【摘要】：目的:通過解剖學研究觀察椎體后通路的相關(guān)結(jié)構(gòu)，探討健側(cè)C7神經(jīng)經(jīng)椎體后通路移位治療對側(cè)臂叢神經(jīng)根性撕脫傷的可行性。 材料與方法:選取10具經(jīng)福爾馬林固定的尸體標本，其中男7具，女3具，標本均無明顯畸形，組織無缺損，頸部中立位。模擬臂叢神經(jīng)損傷手術(shù)探查術(shù)式，將C7神經(jīng)根的前后股向遠端行干支分離使其長度增加后再切斷，同時測量C7神經(jīng)根自椎間孔發(fā)出至分股處的長度及其前后股的長度；模擬頸椎后路手術(shù)入路，充分暴露C6頸椎及C7棘突，并于其間靠近椎體側(cè)鉆孔，測量經(jīng)椎體后通路到達對側(cè)上干與下干所需長度。 結(jié)果: 1.與椎體后通路相關(guān)的解剖結(jié)構(gòu) C7為頸椎和胸椎的交界區(qū)，，生理曲度由頸曲向胸曲過度，其走行在矢狀面上為向后下方走行，其與胸椎之間有8~10°夾角，C7橫突前結(jié)節(jié)很小或缺如，對C7神經(jīng)轉(zhuǎn)向后方無卡壓且一定程度上能減小神經(jīng)繞行距離；頸椎與胸椎連接處的椎間盤較厚，棘突間隙寬1.8~2.6cm，遠遠超過C7神經(jīng)根的直徑，C7神經(jīng)易于通過；頸椎側(cè)屈，前屈后伸活動對神經(jīng)無卡壓，且頸椎棘突對神經(jīng)通道有保護作用，所以頸部活動對患者術(shù)后恢復所造成的影響很小。 2.C7神經(jīng)相關(guān)測量結(jié)果 1) C7神經(jīng)長度為（58.62±8.70）mm，加后股長度為（65.15±9.11）mm,加前股長度為（70.03±10.79）mm。經(jīng)椎體后通路C7神經(jīng)根至對側(cè)臂叢上干距離為（72.12±10.22）mm，至對側(cè)臂叢下干距離為（95.21±12.50）mm。 2) C7神經(jīng)橫徑測量結(jié)果，C7神經(jīng)根部的橫徑（4.93±1.25）mm、縱徑（4.26±1.05）mm；C7神經(jīng)干股結(jié)合部的橫徑（4.61±0.75）mm，縱徑（4.03±0.71）mm。 結(jié)論:健側(cè)C7神經(jīng)可以經(jīng)椎體后入路移位至對側(cè)，僅需一小段橋接神經(jīng)，該通路能有效避免經(jīng)椎體前路損傷血管、神經(jīng)和前路手術(shù)后帶來的并發(fā)癥，可能成為治療臂叢神經(jīng)根性撕脫傷手術(shù)另一可選擇入路。
[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 擄10 擄. 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 鹵8.70) mm, the length of posterior femur was (65.15 鹵9.11) mm, and the length of anterior femur was (70.03 鹵10.79) mm. The distance between the C7 nerve root and the contralateral brachial plexus was (72.12 鹵10.22) mm, (95.21 鹵12.50) mm 路2) the transverse diameter of the C7 nerve root was (4.93 鹵1.25) mm, the longitudinal diameter was (4.26 鹵1.05) mm, the longitudinal diameter was (4.61 鹵0.75) mm, the longitudinal diameter was (4.03 鹵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.
【學位授予單位】：南華大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R322

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