頸段脊神經(jīng)的解剖及臨床應(yīng)用研究
發(fā)布時(shí)間：2018-10-22 18:31
【摘要】：目的：通過在顯微鏡下對(duì)10例男性尸體頸部標(biāo)本進(jìn)行解剖,對(duì)頸段脊髓后根所含的各級(jí)神經(jīng)束組成進(jìn)行統(tǒng)計(jì)描述,對(duì)頸段各節(jié)段脊髓后根的粗細(xì)進(jìn)行測(cè)量并比較,并通過解剖頸椎間孔與椎間孔處脊神經(jīng)根的關(guān)系,為臨床處理該區(qū)域的手術(shù)治療提供解剖學(xué)依據(jù)和參考�？偨Y(jié)高頸段椎管內(nèi)腫瘤的臨床表現(xiàn)、影像學(xué)特點(diǎn)、病理診斷及預(yù)后,評(píng)價(jià)高頸段椎管內(nèi)腫瘤顯微手術(shù)治療效果。 方法：應(yīng)用經(jīng)防腐的尸體頸部標(biāo)本10例,分離肌肉,暴露頸椎椎板,切除C3-T1的棘突、椎板、黃韌帶和椎間關(guān)節(jié),暴露硬脊膜和脊神經(jīng)根。切開硬脊膜,用游標(biāo)卡尺(精確度0.02mm)、直尺(精確度1mm),對(duì)10例(20側(cè))C3-T1各節(jié)段頸段脊神經(jīng)后根的自然分束進(jìn)行顯微外科解剖學(xué)觀察；對(duì)C3-T1節(jié)段的脊神經(jīng)后根的粗細(xì)進(jìn)行測(cè)量并比較；通過測(cè)量椎間孔及其相對(duì)應(yīng)的椎間孔處脊神經(jīng)根的前后徑和上下徑,分析椎間孔及其相對(duì)應(yīng)的椎間孔處脊神經(jīng)根的關(guān)系。分析武漢大學(xué)中南醫(yī)院2010年1月至2012年1月收治的18例高頸段椎管內(nèi)腫瘤患者的臨床資料,結(jié)合文獻(xiàn)復(fù)習(xí),進(jìn)行回顧性研究。 結(jié)果：頸部各節(jié)段脊神經(jīng)后根所含神經(jīng)小束、神經(jīng)亞束、神經(jīng)束的數(shù)目基本一致,但C6后根所含神經(jīng)小束、神經(jīng)亞束較其他后根略多,且各級(jí)神經(jīng)束也較其他后根粗大,C6脊神經(jīng)后根也最為粗大；頸椎間孔矢狀面呈橢圓形或卵圓形；頸段脊神經(jīng)根與相應(yīng)椎間孔的前后徑和上下徑比值,下頸段(C5-C7)較上頸段(C3～C4)比值大。臨床分析18例高頸段椎管內(nèi)腫瘤患者,臨床癥狀主要表現(xiàn)為肢體無力和(或)麻木者13例,枕頸部疼痛7例,根性疼痛10例,四肢不同程度癱瘓6例,肌肉萎縮5例,呼吸困難1例,排尿障礙3例,后組顱神經(jīng)受累1例。平均病程21±8.7個(gè)月；術(shù)后病理大部分為神經(jīng)鞘瘤(8例),其次為脊膜瘤(3例)、星形細(xì)胞瘤(2例),室管膜瘤及血管母細(xì)胞瘤(各I例),硬膜外脂肪血管瘤(1例)。經(jīng)過平均(12.3±1.5)個(gè)月的隨訪,手術(shù)治療后患者臨床癥狀和體征較術(shù)前顯著改善。 結(jié)論：頸C6脊神經(jīng)后根手術(shù)中最容易受損,為頸髓最為重要的節(jié)段；脊神經(jīng)根受壓癥狀與脊神經(jīng)根本身的粗細(xì)和椎間孔相對(duì)大小以及管內(nèi)的軟組織受損有關(guān),下頸段(C5～C7)病變較上頸段(C3～C4)病變癥狀發(fā)生較早及較重。高位頸椎管內(nèi)腫瘤多為良性,但早期癥狀不典型,易于誤診,MRJ是高頸段椎管內(nèi)腫瘤診斷的首先影像學(xué)檢查,高頸段椎管內(nèi)腫瘤手術(shù)風(fēng)險(xiǎn)高,顯微手術(shù)治療高頸段椎管內(nèi)腫瘤技術(shù)日益完善,全切率提高,顯微手術(shù)及術(shù)中電生理監(jiān)測(cè)能夠保護(hù)脊髓及重要神經(jīng)血管結(jié)構(gòu)。
[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 鹵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 鹵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.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.42
本文編號(hào)：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 鹵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 鹵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.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.42
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 ;Radical microsurgical treatment of intramedullary spinal cord tumors[J];Chinese Medical Journal;2006年16期
2 徐朋,徐達(dá)傳;腰骶部脊神經(jīng)后根的顯微外科解剖學(xué)研究[J];中國(guó)臨床解剖學(xué)雜志;1997年04期
，本文編號(hào)：2287972
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