臂丛神经根性撕脱伤前根椎管内植入手术入路探讨  

A study of approaches in reimplantation of avulsed brachial plexus ventral roots into the spinal cord

作　　者：张信英[1] 韩成龙[1] 杜劲松[1] 张军[1] 曹杨[1] 

机构地区：[1]哈尔滨医科大学附属第一医院骨科,150001

出　　处：《中华创伤骨科杂志》2006年第12期1157-1160,共4页Chinese Journal of Orthopaedic Trauma

基　　金：黑龙江省"十五"攻关课题(G99C19-10-1)

摘　　要：目的通过对臂丛神经根部及椎管内结构的显微外科解剖学研究,寻找臂丛神经前根再植入脊髓的最佳手术入路。方法在成人19例38侧颈胸段尸体标本上,显露臂丛神经并追踪至椎间孔,切除椎弓,切开硬脊膜,暴露脊髓及臂丛神经根,对臂丛神经根走行、长度及周围相关骨性结构,各脊髓节段与对应椎间盘相对位置和椎动脉与臂丛神经的关系进行观测。结果脊髓节段与椎间盘的对应关系为：C_(5-7)脊髓节段对应C_(3-4)、C_(4-5)、C_(5-6)椎间盘,C_8、T_1脊髓节段对应C_6、C_7椎体,根据解剖学结果寻找出侧前方、椎间孔扩大侧方、侧后方、侧-后方联合四条可行的手术入路。结论侧前方及侧方入路是臂从神经前根再植入脊髓的最佳入路,侧后方及侧-后方联合入路再植入脊髓的位点差,但其难度和危险小。Objective To study the microsurgical and anatomic structures of brachial plexus roots and vertebral canal to find the best approaches for reimplantation of avulsed brachial plexus ventral roots into the spinal cord. Methods On nineteen cervicothoracic spine specimens, the brachial plexus nerves were exposed along to intervertebral foramen, and the spinal cord and brachial plexus roots were exposed by excising the vertebral arch and sectioning the spinal dura mater. The anatomy of brachial plexus roots and vertebrae, and the relative positions of spinal cord segments to vertebral discs were measured and observed. Results The relative positions of spinal cord segments to vertebral discs are： C5-7 spinal cord segments face C3, 4, C4, 5 and C5, 6 vertebral discs; and C8 and T1 spinal cord segments face C6 and C7 vertebrae. Based on the anatomic finding, four approaches were found out： the lateroventral approach, the lateral approach by enlarging intervertebral foramen, the laterodorsal approach and the lateral and dorsal combined approach. Conclusions The brachial plexus ventral roots can be best reimplanted into the spinal cord by the lateroventral approach and the lateral approach. Although the laterodorsal approach and the lateral and dorsal combined approach are not the best, they are less difficult and dangerous.

关 键 词：臂丛神经 植入 解剖学 脊髓 

分 类 号：R651.3[医药卫生—外科学]