颈段脊神经的解剖及临床应用研究
发布时间：2018-10-22 18:31
【摘要】：目的：通过在显微镜下对10例男性尸体颈部标本进行解剖,对颈段脊髓后根所含的各级神经束组成进行统计描述,对颈段各节段脊髓后根的粗细进行测量并比较,并通过解剖颈椎间孔与椎间孔处脊神经根的关系,为临床处理该区域的手术治疗提供解剖学依据和参考。总结高颈段椎管内肿瘤的临床表现、影像学特点、病理诊断及预后,评价高颈段椎管内肿瘤显微手术治疗效果。 方法：应用经防腐的尸体颈部标本10例,分离肌肉,暴露颈椎椎板,切除C3-T1的棘突、椎板、黄韧带和椎间关节,暴露硬脊膜和脊神经根。切开硬脊膜,用游标卡尺(精确度0.02mm)、直尺(精确度1mm),对10例(20侧)C3-T1各节段颈段脊神经后根的自然分束进行显微外科解剖学观察；对C3-T1节段的脊神经后根的粗细进行测量并比较；通过测量椎间孔及其相对应的椎间孔处脊神经根的前后径和上下径,分析椎间孔及其相对应的椎间孔处脊神经根的关系。分析武汉大学中南医院2010年1月至2012年1月收治的18例高颈段椎管内肿瘤患者的临床资料,结合文献复习,进行回顾性研究。 结果：颈部各节段脊神经后根所含神经小束、神经亚束、神经束的数目基本一致,但C6后根所含神经小束、神经亚束较其他后根略多,且各级神经束也较其他后根粗大,C6脊神经后根也最为粗大；颈椎间孔矢状面呈椭圆形或卵圆形；颈段脊神经根与相应椎间孔的前后径和上下径比值,下颈段(C5-C7)较上颈段(C3～C4)比值大。临床分析18例高颈段椎管内肿瘤患者,临床症状主要表现为肢体无力和(或)麻木者13例,枕颈部疼痛7例,根性疼痛10例,四肢不同程度瘫痪6例,肌肉萎缩5例,呼吸困难1例,排尿障碍3例,后组颅神经受累1例。平均病程21±8.7个月；术后病理大部分为神经鞘瘤(8例),其次为脊膜瘤(3例)、星形细胞瘤(2例),室管膜瘤及血管母细胞瘤(各I例),硬膜外脂肪血管瘤(1例)。经过平均(12.3±1.5)个月的随访,手术治疗后患者临床症状和体征较术前显著改善。 结论：颈C6脊神经后根手术中最容易受损,为颈髓最为重要的节段；脊神经根受压症状与脊神经根本身的粗细和椎间孔相对大小以及管内的软组织受损有关,下颈段(C5～C7)病变较上颈段(C3～C4)病变症状发生较早及较重。高位颈椎管内肿瘤多为良性,但早期症状不典型,易于误诊,MRJ是高颈段椎管内肿瘤诊断的首先影像学检查,高颈段椎管内肿瘤手术风险高,显微手术治疗高颈段椎管内肿瘤技术日益完善,全切率提高,显微手术及术中电生理监测能够保护脊髓及重要神经血管结构。
[Abstract]:Objective: by dissecting the cervical specimens of 10 male cadaveric cadavers under microscope, the composition of the nerve bundles in the posterior root of the cervical spinal cord was statistically described, and the thickness of the posterior roots of the cervical spinal cord was measured and compared. The relationship between the intervertebral foramen and the spinal nerve root at the intervertebral foramen was dissected to provide anatomic basis and reference for the surgical treatment of the region. To summarize the clinical manifestations, imaging features, pathological diagnosis and prognosis of tumors in the high cervical spinal canal, and to evaluate the effect of microsurgical treatment of tumors in the high cervical spinal canal. Methods: 10 cadaveric specimens were used to separate the muscles, expose the cervical lamina, remove the spinous process, lamina, ligaments flavum and intervertebral joint of C3-T1, and expose the dura mater and spinal nerve root. With Vernier caliper (0.02mm) and Vernier caliper (1mm), 10 cases (20 sides) of the posterior root of cervical spinal nerve of C3-T1 were observed by microsurgical anatomy, the thickness of posterior root of spinal nerve in C3-T1 segment was measured and compared, and 10 cases (20 sides) of C3-T1 were treated with Vernier caliper (0.02mm) and Vernier caliper (1mm). The relationship between intervertebral foramen and its corresponding spinal roots was analyzed by measuring the anteroposterior and inferior diameters of the intervertebral foramina and the corresponding spinal roots of the intervertebral foramen. To analyze the clinical data of 18 patients with high cervical spinal canal tumor treated in Central and Southern Hospital of Wuhan University from January 2010 to January 2012. Results: the number of nerve bundles, nerve subtracts and nerve bundles in the posterior roots of the cervical spinal nerves were basically the same, but the number of nerve bundles in the C6 posterior roots was slightly more than that in the other posterior roots. The posterior root of C6 spinal nerve is also the thickest, the sagittal plane of intervertebral foramen is oval or oval, the ratio of anterior diameter and inferior diameter of cervical spinal nerve root to corresponding intervertebral foramen is higher than that of other posterior roots. The ratio of lower cervical segment (C5-C7) to upper cervical segment (C3~C4) was higher. The clinical manifestations of 18 patients with high cervical spinal canal tumors were as follows: 13 cases of limb weakness and / or numbness, 7 cases of occipitocervical pain, 10 cases of root pain, 6 cases of quadriplegia and 5 cases of muscular atrophy. Dyspnea in 1 case, dysuria in 3 cases, cranial nerve involvement in the posterior group in 1 case. The mean course of disease was 21 卤8.7 months, and most of them were neurilemmoma (8 cases), followed by meningioma (3 cases), astrocytoma (2 cases), ependymoma and hemangioblastoma (1 case), epidural adipose hemangioma (1 case). After an average follow-up of (12.3 卤1.5) months, the clinical symptoms and signs were significantly improved after surgical treatment. Conclusion: the cervical C6 posterior root is the most easily damaged and the most important segment of the cervical spinal cord, and the compression symptoms of the spinal nerve root are related to the thickness of the root itself, the relative size of the intervertebral foramen and the damage of soft tissue in the canal. The lesion of lower cervical segment (C5~C7) was earlier and more severe than that of upper cervical segment (C3~C4). Most of the tumors in the high cervical canal are benign, but the early symptoms are not typical and easy to be misdiagnosed. MRJ is the first imaging examination for the diagnosis of tumors in the high cervical spinal canal, and the surgical risk of the tumors in the high cervical spinal canal is high. The technique of microsurgery for the treatment of high cervical spinal canal tumors has been improved day by day. The microsurgery and intraoperative electrophysiological monitoring can protect the spinal cord and important neurovascular structures.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R739.42
本文编号：2287972
[Abstract]:Objective: by dissecting the cervical specimens of 10 male cadaveric cadavers under microscope, the composition of the nerve bundles in the posterior root of the cervical spinal cord was statistically described, and the thickness of the posterior roots of the cervical spinal cord was measured and compared. The relationship between the intervertebral foramen and the spinal nerve root at the intervertebral foramen was dissected to provide anatomic basis and reference for the surgical treatment of the region. To summarize the clinical manifestations, imaging features, pathological diagnosis and prognosis of tumors in the high cervical spinal canal, and to evaluate the effect of microsurgical treatment of tumors in the high cervical spinal canal. Methods: 10 cadaveric specimens were used to separate the muscles, expose the cervical lamina, remove the spinous process, lamina, ligaments flavum and intervertebral joint of C3-T1, and expose the dura mater and spinal nerve root. With Vernier caliper (0.02mm) and Vernier caliper (1mm), 10 cases (20 sides) of the posterior root of cervical spinal nerve of C3-T1 were observed by microsurgical anatomy, the thickness of posterior root of spinal nerve in C3-T1 segment was measured and compared, and 10 cases (20 sides) of C3-T1 were treated with Vernier caliper (0.02mm) and Vernier caliper (1mm). The relationship between intervertebral foramen and its corresponding spinal roots was analyzed by measuring the anteroposterior and inferior diameters of the intervertebral foramina and the corresponding spinal roots of the intervertebral foramen. To analyze the clinical data of 18 patients with high cervical spinal canal tumor treated in Central and Southern Hospital of Wuhan University from January 2010 to January 2012. Results: the number of nerve bundles, nerve subtracts and nerve bundles in the posterior roots of the cervical spinal nerves were basically the same, but the number of nerve bundles in the C6 posterior roots was slightly more than that in the other posterior roots. The posterior root of C6 spinal nerve is also the thickest, the sagittal plane of intervertebral foramen is oval or oval, the ratio of anterior diameter and inferior diameter of cervical spinal nerve root to corresponding intervertebral foramen is higher than that of other posterior roots. The ratio of lower cervical segment (C5-C7) to upper cervical segment (C3~C4) was higher. The clinical manifestations of 18 patients with high cervical spinal canal tumors were as follows: 13 cases of limb weakness and / or numbness, 7 cases of occipitocervical pain, 10 cases of root pain, 6 cases of quadriplegia and 5 cases of muscular atrophy. Dyspnea in 1 case, dysuria in 3 cases, cranial nerve involvement in the posterior group in 1 case. The mean course of disease was 21 卤8.7 months, and most of them were neurilemmoma (8 cases), followed by meningioma (3 cases), astrocytoma (2 cases), ependymoma and hemangioblastoma (1 case), epidural adipose hemangioma (1 case). After an average follow-up of (12.3 卤1.5) months, the clinical symptoms and signs were significantly improved after surgical treatment. Conclusion: the cervical C6 posterior root is the most easily damaged and the most important segment of the cervical spinal cord, and the compression symptoms of the spinal nerve root are related to the thickness of the root itself, the relative size of the intervertebral foramen and the damage of soft tissue in the canal. The lesion of lower cervical segment (C5~C7) was earlier and more severe than that of upper cervical segment (C3~C4). Most of the tumors in the high cervical canal are benign, but the early symptoms are not typical and easy to be misdiagnosed. MRJ is the first imaging examination for the diagnosis of tumors in the high cervical spinal canal, and the surgical risk of the tumors in the high cervical spinal canal is high. The technique of microsurgery for the treatment of high cervical spinal canal tumors has been improved day by day. The microsurgery and intraoperative electrophysiological monitoring can protect the spinal cord and important neurovascular structures.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R739.42
【参考文献】
相关期刊论文 前2条
1 ;Radical microsurgical treatment of intramedullary spinal cord tumors[J];Chinese Medical Journal;2006年16期
2 徐朋,徐达传;腰骶部脊神经后根的显微外科解剖学研究[J];中国临床解剖学杂志;1997年04期
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