健侧C7神经经椎体后通路移位治疗臂丛神经根性撕脱伤的解剖学研究

发布时间：2018-07-26 14:25

【摘要】：目的:通过解剖学研究观察椎体后通路的相关结构，探讨健侧C7神经经椎体后通路移位治疗对侧臂丛神经根性撕脱伤的可行性。材料与方法:选取10具经福尔马林固定的尸体标本，其中男7具，女3具，标本均无明显畸形，组织无缺损，颈部中立位。模拟臂丛神经损伤手术探查术式，将C7神经根的前后股向远端行干支分离使其长度增加后再切断，同时测量C7神经根自椎间孔发出至分股处的长度及其前后股的长度；模拟颈椎后路手术入路，充分暴露C6颈椎及C7棘突，并于其间靠近椎体侧钻孔，测量经椎体后通路到达对侧上干与下干所需长度。结果: 1.与椎体后通路相关的解剖结构 C7为颈椎和胸椎的交界区，，生理曲度由颈曲向胸曲过度，其走行在矢状面上为向后下方走行，其与胸椎之间有8~10°夹角，C7横突前结节很小或缺如，对C7神经转向后方无卡压且一定程度上能减小神经绕行距离；颈椎与胸椎连接处的椎间盘较厚，棘突间隙宽1.8~2.6cm，远远超过C7神经根的直径，C7神经易于通过；颈椎侧屈，前屈后伸活动对神经无卡压，且颈椎棘突对神经通道有保护作用，所以颈部活动对患者术后恢复所造成的影响很小。 2.C7神经相关测量结果 1) C7神经长度为（58.62±8.70）mm，加后股长度为（65.15±9.11）mm,加前股长度为（70.03±10.79）mm。经椎体后通路C7神经根至对侧臂丛上干距离为（72.12±10.22）mm，至对侧臂丛下干距离为（95.21±12.50）mm。 2) C7神经横径测量结果，C7神经根部的横径（4.93±1.25）mm、纵径（4.26±1.05）mm；C7神经干股结合部的横径（4.61±0.75）mm，纵径（4.03±0.71）mm。结论:健侧C7神经可以经椎体后入路移位至对侧，仅需一小段桥接神经，该通路能有效避免经椎体前路损伤血管、神经和前路手术后带来的并发症，可能成为治疗臂丛神经根性撕脱伤手术另一可选择入路。
[Abstract]:Objective: to observe the related structure of posterior pathway of vertebral body and explore the feasibility of contralateral C7 nerve transposition in treating contralateral brachial plexus nerve root avulsion by anatomical study. Materials and methods: ten formalin fixed cadavers were selected, including 7 males and 3 females. There were no obvious deformities, no tissue defects and neutral cervical position. To simulate the exploration of brachial plexus injury, the length of C7 nerve root from intervertebral foramen to femoral branch and the length of anterior and posterior femoris were measured by separating the anterior and posterior strands of C7 nerve root to the distal end of the nerve root and then cutting off the C7 nerve root from the intervertebral foramen to the femoral branch. The C6 cervical spine and C7 spinous process were fully exposed and drilled near the vertebral body side to measure the length required to reach the contralateral superior trunk and lower trunk via the posterior pathway of the vertebrae. Results: 1. The anatomical structure C7 associated with the posterior pathway of the vertebral body is the junction of the cervical vertebrae and the thoracic vertebrae. The physiological curvature of C7 is excessive from the cervical curvature to the thoracic curvature, and its path is backward and lower on the sagittal plane. The anterior tubercle of the transverse process of C7 is very small or absent from the thoracic vertebrae with an angle of 8 掳10 掳. There is no compression on the posterior part of the C7 nerve and to a certain extent it can reduce the distance of nerve detour, and the intervertebral disc at the junction of the cervical vertebra and the thoracic vertebra is thicker. The width of spinous process space was 1.8 ~ 2.6cm, which was much larger than the diameter of C7 nerve root and C7 nerve was easy to pass through, the lateral flexion, flexion and extension of cervical vertebrae had no compression on the nerve, and the spinous process of cervical spine had protective effect on the nerve channel. The results of 2.C7 nerve correlation measurement showed that the length of C7 nerve was (58.62 卤8.70) mm, the length of posterior femur was (65.15 卤9.11) mm, and the length of anterior femur was (70.03 卤10.79) mm. The distance between the C7 nerve root and the contralateral brachial plexus was (72.12 卤10.22) mm, (95.21 卤12.50) mm 路2) the transverse diameter of the C7 nerve root was (4.93 卤1.25) mm, the longitudinal diameter was (4.26 卤1.05) mm, the longitudinal diameter was (4.61 卤0.75) mm, the longitudinal diameter was (4.03 卤0.71) mm. Conclusion: the contralateral C7 nerve can be transferred to the opposite side via the posterior approach of the vertebral body, only a small segment of the bridging nerve is needed. This pathway can effectively avoid the complications caused by the injury of the blood vessel, nerve and the anterior approach. It may be an alternative approach for the treatment of brachial plexus root avulsion.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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