.1对28具(56侧,男、女各14具,全部标本脊柱胸腰结合段无血管疾患及其它病理性改变)经防腐处理的成人尸体标本进行解剖,将每具标本去除胸、腹腔脏器后,于脊柱胸腰段剥掉壁胸膜、壁腹膜,显露腹主动脉和下腔静脉；分离并切除膈、腰大肌及该结合段的主动脉和下腔静脉,观察其深面的节段血管(在胸腰段为肋间后血管、肋下血管、腰血管)、交感干、内脏大神经、胸导管、奇静脉、半奇静脉等的走行及毗邻关系。采用游标卡尺(精确度为0.01mm)在脊柱侧面正中线上,对上、下位节段动脉之间的距离(如某节段血管缺如,则测量该节段椎体中点水平与另一条相邻节段血管之间的距离)进行测量。3.2对26(52侧,男、女各13例)例正常成人经肘静脉造影后行脊柱胸腰段CT扫描。扫描前对参与者详细询问病史以排除胸腰椎及相关毗邻组织的疾患,确保自愿参与者体内无金属植入物,去除体表衣物上的金属饰物,受检者于安静小屋中休息10分钟使其心情舒缓,呼吸平稳,瞩其扫描时身体尽量保持静止。扫描范围：上缘包括T3上缘,下缘超过L5下缘。参与者取仰卧位。图像后处理：所有志愿者扫描原始图像以BMP格式导入CT图像工作站,完成最大密度投影(maximum intensiity projection,MIP),多层面容积重组(multiplane volume reconstructions,MPVR),容积重建(volune rendering,VR)等进行图像重建,MIP/MPVR/VR图像重建层厚0.1mm,MPVR/VR重建图像采用阈值彩色技术显示。图像上观测：对节段血管、交感干、内脏大神经、胸导管、奇静脉、半奇静脉及椎体等的走行及毗邻关系进行观察并用photoshop软件进行测量处理。测量范围：在脊柱侧面正中线上,对上、下位节段动脉之间的距离(如节段血管缺如,则测量该节段椎体中线水平与另一条相邻节段血管之间的距离)进行测量。3.3对尸体标本与影像学图像上所观察与测量的结果进行比较研究以了解其异同。3.4对两例成年防腐固定尸体标本(男性1例,身高173cm,女性1例,身高161cm)在胸腰段胸腹部等外围结构进行逐层解剖并观察其大体解剖结构。3.5对1例新鲜男性成人尸体标本模拟胸腔镜下脊柱胸腰结合段手术进行镜下解剖观察。模拟胸腔镜下手术过程：尸体标本采取侧卧位,将标本固定并抬高腰部,使肋间隙张开,以利于器械进入。以腋前线及腋后线为标志,在腋后线第8、9肋间隙处插入摄像机镜头(光源),在腋前线第7、8,第5、6,第3、4肋间隙处插入拉钩、工作通道及冲洗吸引管等操作器械,这样全面地观察脊柱侧前方,同时入口处根据需要进行调整。在插入30°角摄像镜头后,观察胸腔内情况,在监视下插入另外2～3根管道。当肺塌陷,影响观测脊柱时,用拉钩挡开肺,并通过调整手术床的倾斜度以加强对脊柱胸腰结合段毗邻结构的观察。3.6对12具成人防腐固定尸体标本(男、女性各6具,身高156～177cm)进行解剖。将每具标本去除胸腔脏器后,暴露肋膈隐窝,按照胸腔镜下经膈胸腰椎前入路手术的径路操作。于膈与脊柱附着线上1～2cm处切开膈,分离腹膜后间隙,暴露膈的内侧弓状韧带、腰大肌,然后分离剔除腰大肌,充分显露上腰椎左侧面及邻近血管、神经等结构。在上腰椎左侧面上,观察膈及评估该手术径路中胸膜返折线(胸膜下界)、腹膜后间隙、内侧弓状韧带及膈脚的应用解剖学特点。测量指标：①胸膜返折线分别与L1动脉、内侧弓状韧带最高点、内脏大神经穿出点之间的距离；②内侧弓状韧带最高点分别与L1动脉、L2动脉、腰交感干穿出点之间的距离(如腰动脉缺如,则测量与腰静脉或椎体中点水平的距离)。3.7统计学处理方法数据以均数±标准差(x±S)表示。选用spss13.0软件进行统计分析。各节段两侧采用配对t检验,男女之间比较采用成组t检验,尸体标本与影像学资料之间分性别进行成组t检验。并采用相关分析对各指标和年龄、身高进行分析。显著性水平α=0.05。4结果4.1在成人尸体标本上可观察脊柱胸腰段侧面,节段动、静脉较为恒定地存在并走行于相应椎体侧面中央浅沟内,动脉有两个主要的分支。上、下位节段动脉间构成了一个相对无血管神经的安全区,椎间盘恰好位于该安全区中部。并且测量了相关数据。各相邻椎间节段动脉安全区在T10／11、T11／12、T12／L1、L1/2、L2/3椎间逐渐增大,男性依次为(23.86±0.69)mm、(26.20±0.46)mm、(29.43±0.57)mm、(32.96±0.32)mm、(34.13±0.37)mm和女性依次为(22.91±0.32)mm、(25.53±0.60)mm、(28.61±0.24)mm、(32.23±0.38)mm、(33.41±0.26)mm。且左右两侧比较无显著性差异(P>0.05),男女之间比较有显著性差异(P<0.05)。身高与各指标呈正相关关系(P<0.05)。4.2在影像三维图像上可观察脊柱胸腰段侧面,节段动脉较为恒定地存在并走行于相应椎体侧面中央浅沟内。上、下位节段动脉间构成了一个相对无血管神经的安全区,椎间隙恰好位于该安全区中部。并且测量了相关数据。各相邻椎间节段动脉安全区在T10／11、T11／12、T12／L1、L1／2、L2／3椎间逐渐增大,男性依次为(23.67±0.28)mm、(26.07±0.21)mm、(29.55±0.32)mm、(32.71±0.74)mm、(34.19±0.16)mm和女性依次为(23.01±0.18)mm、(25.28±0.28)mm、(28.49±0.33)mm、(32.17±0.14)mm、(33.49±0.25)mm。且左右两侧比较无显著性差异(P>0.05),男女之间比较有显著性差异(P<0.05)。身高与各指标呈正相关关系(P<0.05)。4.3经比较尸体标本与影像学三维重建图像上所观察与测量的结果可知：两者脊柱胸腰段侧面的节段血管的具体走行及毗邻关系基本一致。且上、下位节段血管间构成的一个相对无血管神经的安全区,同性别在两标本间比较无显著性差异(P>0.05)。4.4观察了胸腰段脊柱区外围结构的大体解剖,了解了脊柱区的毗邻关系,并测得膈脚长为1 2.30cm,其中间部位宽为1.45cm,厚为1.02cm。进一步明确了前纵韧带、膈脚及腰大肌将胸腰段及腰段脊柱紧密包围的的关系。4.5观察了腔镜下脊柱胸腰结合段的解剖形态。4.6在T12／L1椎间盘处切开壁胸膜,向下一椎体中部分离(19.56±0.58)mm即可暴露第1腰椎节段动脉。左内侧弓状韧带最高点大约位于L1椎体下缘水平,较右侧位置稍高,但低于第1腰椎节段动脉水平(6.24±0.33)mm,距离第2腰椎节段动脉水平(23.35±0.24)mm。内脏大神经多在L1椎体中上份前侧方距离胸膜返折线(26.70±0.31)mm穿出膈。腰交感干于腰椎前外侧、腹主动脉外侧走行于膈脚深面,约在L2椎体中上份高度于膈的中间脚与左脚之间的裂隙穿出。5结论5.1脊柱胸腰段侧面节段动脉所组成的安全区可为胸腔镜下前路手术提供足够的操作空间,并以椎间盘为参考标志,可减少对血管的损伤,并尽可能少阻断节段动脉以确保脊髓血供,降低手术并发症。5.2 CT三维重建图像能有效观察脊柱胸腰结合段侧面节段动脉的走行及毗邻关系,并能准确测量出安全区。5.3尸体标本与CT三维图像对节段动脉所观察与测量结果基本一致,术前可以通过CT三维图像制定个性化手术方案。5.4进一步观察了胸腰结合段外围的大体解剖结构以避免术中损伤相关组织结构的可能。5.5熟悉该区域胸腔镜下解剖特点从而可以避免手术入路中损伤相关组织结构。5.6胸膜返折线、内侧弓状韧带、内脏大神经穿出点可作为经膈进行手术的标志。本研究主要创新点：1.通过对尸体标本研究,在脊柱胸腰段侧面,发现了上、下相邻两节段动脉之间构成了一个相对无血管神经的安全区,椎间盘(隙)位于此安全区的中间部分。证实了进行两节段椎体之间或单节段的手术时,完全可以在此安全区进行操作而不必结扎节段动脉；前路多节段脊柱手术时,也可以尽量减少结扎节段动脉的数量。因此在进行脊柱胸腰结合段手术时,以椎间盘(隙)为解剖标志,在该安全区内操作可减少对血管神经的损伤,降低手术并发症。2.应用影像学手段(造影,三维重建等)对脊柱胸腰段侧面的节段血管加以研究,很好显示了节段动脉的解剖学特点从而为临床提供了节段血管的影像学解剖基础；3.通过对尸体标本解剖结果与影像学解剖结果进行比较研究,得出了影像学研究结果与尸体标本的研究结果基本吻合,证实了影像学研究对节段动脉的显示是准确的,也进一步证实了安全区的存在。因而认为,术前对节段动脉的三维重建图像进行分析可以为手术制定个性化的操作方案。4.对各安全区分别与年龄、身高做了相关分析,发现与身高呈正相关关系,而与年龄则无相关关系。5.由于提供了尸体标本与影像学两方面的具体安全区的解剖参数,因而为临床相关器械的设计提供了解剖学基础与思路。更多还原

【Abstract】 1 BackgroundAccording to home and abroad literature, we know that the anatomy of the thoracolumbar spine, especially that of vessels and nerves was done by scholars little even though no relevant reports. For the limitation or shortcoming of the traditional treatment, a number of technologies emerged, surgical approaches and new ideas began to appear, and were used in clinical, such as interbody fusion from the side, which requires us to study specially the basic anatomy of this area in order to meet clinical.The T11-L2 segments, due to small joints have not been fully from the frontal plane into the sagittal plane, are more vulnerable to be violence damaged by rotation and shear injury. Approximately 60% of thoracolumbar injuries occurred in this particular anatomical area. Therefore, the segment’s diseases and surgery are a greater proportion. At present, the video-assisted thoracoscopic surgical(VATS) treatment of thoracolumbar fractures has been gradually spread at home and abroad, mainly used in the front exposure. The study of thoracoscopy-assisted retroperitoneal approach has been carried out at home and abroad, expected to be applied lateral fusion, anterior decompression. Some peritoneal approach damage easily the front blood vessels. The retroperitoneal approach due to the traditional posterior fusion led to complications such as postoperative pain, it is suggested by scholars that retroperitoneal approach for interbody fusion from the side.However, the special study about the side’s neurovascular of the thoracolumbar spine at home and abroad was very few. In peritoneum approach some great blood vessels are likely to injury, while the retroperitoneal approach because the traditional posterior fusion led to complications such as postoperative pain, is suggested by scholars for interbody fusion from the side. However, we know from existed reports, the relevant segmental vascular injury is one of its major complications, therefore, to do a good job with video-assisted thoracoscopic thoracolumbar spine surgery must be familiar with the anatomical features of segmental vessels.However, the the relevant basic anatomy lags far behind, in order to adapt to the development of endoscopic surgery, the research of vessels and nerves is absolutely necessary. The way is to sum up past experiences and avoid a single mean of study, and using a variety of effective means to conduct a study could be more comprehensive and objective approach to acquire the relevant characteristics. At the same time, combined with previous studies deficiencies of this topic (preliminary studies only studied specimens, their research mean is not enough rich and conclusions should be further elaborated) to do something to add and modify. In view of this, to meet the clinical,this study was specifically done.2 Objectives2.1 To provide an anatomical shape base about the variation,the adjacent relationship and the course of the thoracolumbar spinal side segmental vessels and nerves. To identify the anatomical landmark and measure the distance between two adjacent segmental arteries as the largest safe zone of a surgical operation for video-assisted thoracoscopic thoracolumbar surgery.2.2 To provide the anatomic basis of imaging for the segmental vessels of the thoracolumbar spine side and measure the distance between two adjacent segmental arteries in the three-dimensional images.2.3 To provide the theoretical basis for preoperative using the imaging to develop individualized program. 2.4 To provide the outer anatomic basis of thoracolumbar spine for the video-assisted thoracoscopic surgical approach.2.5 To provide surgical approach and anatomy basis for video-assisted thoracoscopic thoracolumbar surgery.2.6 To provide an anatomical basis and related marks for the video-assisted thoracoscopic thoracolumbar spine surgery through the diaphragm.3 Methods3.128 anticorrosion fixed adult corpse specimens (56 sides,male 14, female 14, height 156-177cm) were chosen for this study. All specimens, provided by the Southern Medical University, Human Anatomy Department, had no local vascular disease, or other pathological changes. Removing the internal organs of thoracic and abdominal cavity of each specimen, then the parietal pleura and parietal peritoneum in the thoracolumbar spine segment; separating and removing diaphragm, psoas major muscle; fully displaying structures such as lateral blood vessels and nerves.Observing the course and the adjacent relationship of segment blood vessels, sympathetic trunk, great splanchnic nerve, aorta, azygos vein, hemiazygos vein.Measuring the distance between the upper and lower segment arteries in the mean line of the lateral thoracolumbar spine.3.2 After conducting angiography for 26(52 sides,13 males and 13 females) cases of normal adults through the ulnar vein, carring out thoracolumbar CT scanning. Before the scanning, inquiring the participant the medical record to exclude the thoracolumbar vertebra and the other related adjacent organization’s illness, ensuring that volunteers in vivo without the metal implants, removing the body surface clothing’s metal decorations, then let the volunteers rest 10 minutes in the peaceful hut to cause their mood to be affable, the breath steady. when scanning the body, keeping static as far as possible. Scanning range:The upper edge including the T3 vertebra upper edge, the lower edge surpassing the L5 vertebra lower edge. The participant taking the supine location.Image post-processing:All volunteers’ primitive image had been inducted the CT image workstation by the BMP form, completed the maximum density projection (MIP), multiplane volume reconstructions (MPVR), volune rendering (VR),image reconstruction, MIP/MPVR/VR the image reconstruction level thick 0.1mm, MPVR/VR reconstruction image using the threshold value colored technology demonstration. In the image observation:The course and adjacent relationship of the segmental vessels, sympathetic trunk, splanchnic nerve, thoracic duct, azygos vein, half-azygos vein and the vertebral body. Measuring range(measurement processing using photoshop software):the distance between the the upper and lower segmental arteries of the middle line of spine side (if absence of segmental vessels, then measuring the distance between the mid-point of the level of vertebral body and another vessel).3.3 Comparing the observeing and surveing results between the corpse specimen and the imaging.3.4 Using two example anticorrosion fixed corpse specimens (male 1, height 173cm, female 1, height 161cm) to conduct layer by layer anatomy in the thoracolumbar spinal and observing the anatomy structure.3.5 Using one case fresh male adult specimen to simulate by paragraph thoracoscopic thoracic surgery and observing the anatomy. Analoging video-assisted thoracoscopic surgical procedures:lateral position, fixing and raising the specimen waist for the convenient of intercostal space openning and the equipment.accessing. Taking the anterior axillary line and the post-axillary line as a symbol, in the post-axillary line of the 8th,9th intercostal space, inserting the camera lens (light source), in the anterior axillary line 7th,8th, 5th,6th,.3rd,4th intercostal space inserting retractors, the working channel and the flushing operation of equipment such as suction tube so that more fully observing the spine side by making adjustments according to needing. Inserting 30°angle camera lens to observe the situation of the chest cavity, and inserting other 2-3 pipelines under the surveillance. When the lung collapse, affecting the spine observed, with a pull-hook fend off the lung, and by adjusting the inclination of operating table to strengthen the thoracolumbar spine observation. 3.6 Dissecting 12 adult fixed anticorrosion spcimens(male 6, female 6, height 156-177cm). After removing each specimen thoracic organ and exposing the costophrenic recess, simulating video-assisted thoracoscopic thoracolumbar spine anterior approach through the diaphragm to operate. Separating diaphragm at 1-2cm line from spine. Separating retroperitoneal space, exposing the medial arcuate ligament diaphragm, psoas major muscle, then removing psoas major muscle, fully revealing the left side of the lumbar spine and the surrounding blood vessels, nerves and other structures. In left surface of the upper lumbar, observing the anatomy significance of the surgical approach in the pleura back polyline (pleura lower bound), retroperitoneal space, the medial arcuate ligament and the crura diaphragmatis.measuring range:①The distance between pleural arteries back broken line and L1, the highest point of the medial arcuate ligament, visceral nerve piercing points, respectively;②The distance between the highest point of the medial arcuate ligament and L1 artery, L2 artery, lumbar sympathetic trunk piercing point (if the absence of lumbar arteries, measuring the distance between the lumbar vein or vertebral body and the the mid-point), respectively.3.7 Statisticalmethods Comparisons of means were performed using paired sample t-tests fot two sides, and the independent sample T-test in terms of gender and between the specimen and image. Conducting the correlation analysis between age, height and the each indicator. Statistics were performed using the SPSS for Windows software package (version 13.0, SPSS Inc., Chicago,Ill.) and probabilities of two sided P less than 0.05 were regarded as statistical significance.4 Results4.1 We could observe the side of the thoracolumbar spine on the adult corpse specimens, segmental arteries and veins exist and run in the central supersulcus of the corresponding vertebral body’s side. An segmental artery has two main branches. That between the upper and lower segmental vessels consists a relatively non-vascular nerve safe zone where the intervertebral disc locates. And we surveyed the related datas. The distance between adjacent segmental arteries in the T10/11,T11/12,T12/L1,L1/2,L2/3 is, male:(23.86±0.69) mm, (26.20±0.46) mm, (29.43±0.57)mm,(32.96±0.32)mm,(34.13±0.37)mm and female:(22.91±0.32) mm,(25.53±0.60)mm,(28.61±0.24)mm,(32.23±0.38)mm, (33.41±0.26)mm respectively.4.2 We could observe the course and the adjacent relationship of thoracolumbar spine lateral vascular. That between the upper and lower segmental vessels consists a relatively non-vascular nerve safe zone where the intervertebral space locates. And we surveyed the related datas. The distance between adjacent segmental arteries in the T10/11,T11/12,T12/L1,L1/2,L2/3 is,male:(23.67±0.28)mm, (26.07±0.21)mm,(29.55±0.32)mm,(32.71±0.74)mm,(34.19±0.16)mm and female: (23.01±0.18)mm,(25.28±0.28)mm,(28.49±0.33)mm,(32.17±0.14)mm,(33.49±0.2 5)mm respectively.4.3 By the comparison of the observation and measurement results between specimens and images we can see:the course and adjacent relationship of the thoracolumbar segmental vessels are consistent. There is a relatively non-vascular nerve safe zone between the upper and lower segmental vessels. The difference was not statistically significant (P>0.05)4.4 We observed the anatomical structure of the dorsal spine and the abdominal side and understood the spinal column area adjacent relationship. And measured the length of crura diaphragmatis be 12.30cm, width 1.45cm, thickness 1.02cm. Further defined thoracolumbar spine surrounded by the anterior longitudinal ligament, crura diaphragmatis, greater psoas muscle.4.5 We observed that the video-assisted thoracoscopic spinal thoracolumbar anatomy.4.6 L1 artery locates in the middle of L1 vertebral.Incision the wall pleura at the T12/L1 disc.，down to the middle of vertebral body separating (19.56±0.58) mm can expose L1 artery. The highest point of the left medial arcuate ligament locates in the lower edge of the L1 vertebral level, slightly higher than the right position, but lower than the level of L1 artery about (6.24±0.33) mm, the distance from L2 artery is approximately (23.35±0.24) mm. Greater splanchnic nerve in the anterior-lateral of Li from pleural back broken line about (26.70±0.31) mm piercing diaphragm.Lumbar sympathetic trunk travels at the deep surface of the crura diaphragmatis in the lumbar lateral, lateral abdominal aorta.5 conclusions5.1 Safe zone can provide sufficient space for anterior thoracoscopic surgery, and taking the disc as a reference mark can reduce the damage of blood vessels, besides blocking blood vessels as little as possible can ensure that the spinal cord segmental arterial blood supply and reduce complications.5.2 Three-dimensional reconstruction of CT images can effectively observe the course and adjacent relationship of the thoracolumbar spinal lateral segmental artery, and can accurately measure the safe zone.5.3 The segmental arteries results of the observation and measurement are consistent between specimens and CT three-dimensional images, so in the preoperative, CT three-dimensional image can be used as the plan for operation.5.4 Familiar with the general anatomy can avoid injuring related organizational structure.5.5 Familiar with the microscopic anatomy of thoracoscopic can avoid injuring related organizational structure.5.6 Pleural back broken line, medial arcuate ligament, visceral nerve piercing point can be marked as the surgery.The principal innovation of this study1. Through the study of the specimens in the thoracolumbar spine side, we found between the two adjacent segmental arteries form a relatively safe zone without vessels and nerves, intervertebral discs (gap) locate in the middle part of this safe zone. If carry out between the two vertebral segments or a single operation, we can operate in this safe zone without the ligation of segmental arteries. When multi-segmental anterior spinal surgery, we can also minimize the number of ligation of segmental arteries. Therefore, taking the disc (gap) as anatomical landmark can reduce the damage to the vessels and nerves and reduce complications.2. Using the imaging methods (imaging, three-dimensional reconstruction, etc.) to study the side segmental vessels of the thoracolumbar can show the anatomical features of segmental arteries and thus provides a segmental vascular anatomy base of imaging.3. Through a comparative study of the results of cadaver dissection and imaging anatomy, imaging results obtained in full compliance with the findings of specimens, and further imaging studies obtained segmental arteries display is accurate.We conclude that, preoperative the three-dimensional reconstruction of segmental arteries can be personalized for the surgical operation to develop the program.4. After relatively analysing of height，age and each item,we find that there is relative relationship between the height and each item,but there is no relative relationship between the age and each item.5. By providing the safe zone specific anatomic parameters of specimens and imaging, it provides the anatomical basis for the design and ideas of clinically relevant equipment.更多还原