产瘫与成人臂丛损伤发生机制差异的解剖学研究  

Applied anatomy of the different mechanism that the brachial plexus are injuried in newborn and adult cases

作　　者：黄轶刚[1] 陈亮[1] 顾玉东[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040

出　　处：《中华手外科杂志》2005年第2期75-78,共4页Chinese Journal of Hand Surgery

基　　金：国家973重点基础研究发展计划资助项目(2003CB515305)

摘　　要：目的研究产瘫较成人臂丛损伤更容易出现C7神经根撕脱的解剖学基础,以进一步了解产瘫的特殊性。方法1.解剖新生儿与成人尸体各6具( 12侧) ,观察并比较新生儿与成人C5～T1神经根在椎管内外的形态特点。具体指标为神经根分出角、前支分出角、前根长度、前根发出区长度、前根根丝数目。2 .解剖新鲜新生儿尸体6具( 12侧) ,采用HE染色及Mallory三色染色观察臂丛诸根与周围组织的关系并比较不同神经根之间的差异。结果新生儿C7神经根分出角小于其前支分出角,成人C7神经根分出角大于其前支分出角,其余指标未见显著性差异。新生儿C5 7神经根在椎间孔处的主要保护性结构为上半椎韧带,但C7神经根上半椎韧带内胶原纤维面积比小于C5、6神经根,且差异有统计学意义(P <0 .0 5 )。此外,在C5、6上半椎韧带与横突附着处常可见Sharpey纤维而C7上半椎韧带内几乎见不到Sharpey纤维。结论新生儿C7神经根在椎管内外走行方向的特点及其上半椎韧带较薄弱,可能是造成产瘫患儿C7常表现为根性撕脱的重要原因。Objective In order to identify the mechanism that the C_7 nerve root is more prone to avulsion in obstetric brachial plexus palsy (OBPP) comparing to that in adult brachial plexus injury, the anatomical features of brachial plexus nerve roots were investigated. Methods 1.6 newborn (12 sides) and 6 adult (12 sides) cadavers were dissected to observe the intravertebral and extravertebral morphological features of the C_5-T_1 nerve roots, which form the brachial plexus. The following data were recorded: the cranial angle of nerve roots with cords, the cranial angle of the anterior rami with cords, the length of the ventral root emerging zone, the length of the ventral roots, and the number of ventral rootlets. 2. In 6 fresh newborn cadavers, the C_5-T_1 nerve roots were histologically analyzed using hematoxylin eosin and Mallory trichrome staining to observe the connection between nerve roots and their surrounding tissue. Results 1. In newborns, the nerve roots emerged at a relatively more horizontal angle when compared with adults. Therefore, the cranial angle of C_7 nerve roots with cords in newborns were smaller than that of their anterior rami, whereas the trend was reverse in adults. 2. In newborns, the primary protective attachment of C_5-C_7 nerve roots was the transverse-radicular ligaments, which are composed of collagen fibers. The collagen composition of this ligament around C_7 nerve roots, however, was smaller than that of the ligament around C_5 and C_6 nerve roots. The difference was statistically significant (P<0.05). Furthermore, the transverse-radicular ligaments of the C_5 and C_6 nerve roots were reinforced by Sharpey fibers at its insertion to the transverse process. Sharpey fibers were hardly seen at the ligament around the C_7 nerve root. Conclusion The higher incidence of C_7 avulsion injury in OBPP may be attributed to the gross anatomic features and relatively weak transverse-radicular ligaments in newborns.

关 键 词：臂丛损伤 解剖学研究 产瘫 发生机制 C7神经根 椎管内外 新生儿 解剖学基础 神经根撕脱 显著性差异 成人尸体 形态特点 周围组织 染色观察 HE染色 胶原纤维 韧带 半椎 特殊性 C5 前根 保护性 椎间孔 统计学 指标 长度 

分 类 号：R726.5[医药卫生—儿科] R651.3[医药卫生—临床医学]