改良高选择性脊神经后根部分切断术中前后根神经分束的应用解剖(英文)  

Applied anatomy of anterior and dorsal root nerve tracts in the improved high selective dorsal rhizotomy

作　　者：梅晰凡[1] 王伟[1] 秦书俭[2] 张平[2] 

机构地区：[1]锦州医学院附属第一医院骨科,辽宁省锦州市121001 [2]锦州医学院解剖教研室,辽宁省锦州市121001

出　　处：《中国临床康复》2005年第29期178-180,共3页Chinese Journal of Clinical Rehabilitation

基　　金：辽宁省博士启动基金(971083)~~

摘　　要：背景:高选择性脊神经后根部分切断术中前后根的神经分束应达到神经小束水平,分束越多越利于电刺激选择,利于准确地切断阈值低的引起痉挛的Ia类神经纤维,也越可能最大限度地保留后根中的感觉神经纤维。目的:根据限制性和高选择性脊神经后根切断术的要求,对脊神经前后根进行显微解剖,确定神经小束的分束标准和数目,为临床手术提供可靠的依据和新的手术标准。设计:以成人尸体标本为观察对象,单一样本实验。单位:锦州医学院附属第一医院骨科和锦州医学院解剖教研室。对象:实验于1999-12在锦州医学院解剖学实验室进行。以志愿捐献的15具成人尸体标本为观察对象,男11具,女4具,生前均签署志愿捐献书。方法:①在15具(30侧)成人脊柱标本上,对L1～S2节段的脊神经前后根进行形态学观察和显微测量。②取新鲜尸体的L5脊神经前后根进行免疫组化染色,将脊神经后根起始部、中间部和椎间孔外部3个部位切片,分别测定神经纤维总数、引起痉挛的Ia类神经纤维的数目及其占神经纤维总数的百分率,比较3个部位Ia类神经纤维的分布规律和数量。主要观察指标:①脊神经根神经分束情况及神经小束的直径。②脊神经后根起始部、中间部和椎间孔外部计数100μm2神经纤维总数及Ia类神经纤维占神经纤维总数的百分率。结果:①脊髓圆锥部脊神经根是由根丝逐步汇合而成。应用显微外科技术,后根一般可分为10～18小束,前根一般分为6～11小束,其小束的直径是基本一样,数值较为恒定。②脊神经后根起始部、中间部和椎间孔外部计数100μm2总的神经纤维数为(3243±143)根,Ia类神经纤维为(1702±85)根,占总神经纤维数的52.5%。Ia类神经纤维在后根内呈均匀分布,没有集中分布区。结论:改良脊神经后根部分切断术的最大特点即脊神经前后根的分束标准应尽量细,这样有利BACKGROUND： Anterior and dorsal root nerve tracts should be separated to small tracts in high selective dorsal rhizomy, because detailed tract separation will benefit eleetrostimulation, thereby, helping correctly cutting the lower-threshold la nerve fibers thai cause convulsion, and meanwhile sensory nerve fibers in dorsal nerve root can be reserved as many as possible. OBJECTIVE： To meet the needs of limited and high selective spinal dorsal rhizotomy, anterior and dorsal root of spinal nerve were microanatomized to be certain of the separatio, standard and the number of small nerve tracts, so as to provide reliable basis and nnvel operative standard for clinical operation. DESIGN： Single sample experiment with adult corpses as subjects. SETTING： Orthopedie Departmenl of the First Affiliated Hospital and Department of Anatomy, Jinzhou Medical College. PARTICIPANTS： This study was carried out at the Anatomical Laboratory of Jinzhou Medical College in December 1999. Fifteen adult corpses, 11 males and 4 males, were donated, and the donators signed informed consent when alive. METHODS：① The anterior and dorsal roots of spinal nerves were obtained fi＇om the 15 adult spinal cords （30 sides） and subjected to morphological observation and micro-measurement at the level of L4-S2.② The anterior and dorsal roots of L5 spinal cord were obtained from a fresh corpse for immunohistochemical staining. The starting part, middle part and the exterior of intervertebral foremen was cut into slices, and the total number of nerve fibers, the number of la nerve fibers responsible for convulsion, and their percentage in the total fibers were counted. Meanwhile the distribution and the number of la nerve fibers in the three parts were compared. MAIN OUTCOME MEASURES： ① The nerve tract separation in spinal nerve root and the diameter of small nerve tract. ② The total number of nerve fibers per 100μm^2, the pereentage of la nerve fibers in the total nerve fibers at the starting part, middle part and exterior

关 键 词：脊神经 神经根 显微解剖 选择性脊神经后根切断术 

分 类 号：R745[医药卫生—神经病学与精神病学]