单切口椎管内经硬脊膜下通路健侧颈7神经移位手术的解剖学研究  

Anatomical study on the contralateral C_(7)nerve transfer surgery through subdural approach with a single incision in the spinal canal

作　　者：姚龙 张恒柱 严正村 王晓东 顾加祥 刘宏君 Yao Long;Zhang Hengzhu;Yan Zhengcun;Wang Xiaodong;Gu Jiaxiang;Liu Hongjun(Department of Neurosurgery,School of Clinical Medicine,Yangzhou University,Yangzhou 225001,China;Hand and Foot Microsurgery,School of Clinical Medicine,Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院神经外科,扬州225001 [2]扬州大学临床医学院手足显微外科,扬州225001

出　　处：《中华神经外科杂志》2023年第8期814-818,共5页Chinese Journal of Neurosurgery

基　　金：江苏省第五期"333工程"科研项目(BRA2019026);扬州市科技局社会发展项目(YZ2019056)。

摘　　要：目的通过解剖学研究探讨单切口椎管内经硬脊膜下通路健侧颈7(C_(7))神经移位手术的可行性。方法采用4具新鲜冰冻尸体标本进行研究。在神经内镜和显微镜下进行操作,观察并测量C_(7)神经从出硬脊膜至椎间孔前、后根神经融合处的长度。将健侧前根的神经亚束及患侧前根的神经小束平均分成3束,健侧和患侧后根的神经亚束平均分成5束。模拟单切口椎管内经硬脊膜下通路健侧C_(7)神经移位手术,在脊髓背侧分别行健侧前根与患侧前根神经亚束-神经小束的吻合,健侧后根与患侧后根神经亚束-神经亚束的吻合。结果C_(7)神经在硬膜内出硬脊膜时前根与后根分开走行,C_(7)神经呈丝状结构,左右对称排列,根丝附着在软膜下的结缔组织上。根丝长度由上到下逐渐缩短,其中左侧前根长度由(12.25±0.68)mm减小至(9.75±1.40)mm,右侧前根长度由(12.95±1.49)mm减小至(10.00±2.00)mm,左侧后根长度由(15.63±1.55)mm减小至(12.38±0.71)mm,右侧后根长度由(15.48±1.37)mm减小至(12.30±0.90)mm。4具户体标本均在神经内镜和显微镜的辅助下完成了C_(7)神经根神经束的吻合模拟手术,其中后根的吻合均为1~5束一对一吻合;有2具尸体标本吻合前根时采用了交叉吻合,即健侧第1束与患侧第3束吻合;另外2具尸体标本为1~3束一对一吻合。在缝合蛛网膜时均出现蛛网膜撕裂现象,硬脊膜可完整地缝合。结论从解学角度分析,单切口健侧C_(7)神经在硬脊膜下切断后与患侧根丝在脊髓背侧束-束吻合是可行的,为健侧C_(7)神经椎管内移位手术的可行性提供了理论依据。ObjectiveTo explore the feasibility of contralateral cervical 7(C_(7))nerve transfer surgery via subdural approach with a single incision in the spinal canal based on anatomical research.Methods Four fresh frozen cadaver specimens were used for the study.The operation was performed under neuroendoscope and microscope to observe and measure the length of C_(7)nerve from its exit from the dura mater to the fusion of anterior and posterior roots of intervertebral foramen.We then divided the nerve subbundles of the healthy anterior root into 3 bundles,the nerve sub-bundles of the affected anterior root into an average of 3 bundles,and the nerve sub-bundles of the healthy and affected posterior roots into 5 bundles.We simulated a single incision in the spinal canal via the subdural approach for contralateral C_(7)nerve transfer surgery,and performed anterior-root-to-anterior-root anastomosis and posterior-root-to-posterior-root anastomoses on the dorsal side of the spinal cord.Results When the C_(7)nerve exited the dura mater,the anterior root and the posterior root ran separately.The C_(7)nerve had a filiform structure,arranged symmetrically left and right.The root filaments were attached to the connective tissue under the soft membrane,and the length of the root filaments was gradually shortened from top to bottom.The average length of left anterior root decreased from 12.25±0.68 mm to 9.75±1.40 mm,the average length of right anterior root decreased from 12.95±1.49 mm to 10.00±2.00 mm,the average length of left posterior root decreased from 15.63±1.55 mm to 12.38±0.71 mm,and the average length of right posterior root decreased from 15.48±1.37 mm to 12.30±0.90 mm.All 4 specimens completed the simulated anastomosis of C_(7)nerve root Nerve fascicle with the assistance of neuroendoscope and microscope,and the anastomosis of the posterior root was one-to-one anastomosis of 1-5 bundles.Cross anastomosis was used for anterior root anastomosis in two specimens,that is,the first bundle on the healthy side was anasto

关 键 词：神经移位 模型 解剖学 颈7神经 椎管内 硬脊膜下通路 

分 类 号：R651.1[医药卫生—外科学]