胸腰段脊柱手术与脊髓血供损伤的相关研究

目的探讨胸腰段脊柱手术与脊髓血供损伤的相关性,为合理的手术提供基础。方法选择19例成人脊柱脊髓标本、15例乳胶血管灌注,3例铸型及10例胸腰段脊柱手术患者行超选择性脊柱脊髓血管造影,充分了解脊髓血管的解剖结构。结果节段动脉在肋横突关键内侧发出根髓动脉;胸段动脉吻合主要在椎间孔周围,腰段动脉吻合主要在髂腰肌和腰大肌中;血管造影可见胸腰段、相邻动脉节段之间以及对侧同名动脉之间存在广泛吻合。结论脊柱前路矫形宜选择在根髓动脉分支前,行多个节段血管结扎;侧前入路尽量选择在根髓动脉分支后,经胸腰段毗邻动脉之间;后入路截骨尽量选择在椎弓、椎体中部可最大限度保护血管免受损伤。     

胸腔镜下脊柱胸腰结合段手术相关应用解剖与临床意义

目的: 对脊柱胸膜结合段侧面血管神经进行应用解剖学研究,为胸腔镜下脊柱胸腰段前路手术提供解剖学基础.方法: 观察29具(58侧)经防腐处理的成人尸体标本脊柱胸腰段侧面血管神经的走行、分布及毗邻关系并测量相关数据.结果: 在成人尸体标本上可观察脊柱胸腰段侧面,节段动、静脉较为恒定地存在并走行于相应椎体侧面中央浅沟内,且动脉有细小的分支.上、下位节段动脉间构成了1个相对较少血管神经的安全区,椎间盘恰好位于该安全区中部.结论: 脊柱侧面存在一个血管神经较少的安全区,以椎间盘为参考标志,安全区可为胸腔镜下前路椎间融合等手术提供足够的操作空间.     

结扎数支肋间后动脉对胸腰段脊髓血供影响

目的：探讨在脊柱侧凸前人路手术中结扎第7～11肋间后动脉对脊髓血供的影响。方法：将11例14～50岁、无严重心血管疾病和中枢神经系统无损伤的新鲜尸体随机分在A组(不手术)、B组和C组(分别结扎左侧和双侧第7～11肋间后动脉起始部)，全身墨汁福尔马林灌注，取T5～L1段脊髓作250μm连续冰冻切片，镜下观察和拍照，并进行测量和统计分析。结果：C组标本的节段间血管数及血管密度有显著性差异；A组与B组及A组与C组某些节段的血管数或／和血管密度存在差异。结论：胸腰段脊髓的血供不存在节段间差异，双侧结扎第7～11肋间后动脉起始段对脊髓血供影响较大，单侧结扎第7～11肋间后动脉起始段对胸腰段脊髓血供有影响。     

成年家犬胸腰段脊髓营养动脉的解剖学研究

目的 :了解成年家犬胸腰段脊髓营养动脉的数目、管径和配布特点。方法 :7只成年家犬动脉灌注乳胶后取脊髓全长 ,对其胸腰段脊髓营养动脉进行观测。结果 :胸腰段脊髓的前根髓动脉 (12 .6± 2 .1)条 ,管径 (0 .2 182± 0 .0 773 )mm ,基本不成对分布 ,左侧者居多 ;最大前根髓动脉位于中腰髓 ,管径 (0 .3 83 6± 0 .0 3 3 1)mm ,动脉干长 (9.17± 1.68)mm。胸腰段脊髓后根髓动脉数目 (12 .7± 3 .4)条 ,管径 (0 .1663± 0 .0 3 72 )mm ,多不成对分布。前正中动脉在胸髓较细 ,管径为 (0 .14 68± 0 .0 2 5 2 )mm ,在腰髓较粗 ,管径为 (0 .2 677± 0 .0 414 )mm。两条后外侧动脉均较细 ,其间多吻合。结论 :与人类不同 ,成年家犬胸腰段脊髓动脉血供相当丰富 ,以犬为实验动物 ,制作急性脊髓缺血损伤模型时必须考虑到被阻断血流动脉的级别、节段、侧别、数目等因素对局部脊髓血供的影响。     

脊髓的血管及其构筑

本文综述了脊髓外部动脉即根动脉的来源、走行和供血特点，根动脉与脊髓神经伴行的位置关系，根动脉与脊髓前、后动脉吻合形态学特征。大根动脉的出现部位，血供特点。脊神经根与马尾为两套供血系统：远侧端由脊神经节丛供给；近侧端由软膜下动脉丛供给，它们的供血范围各占神经根与马尾长度的一半。脊髓内部的血管分布由：①中央动脉系统即由脊髓前动脉发出，经前正中裂穿脊髓实质，每ｃｍ脊髓出现营养动脉支数胸段最少，只有２～５支，而颈、腰段分别为５～８支／ｃｍ和５～１２支／ｃｍ。每一条中央动脉的终未支纵向覆盖长度为１０～２０ｃｍ；②周围动脉系统即软脊膜下动脉丛的穿支。两系统的终未动脉一般无毛细血管前吻合。     

颈胸段脊柱骨折的临床特点及后路手术疗效探讨

目的探讨颈胸段脊柱脊髓损伤的临床特点及后路椎板减压、植骨、椎弓根螺钉内固定术的治疗作用。方法 8例颈胸段脊柱损伤患者,损伤部位为第6颈椎至第1胸椎,损伤类型为椎体爆裂性骨折2例,椎体压缩性骨折5例,压缩性骨折伴脱位1例。分析上述患者的临床表现,并分别经后路颈胸段椎板减压椎弓根或侧块螺钉内固定术。结果所有患者随访6~20个月,植骨均在3~4个月完全融合,所有患者术后脊髓神经功能均有不同程度症状改善,伴有交感神经节刺激症状者有所缓解。结论颈胸段后路椎板开窗减压植骨融合内固定术对颈胸段脊柱脊髓损伤具有较好的疗效。后路椎弓根螺钉及侧块螺钉固定系统有助于植骨节段融合、重建和稳定颈胸段脊柱。     

下颈椎血供的解剖研究及其临床意义

目的为颈椎前路减压手术中减少出血量,改善显露和减少手术并发症的发生提供解剖学基础。方法在15具成人尸体标本上,解剖观测C3～7椎体前后部血供的起源、走行、分支及吻合。结果椎体前部血供来自颈升动脉脊支、甲状腺下动脉和颈深动脉脊支,C4～7椎前动脉在椎体上的分支相互吻合,在颈长肌的内侧缘处常吻合成一纵行动脉链;椎体后部血供来自椎间动脉发出的椎后动脉,其分支在颈椎体后部吻合形成节段性弧形动脉吻合链。结论阻断术椎的椎前动脉及其与相邻椎前动脉的纵行动脉吻合,并在颈椎后部减压时注意对硬膜囊外侧缘及椎体中部处的椎后动脉及其分支的处理,可减少颈椎前路减压手术的术野出血,改善手术显露。     

后路单侧截骨椎体切除内固定修复胸腰段后凸畸形

<正>陈旧性胸腰段椎体压缩骨折和胸腰段先天性楔形椎常引起局部的后凸畸形,多数患者存在胸背部疼痛,少数伴有脊髓神经压迫症状,若保守治疗无效且严重影响工作和生活,常需手术矫形治疗。目前普遍观点认为,超过45°的胸腰段脊柱后凸畸形,经椎弓根椎体楔形截骨矫形术难以达到理想的矫形效果。当椎体压缩明显而前柱骨质较少无法发挥铰链作用时,经椎弓根椎体楔形截     

脊柱胸腰段侧面血管解剖与影像学研究及其临床意义

目的为胸腔镜下行脊柱胸腰段前路手术提供节段血管解剖学基础。方法 (1)观测29具(58侧)经防腐处理的成人尸体标本脊柱胸腰段侧面血管神经的走行、分布及毗邻关系。(2)对25(50侧)例正常成人行脊柱胸腰段造影后CT扫描,然后进行三维重建并对其图像上的脊柱胸腰段侧面血管走行、分布及毗邻关系进行观测,分析。结果观察了脊柱胸腰段侧面的节段血管的具体走行及毗邻关系,且动脉有两个主要分支。上下位节段血管间构成了一个相对无血管神经的"安全范围",椎间隙(盘)恰好位于该"安全范围"内;并且测量了相关数据。各椎间血管"安全范围"在T10/11、T11/12T12/L1、L1/2、L2/3椎间逐渐增大,尸体标本与影像上分别依次为(23.38±0.88)、(25.57±0.95)、(29.07±1.11)、(32.63±1.28)、(33.62±1.47)mm和(23.43±1.40)、(25.63±2.01)、(29.13±2.10)、(32.59±2.10)、(33.52±2.11)mm。结论安全空间可以提供足够的手术空间,并在术前可以通过对CT三维图像观察并测量安全空间而制定手术方案。     

脊柱胸腰段薄层断层解剖及临床意义

目的：明确脊柱胸腰段冠状、矢状和横断面解剖学特点，探索薄层断层切片在观测各髓节及脊神经根走行过程的临床应用价值。方法：采用40具成人脊柱胸腰段标本经改良火棉胶包埋法处理，制作16具冠状、8具矢状和16具横位的0．25mm厚连续切片，观察脊神经根走行于侧椎管和椎间管不同区段的解剖关系和椎间孔韧带分布特征，并直接测量相关结构参数。结果：观测了脊柱胸腰段A、B、C、D经4区横断层面、经椎间管内口矢状层面、经两侧椎弓根中心冠状层面的形态和相关参数。结论：三种方位断层切片可较好显示诸多结构位置关系，对脊髓或脊神经源性疾病诊疗和正确辨认手术视野所见具有重要价值。     

Location of the spinal nucleus of the accessory nerve in the human spinal cord

The segmental extent and topography of the spinal nucleus of the accessory nerve (SNAN) was investigated in the adult human spinal cord. Transverse sections of segments between the lower medulla and C6 were stained with cresyl violet and the motor cell columns identified according to the numerical locations defined by Elliott (1942). The segmental extent and topography of the cervical part of column 2 resembled that previously described for the SNAN of primates.     

Histochemistry of choline acetyltransferase in the spinal cord and spinal ganglia of the cat

Conclusion During specific detection of ChAT a precipitate which differs in amount and color is formed in the perikaryon of the neuron, whereas blood vessels and glial cells do not react with acetyl CoA. All motoneurons of the lumbar enlargement of the spinal cord contain different levels of activity of the enzyme. A positive reaction is found in the spinal ganglia in 58% of pseudounipolar cells, which are evidently true cholinergic neurons.Translated from Arkhiv Anatomii, Gistologii i Émbriologii, Vol. 75, No. 9, pp. 52–56, September, 1978.     

Intraoperative monitoring of spinal cord function in spinal and spinal cord surgery

It has become essential to monitor spinal cord function during operations which may involve the risk of stretching, compressing, or injuring the spinal cord, or compromise its blood supply. The recordings of sensory and motor functions include the spinal cord-evoked potential (SCEP), motor-evoked potential (MEP), and somatosensory-evoked potential (SEP). Each of these recordings is not sufficient as a single modality to evaluate the integrity of spinal cord function, so they are used in combination. In particular, to prevent and detect early motor disturbance, the MEP is widely used, which has the advantages of the lowest invasiveness and greatest case of setting. Although spinal cord monitoring is conducted by surgeons, anesthetists, and medical technologists, it should preferably be performed by those routinely engaged in neurophysiological examinations including intraoperative monitoring. Its success depends largely on good coordination and mutual trust between surgeons, anesthesiologists, operative nurses, and clinical engineers, as well as the development of individual expertise.     

Coordination of spinal locomotor activity in the lamprey: long-distance coupling of spinal oscillators

 The extent and strength of long-distance coupling between locomotor networks in the rostral and caudal spinal cord of larval lamprey were examined with in vitro brain/spinal cord preparations, in which spinal locomotor activity was initiated by chemical microstimulation in the brain, as well as with computer modeling. When locomotor activity and short-distance coupling were blocked in the middle spinal cord for at least 40 segments, burst activity in the rostral and caudal spinal cord was still coupled 1:1, indicating that long-distance coupling is extensive. However, in the absence of short-distance coupling, intersegmental phase lags were not constant but decreased significantly with increasing cycle times, suggesting that long-distance coupling maintains a relatively constant delay rather than a constant phase lag between rostral and caudal bursts. In addition, under these conditions, intersegmental phase lags, measured between rostral and caudal burst activity, were significantly less than normal, and the decrease was greater for longer distances between rostral and caudal locomotor networks. The above result could be mimicked by a computer model consisting of pairs of oscillators in the rostral, middle, and caudal spinal cord that were connected by short- and long-distance coupling. With short-distance coupling blocked in the middle spinal cord, strychnine was applied to either the rostral or caudal spinal cord to convert the pattern locally from right-left alternation to synchronous burst activity. Synchronous burst activity in the rostral spinal cord resulted in a reduction in right-left phase values for burst activity in the caudal cord. These results also could be mimicked by the computer model. Strychnine-induced synchronous burst activity in the caudal spinal cord did not appear to alter the right-left phase values of rostral burst activity. Taken together, the experimental and modeling results suggest that the descending and ascending components of long-distance coupling, although producing qualitatively different effects, are comparatively weak. In particular, the descending component of long-distance coupling appears to become progressively weaker with increasing distance between two given regions of spinal cord. Therefore, short-distance coupling probably contributes substantially to normal rostrocaudal phase lags for locomotor activity along the spinal cord. However, short-distance coupling may be more extensive than ”nearest neighbor coupling.” Received: 4 June 1998 / Accepted: 6 November 1998     

Arteriovenous malformation of the spinal cord

Summary We report a case of spinal arteriovenous malformation (AVM) in which detailed morphological examination of the intramedullary vascular lesion was carried out employing serial section studies. The relationship of the malformation to parenchymal lesions was evaluated. An abnormal vessel at the spinomedullary transition, whose lamina elastica was partially interrupted, was suggestive of a shunt vessel. The location of the intramedullary abnormal vessels and foci of softening of the spinal cord almost overlapped in distribution. Three-dimensional reconstruction of the intramedullary abnormal vessels demonstrated marked elongation and tortuosity of the original vascular architecture and they ended in the extramedullary abnormal vessels with thickened wall. Thus, our study showed that the intramedullary abnormal vessels were the result of secondary changes subsequent to pressure and volume overload inflicted upon the spinal venous system through AVM. Compression by tortuous elongation of the intramedullary vessels is the apparent cause of the parenchymal softening. A traumatic factor in the aetiology of the AVM was also discussed, since the patient had had two preceding episodes of traffic accidents with cranial and lumbar injury. Trauma seemed to be significant factor as a trigger of symptoms.