腰骶部脊神经后根选择性切断术治疗痉挛性脑瘫的应用解剖及临床疗效观察  

Applied anatomical study of selective lumbar and sacral posterior rhizotomy and observing of clinical treating result

作　　者：高晓群[1,2,3] 赵保平[1,2,3] 王延芬 高文龙 高龙远 聂培力[1,2,3] 娄季宇 

机构地区：[1]河南医科大学脑瘫外科研究治疗中心 [2]河南省郑州市卫生学校 [3]新疆石河子大学医学院解剖学教研室

出　　处：《中华显微外科杂志》1999年第3期183-185,共3页Chinese Journal of Microsurgery

基　　金：河南省卫生厅基金

摘　　要：目的通过对腰骶部脊神经根形态及周围结构的应用解剖详细观测，以寻求一种对脑瘫双下肢痉挛的治疗既能使肢体运动力功能改善快，且手术创伤小，发生并发症亦少的手术方式。方法在手术显微镜下操作及解剖观测儿童标本４０具，成人标本６０具的腰骶部脊神经根及周围结构。结果儿童自然根丝为４～６束、成人为８～１２束，集成２干形成后根到达硬脊膜初级孔。在儿童标本中硬脊膜内侧段长度为４～１５ｃｍ，在成人标本中其长度为６～２０ｃｍ。棘突根部下缘与椎板下缘交点是两侧脊神经后根穿出椎间孔处连线的对应点。以棘突根部下缘作为寻找同序数脊神经后根的标志，改良了选择性脊神经后根切断术（ＳＰＲ），临床应用２００例，疗效明显优于非改良的手术治疗。结论棘突根部下缘可作为寻找同序数脊神经后根的标志，改良ＳＰＲ术式具有切口小、脊柱稳固、功能改善快等优点。objective By observing the valus of lumbar,secral posterior nerve root and its surrouding structure Author can seek a surgical mathod which can be used to treat spasm of the lower limbs due to cerebral palsy with small injury and rather thoroughly improved symptoms Method The lumbar,sacral posterior nerve root and their surrounding structures were examined with operative microscopy,in 40 child cadavers and 60 adult cadavers Result The posterior nerve root consisted of 4～6 cords in children and 8～12 cords in adults These cords formed of 2 trunks down to the first foramen of spinal dura They were divided into four segments The length of the spinal dural interior segment was 4～15 cm in children,and 6～20 cm in adults inferior margin of the spinal process root can be regarded so a landmark to find the posterior spinal nerve root of the same ordinal number;the traditional SPR has been modified namely that the lumber nerves 2,4,5,and the posterior root of the spinal nerve of sacral 1 were partly cut,and the laminae of 2,4 and the laminae of sacrum 1 and the posterior root of lumbar nerve 4 were preserved The intact treatment of 200 cases of lower extremity spasm due to cerebral palsy showed the characteristics of small injury,stable spinal cord,and early and quick improvement of movement Conclusion Inferior margin of basic part of spinal process can be a landmark to finding the same ordinal number posterior root The modified operation is successful

关 键 词：痉挛性脑瘫 脊神经根切断术 解剖学 

分 类 号：R742.305[医药卫生—神经病学与精神病学] R322.81[医药卫生—临床医学]