人颈椎后纵韧带交感神经节段分布性特点研究及临床意义  

Distribution characteristics of posterior longitudinal ligament sympathetic nerve of human cervical spine and its clinical significance

作　　者：李茂华 王景东 相宏飞[2] 邱晨生 郭柱[2] 张建华[2] 陈伯华[2] 吴晓淋 LI Mao-hua;WANG Jing-dong;XIANG Hong-fei;QIU Chen-sheng;GUO Zhu;ZHANG Jian-hua;CHEN Bo-hua;WU Xiao-lin(Department of Orthopedics,Dezhou Municiple Hospital,Dezhou,Shandong,253012,China)

机构地区：[1]德州市立医院骨外科,山东253012 [2]青岛大学附属医院脊柱外科,山东266100 [3]青岛市立医院骨外科,山东266034

出　　处：《中国骨与关节杂志》2020年第7期491-496,共6页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(81802190、81772412);山东省自然科学基金(ZR2019BH084);泰山学者青年专家工程资助(tsqn201909190)。

摘　　要：目的探讨颈椎后纵韧带上交感神经纤维分布密度的规律,为颈性眩晕的发病机制提供一定的理论支持。方法选取自2012年12月至2019年1月在青岛大学附属医院脊柱外科行前路颈椎手术的颈椎病患者80例,收集术中切下的后纵韧带,将椎间隙区后纵韧带设为A组,椎体区设为B组,经石蜡固定、切片、乙醛酸生物荧光染色后制成玻片,用荧光显微镜观察,统计所有标本后纵韧带上交感神经纤维分布的密度,对组内及组间数据进行统计,分析其分布规律。结果组间对比,同节段后纵韧带交感神经纤维分布密度椎间盘区大于椎体后缘区。不同节段的后纵韧带神经纤维密度为C3~4=C4~5>C5~6>C6~7[(84.06±2.70)%vs.(81.97±3.06)%vs.(76.88±3.02)%vs.(71.19±3.08)%],不同节段椎体后缘层面神经纤维密度C3>C4>C5>C6[(54.64±4.68)%vs.(49.98±3.20)%vs.(44.30±2.69)%vs.(39.08±1.37)%]。颈椎不同节段纤维密度总体趋势是由上到下逐渐递减(F=77.0,P<0.001)。结论人颈椎后纵韧带上存在丰富的交感神经纤维,且分布密度呈区域性变化,由上到下呈总体递减的节段性分布,且椎间盘区>椎体后缘区,这与人椎旁神经节的解剖特点相符,推测这些交感神经纤维是由相应节段椎旁神经节发出的节后纤维,是交感神经感受周围病理刺激引起颈性眩晕的生理基础。Objective To explore the distribution of sympathetic nerve fibers on the posterior longitudinal ligament of the cervical spine,and to provide theoretical support for the pathogenesis of cervical vertigo.Methods A total of 80 cervical spondylosis patients after anterior cervical spine surgery were analyzed from December 2012 to January 2019.Posterior longitudinal ligaments removed from the intervertebral space were set as Group A,while from the vertebral body area as Group B.After paraffin fixation,sectioning,and glyoxylic acid biofluorescence staining,a slide was made and observed with a fluorescent microscope.Distribution densities of sympathetic nerve fibers on the longitudinal ligaments of all specimens were recorded.Distribution laws within and between the two groups were presented after statistical analysis.Results Distribution density of sympathetic nerve fibers on the posterior longitudinal ligament of the same segment was higher than that of the posterior margin of the vertebral body between the two groups.Densities of nerve fibers on the posterior longitudinal ligament of different segments:C3-4=C4-5 > C5-6 >C6-7 [(84.06±2.70) % vs.(81.97±3.06) % vs.(76.88±3.02) % vs.(71.19±3.08) %].Densities of nerve fibers at different posterior vertebral body levels:C3 > C4 > C5 > C6 [(54.64±4.68) % vs.(49.98±3.20) % vs.(44.30±2.69) % vs.(39.08±1.37) %].Densities of different segments of the cervical spine gradually decreased from top to bottom (F=77.0,P < 0.001).Conclusions Distribution densities of abundant sympathetic nerve fibers on the posterior longitudinal ligament of the human cervical spine change regionally,showing a generally decreasing segmental distribution from top to bottom.Higher density is observed in the intervertebral disc area,which is consistent with anatomical characteristics.It is speculated that these sympathetic nerve fibers are the postganglionic fibers emitted by the corresponding paravertebral ganglia,which is considered as the physiological basis of cervical dizziness caused by pat

关 键 词：颈椎 纵韧带 肾上腺素能纤维 眩晕 

分 类 号：R681.5[医药卫生—骨科学]