腰骶部马尾神经临床应用解剖  

Clinical Anatomy of Cauda Equina

作　　者：乔梁[1] 谭保斌[2] 卢洪凯[1] 杜茂信[3] 刘钊[3] 吴新红[3] 李文成[3] 

机构地区：[1]潍坊医学院附属潍坊市人民医院泌尿外科,山东潍坊261041 [2]潍坊医学院 [3]华中科技大学协和医院泌尿外科

出　　处：《潍坊医学院学报》2006年第2期121-124,T0001,共5页Acta Academiae Medicinae Weifang

摘　　要：目的 为肖氏反射弧手术术中马尾神经前．后根鉴别以及反射弧手术术前MRI脊神经根定位提供解剖学依据。方法 8例（男6例，女2例）防腐固定的成人脊柱标本，显露T11以下脊髓节段及其神经根和马尾神经，并行解剖学观察。结果 腰骶部各节段的前根漂浮在脑脊液中下行，与后根一起构成马尾神经。各节段前根在不同水平，其所在位置也不同。进入脊髓圆锥处，各节段前根里上下排列，自上而下，依次是L1～S2的前根，在马尾近端水平，各节段前根在冠状面呈平排，自内侧到外侧，依次为S2～L1的前根；S3～S5形成一个神经束，位于S2和终丝之间。在马尾远端水平，S3～S5逐渐分开，但与终丝距离仍较近出。整体上，脊神经前根位于马尾的前半部，后根占据马尾的后半部。结论 在肖氏反射弧手术中，先确定腰骶椎体的序数，然后，依据前、后根的解剖特点，能较准确的辨别神经前、后根；运用MRI技术能够做到，先辨别腰骶椎管内的脊神经节，从而辨别脊神经后根、脊神经前根；但同时要注意腰骶神经根畸形的情况。Objective To provide anatomical basis for MRI study trying to accurately identify the spinal nerve ventral and dorsal root during Xiao＇s procedure. Methods Spinal cord under T11 segment were exposed and each nerve roots were observed on 8 adults spinal specimens （6 male,2 female）. And to make a literature review about the dorsal root ganglia and lumbosacral nerve root anomalies. Results The nerve roots within the lumbar dural sac were arranged loosely with the sacral and coceygeal nerve roots to form the caudu equina. Each root was covered with its ownsleeve of pia mater that is continuous with the pia matter of the spina cord.The nerve roots within the cauda equina were well orgmized in a symmetric layering pattern. The most inner nerve elements were the bundle consists of S1, S4 and S5 roots, progressing latterly to S2 to I4 roots at the cephalic eauda equina level. This arrangement was verified at different level. In general, the vcntral roots occupied the anteriody half part of conda eqaina and the dorsal roots occupied its posterior half part.Through literature review, we found thai S1 DRGs were located in the intraforaminal region in 55 - 60% and in the intracanalar region in 40 - 45%. S2 DRGs were in the intraforaminal region in 15 ～ 50% and in the intracanalar region in 50-85%. All the S3 and S4 DRGs were located in the intracanalar region. None of the sacral DRGs was located in the extraforaminal region. The most posterior nerve elements were the S5 roots, progressing anteriorly to S4, S3, S2, and S1 at thc L5 - S1 level. The lumbosacral nerve root anomalies were most frequently occurred in L5 and S1 roots, and fewer in I4 and S2 roots. Conclusions There were always minor differemces in normal anatomy of the lumbar saeral spinal nerve roots and ganglion. There also exist occurrenee of lumbosacral nerve root anomalies. It is important to know the comlmeal information of anatomy and anomalies of spirtal nerve.

关 键 词：人工体神经-内脏神经反射弧 手术 脊神经 脊根节 腰骶神经根畸形 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学]