神经根型颈椎病解剖因素探讨

目的　探讨颈神经在椎间孔及脊神经沟处受嵌压的解剖学因素。方法　取 6 0具成尸 (男 2 8,女32 ) ,对颈椎间孔及其脊神经根的前后径、上下径进行观测 ,统计出颈神经根前后径、上下径分别大于或等于椎间孔的前后径、上下径的出现率 ;同时观测脊神经沟外口宽度及其沟内段脊神经前支横径 ,统计出脊神经前支横径大于或等于脊神经外口宽度的出现率。结果　①颈神经根在椎间孔处可造成嵌压 ,其出现率为 2 4 6 % ,其中女性为 35 2 %明显高于男性的 12 5 % (P <0 0 1) ;②颈神经前支在颈椎脊神经沟处可造成嵌压 ,其出现率为 6 3% ,其中男性为 8 9%明显高于女性的 2 9% (P <0 0 1)。结论　颈神经受累不仅与椎间孔狭窄有关 ,而且与脊神经根外径和周围软组织损伤有关 ,临床诊断颈椎病应采用X线片与临床表现相结合方可减少漏诊率。     

颈椎脊神经沟的形态学研究

通过对70例成人干燥颈椎的脊神经沟的观测,结果表明:(1)颈3～7内口宽值均在5±1mm范围;(2)前结节纵径以颈5最大;(3)沟深值在颈5.6明显增大.提出:(1)内口宽值在3mm以下可认为狭窄(2)颈5、6外口宽值分别在2.7mm和4.2mm以下或沟深值分别在7.7mm和8.5mm以上时,均可认为狭窄;(3)颈5、6臂丛神经根在外口处易受暴力伤.     

颈椎脊神经沟及其沟内段脊神经形态学观察

目的　探讨脊神经沟与沟内段脊神经受嵌压的关系。方法　取 6 0具成尸 (男 2 8,女 32 ) 12 0侧颈椎 ,对脊神经沟外口宽度、深度及其沟内段脊神经前支横径进行观察 ,并统计脊神经前支横径与脊神经沟外口宽度之比。结果　①脊神经沟外口宽度、深度自颈 3至颈 6均逐渐增大 ,其平均值分别为 4 5± 1 2mm和4 3± 1 2mm ;② 3到 7颈神经前支横径逐渐增大 ,平均值为 2 9± 1 0mm ;③颈神经前支横径与脊神经沟外口宽度之比 ,颈 5最小 (1∶1 5 4 ) ,颈 4次之 (1∶1 6 7) ,颈 3最大 (1∶1 75 )。结论　脊神经沟与沟内段脊神经受累关系密切 ,下颈段 (5、6 )颈神经受累机率可能大于上颈段 (3、4 )。     

颈椎脊神经沟内口和颈神经的观测

目的　探讨颈椎脊神经沟内口与颈神经受嵌压的关系。方法　取 2 0具成人尸体的颈椎标本 ,选用完整的成人颈椎 4 4套 ,测量颈椎脊神经沟内口的宽度和颈神经穿过脊神经沟内口时的横径 ,并统计两者之间的比值。结果　颈神经穿过脊神经沟内口处的横径为 :C3 为 2 .7± 0 .7mm ,C42 .7± 0 .7mm ,C5为 2 .8± 0 .8mm ,C64.8± 0 .9mm ,C75 .3± 1.1mm。脊神经沟内口的宽度分别为 :C3 为 5 .8± 1.0mm ,C45 .5± 0 .9mm ,C55 .6± 1.0mm ,C65 .5± 1.1mm ,C76 .2± 1.0mm ;颈神经穿过脊神经沟内口时的横径与脊神经沟内口宽度的比值 :C3 为 1∶2 .15 ,C41∶2 .0 5 ,C51∶1.98,C61∶1.14 ,C71∶1.18。结论　脊神经沟内口与穿过内口的颈神经受累关系密切 ,下颈段 (C6、C7)颈神经受累的机率大于上颈段 (C3 、C4)。     

注射疗法治疗神经根型颈椎病的解剖观察

目的：为神经根型颈椎病注射疗法的进针定位提供解剖依据。方法：取30具成年尸体，通过对相关指标的测量来确定C3～7神经的定位。结果：以棘突为参照点确定C3～7颈脊神经的定位；（1）进针点位于棘突旁开距离为23．18—24．72mm，棘突上方11．65-19．68mm；（2）垂直进针至深度为16．67—37．87mm，此点是脊神经后支绕过关节突腰部的位置；（3）从关节突再向前进针7．51～9．15mm到达颈神经前支；进针到达横突外侧缘时与矢状面夹角5．50—11．5°。结论：颈椎棘突位置表浅较易摸到，以各棘突作为解剖标志来定位相应的颈脊神经，为临床颈椎注射疗法治疗神经根型颈椎病提供解剖学依据。     

显微内镜治疗神经根型颈椎病后侧入路的解剖学研究

目的　探讨后侧手术入路的显微内镜治疗神经根型颈椎病的可行性和安全性。方法　取 10具尸体的第 3～ 7颈椎。以其棘突中点连线为后正中线 ,上、下小关节突外缘为外边线 ,两侧上、下位椎板重叠内缘交点相连为横线 ,分别测量横线及外边线间距。距后正中线旁开 10mm处垂直插入定位针达相应间隙椎板后缘 ,测量进针深度 ,沿定位针逐层解剖 ,观测入路行径。结果　横线间距为 11 3 8～ 19 0 2mm ,平均每侧为后正中线旁开 5 69～ 9 5 1mm ,而边线间距为 4 6 3 2～ 5 7 2 8mm ,平均每侧为后正中线旁开 2 3 16～ 2 8 64mm。进针深度为 2 0 0 5～ 3 1 98mm。取距后正中线旁开 10mm处为进针点 ,进针角度以矢状面 0° ,横断面向下倾斜 0°～ 2 0°插入定位针 ,不会引起意外损伤。结论　后侧入路显微内镜治疗神经根型颈椎病是一种可行而安全的入路     

肌电图联合颈椎MRI检查在神经根型颈椎病诊断中的应用

目的:探讨肌电图联合颈椎MRI检查在神经根型颈椎病诊断中的应用价值。方法:选取2019年1月至2020年1月就诊于福建省立医院的神经根型颈椎病患者45例,分别给予肌电图和颈椎MRI检查,分析两种方法的检查结果。结果:肌电图诊断准确率为97.8%(44/45例),漏诊1例,无误诊患者。颈椎MRI诊断准确率为88.9%(40/45例),存在3例漏诊,2例误诊为腕管综合征。肌电图检查显示颈椎病患者最常受累的是C_6、C_7神经根,颈椎MRI检查显示C_5、C_7最常受累。颈椎MRI检查,累及C_5、C_8神经根者,明显高于肌电图检查,差异具有统计学意义(P0.05),累及C_6、C_7者差异无统计学意义(P0.05)。结论:在神经根型颈椎病患者临床诊断上,肌电图联合颈椎MRI检查可更加精准定位,且可反映神经功能状态,对需要外科手术的患者具有重要的指导意义。     

颈椎间孔韧带的解剖特点及其临床意义

神经根型颈椎病是临床常见疾病,可引起上肢感觉或运动障碍,其病因可能是神经根受到各种直接机械压迫[1]。神经根自硬膜囊发出后向外下方走行,经椎间孔出椎管,椎间孔内软组织增生、肥厚、粘连等病理改变均可使经过该处的神经根受到压迫,导致出现相应的临床症状如放射性上肢疼痛、麻木或无力等。想要更清楚地了解神经根卡压的机制,需要对颈椎间孔区域进行更加深入的解剖学研究。掌握颈椎间孔韧带的解剖特点有助于提高神经根型颈椎病的诊断和治疗水平,在该区域手术操作时尽可能地减少医源性损伤。有关胸腰椎(T1~5)的椎间孔韧带研究证明其韧带起到限制神经根移位并防止拉伤的作用[2~4]。然而,目前关于颈椎间孔韧带的研究尚少。本文结合国内外文献资料,对颈椎间孔韧带的相关知识作一综述。     

颈椎椎板切除术后神经根病的解剖学研究

目的 :探讨多节段颈椎椎板切除术后神经根病的解剖学基础及其发病机理。方法 :对 2 0具 (4 0侧 )成人固定标本的颈段脊髓、椎管及颈段神经根进行观察 ;其中 5具标本模拟颈椎椎板切除术 ,观察脊髓的反弹情况。结果 :颈神经脊髓附着端至椎间孔内侧缘距离平均为 8.5± 0 .3(3.5～ 11.0 )mm ,以C5、C6 最长 ;脊髓反弹紧贴椎管后壁时颈神经根移动平均为 1.2± 0 .5 (0～ 2 .0 )mm ,以C5、C6 神经根移位最大 ,而硬脊膜囊在椎间孔处对移动的脊神经根形成栓系。结论 :颈椎后路减压术后神经根病的发生最可能的原因是脊髓反弹引起神经根栓系卡压 ,神经根病的发病与脊髓反弹时神经根的移动度有关     

颈椎间孔内口锚链韧带的形态和分布特征

目的 通过解剖学观察,揭示颈椎间孔内口区锚链韧带的形态及其分布特征,探讨其与神经根型颈椎病神经卡压之间的关系。 方法 12具成人脊柱颈段防腐标本,正中矢状切开,从脊神经根袖根部切断根袖,在外科显微镜下解剖观察C3/4～C7/T1椎间孔内口处神经根袖周围的锚链韧带,记录韧带的形态、分布、起止点及走行。 结果 120个椎间孔内口脊神经根袖周围共发现560条锚链韧带,所有韧带均呈放射状连于神经根袖与椎间孔内口周围骨膜壁,两端附着紧密,不易分离。各椎间孔内口韧带的数目均≥4个。锚链韧带形态主要包括带形和索形两种。带形韧带258条,宽度（4.5±2.6）mm（4.1~5.2 mm）,索形韧带302条,直径（2.5±1.8）mm（1.2~3.8 mm）。C3/4、C7/T1椎间孔内口区韧带较为松散纤细,数量较少;C4/5~C6/7椎间孔内韧带较为坚韧而粗壮,数量较多。 结论 颈椎椎间孔内口区神经根周围存在锚链韧带,将神经根锚定于周围椎间孔骨膜壁,极大限制了神经根自由移动范围,可能与突出椎间盘一起导致神经根卡压,是神经根型颈椎病的潜在解剖学因素。     

颈椎骨质增生与颈椎病关系的探讨

通过对50例颈椎骨标本的测量,统计了骨质增生的出现率和颈椎各径、钩突各径值及上关节突关节面的角度,比较了正常组与骨质增生组的差异,以阐述骨质增生对颈椎椎管、椎间管的影响,通过对钩突前后径与椎上切迹的相关统计,发现二者呈负相关。随着钩突前后径的增大,椎间管变窄。     

颈神经根槽和颈椎间孔的应用解剖

目的：为颈椎病的病因、诊断和治疗提供补充的定量数据。方法：在干燥的颈椎椎骨标本和福尔马林固定的颈椎标本上，测量颈神经根槽和颈椎椎间孔。结果：内侧区的平均长度，内侧区前缘中点到椎体中线的距离从C3～C7逐渐增加。C3内侧区的宽度较大，C7上、下关节突及峡部高度之和的后中点到颈神经根槽后壁的前后距离最小。结论：研究结果为影像诊断和外科手术提供了相关的应用解剖数据。     

腰椎侧隐窝和脊神经根的观测及临床意义

目的:研究腰椎侧隐窝的形态特点及脊神经根占位,探讨其临床意义.方法:用35套腰椎骨性标本、23例脊柱腰段断层标本和50例腰椎CT片,观察侧隐窝的形态特点,测量侧隐窝矢径及脊神经根直径,骨性标本和断层标本用游标卡尺测量,CT片用"eFilm workstation TM 2.0"软件测量,结果经统计学处理.结果:(1)L3-5形成明显的侧隐窝,其侧隐窝分为上、下两部分,上部入口矢径D1分别为:(8.92±0.86)、(8.55±1.25)、(8.23±1.14)mm,下部上缘入口矢径D2分别为:(11.29±1.34)、(10.18±1.31)、(9.84±1.11)mm;(2)断层标本L3～5侧隐窝入口矢径d1分别为:(5.73±1.89)、(5.34±1.18)、(5.08±0.81)mm,脊神经直径d2为(4.17±0.41)、(4.43±0.47)、(4.62±0.56)mm;(3)CT测量L3～5侧隐窝入口矢径分别为:(5.69±1.36)、(5.42±0.89)、(5.18±1.07)mm,脊神经直径分别为:(4.02±0.74)、(4.36±0.78)、(4.61±0.56)mm.结论:L3～5腰椎侧隐窝由上至下逐渐明显,侧隐窝矢径逐渐减小,脊神经根直径逐渐增大.L3～5侧隐窝分为上、下两部分,其下部的构成特点易因病理改变而引起狭窄.     

Projection of cervical dorsal root fibers to the medulla oblongata in the brush-tailed possum,Trichosurus vulpecula

This study describes the projection of cervical spinal afferent nerve fibers to the medulla in the brush-tailed possum, a marsupial mammal. After single dorsal roots (between C₂ and T₁) were cut in a series of animals, the Fink-Heimer method was used to demonstrate the projection fields of fibers entering the CNS via specific dorsal roots. In the high cervical spinal cord, afferent fibers from each dorsal root form a discrete layer in the dorsal funiculus. The flattened laminae from upper cervical levels are lateral and those from lower cervical levels are medial within the dorsal columns. All afferent fibers at this level are separated from gray matter by the corticospinal fibers in the dorsal funiculus. All cervical roots project throughout most of the length of the well-developed main cuneate nucleus in a loosely segmentotopic fashion. Fibers from rostral roots enter more lateral parts of the nucleus, and fibers from lower levels pass to more medial areas; but terminal projection fields are typically large and overlap extensively. At more rostral medullary levels, fibers from all cervical dorsal roots also reach the external cuneate nucleus. The spatial arrangement here is more complex and more extensively overlapped than in the cuneate nucleus. Rostral cervical root fibers reach ventral and ventrolateral areas of the external cuneate nucleus and continue to its rostral pole; more caudal root fibers project to more dorsal and medial regions within the nucleus. These results demonstrate that projection patterns of spinal afferents in this marsupial are similar to those seen in the few placental species for which detailed data concerning this system are available.     

Neurophysiological investigation of cervical spondylosis

The difficulties in diagnosing spinal cord lesions due to the cervical spondylosis is well-known in clinical neurology. In order to investigate the contribution of various neurophysiological examinations in the diagnosis in cervical spondylosis, we examined 70 patients suffering from cervical spondylosis, with peripheral nerve conduction studies, F-wave from the upper limb and electromyography from the corresponding muscles, as well as somatosensory evoked potentials (SEPs) from upper and lower limbs. Patients were separated into four groups: 20 patients had cervical spondylosis symptoms only; 15 patients had symptoms and signs of spinal root involvement; 15 patients had symptoms and signs of myelopathy; and 20 patients had symptoms and signs of both myelopathy and spinal root involvement. A group of 20 normal controls was also studied. In all groups of patients SEPs were the most sensitive electrophysiological study. Low-amplitude N13 and increased conduction time of N9-N13 and central conduction N13-N19 and LP-P27 were the most common finding in SSEP testing. SEPs were affected in many cases without CT-MRI findings of spinal cord pressure. From the above findings, SEPs proved to be the most sensitive diagnostic investigation in cervical spondylosis.     

Morphological study of the ansa cervicalis and the phrenic nerve

Morphological features of ansa cervicalis and phrenic nerve were studied in 106 cadavers. Ansa cervicalis was located medial to the internal jugular vein in 63% (medial type) and lateral to the vein in 33.7% (lateral type). Ansa cervicalis was derived from a combination of C1-C4 spinal segments, with C1-C3 being the most frequent pattern (87.5%). In >60% the ansa was bilaterally symmetrical. The distribution of medial and lateral types was equal on left and right sides of the body. The segmental composition of the inferior root was higher in the medial type and also on the left side of the body. In the lateral type the branches that formed the inferior root frequently (75%) formed a common trunk before joining the superior root, but in 74.8% of the medial type they joined the superior root independently. The phrenic nerve was derived from C4 and C5 in 52%. The C4 segment was present in the phrenic nerve in all cases except one. Additional phrenic components that pass anterior to the subclavian vein were defined as accessory phrenic nerves and found in 28.7%, while those passing posterior to the same vein were defined as secondary phrenic nerves (19.8%). Most of the accessory phrenic nerves contained a C5 segment and the nerve to subclavius was the commonest source. Various relationships between the ansa cervicalis and the phrenic nerve are investigated and, based on these findings, two separate classifications for the two nerves are suggested.     

后路减压侧块螺钉置入内固定治疗颈椎多节段后纵韧带钙化：5年36例资料回顾

背景：后路减压侧块螺钉固定能够解除骨化灶对脊髓、神经根的压迫,扩大椎管矢状径,同时重建该区域的稳定。 目的：验证应用后路减压、侧块螺钉置入内固定治疗颈椎多节段后纵韧带骨化症5年36例资料的临床疗效。 方法：36例患者为3个节段9例,4个节段20例,5个节段7例。 结果与结论：随访6~26个月,JOA评分由内固定前平均5.2分提高到 10.2分。颈椎生理曲度由内固定前平均(3.6±0.5) mm提高到内固定后(9.1±0.7) mm,内固定物无松动。提示此方法治疗既能后方直接减压又能前方间接置入减压,既能恢复颈椎生理曲度,又能提供坚强的内固定效应。     

尺神经中第七颈神经成份的行径及临床意义

用神经束追踪分离法解剖观察100侧成人第七颈神经分布至尺神经内的纤维行径。结合临床观察认为,尺神经内部有来自颈七的纤维,主要经4个交通部位加入到尺神经分布区内。证明脊神经相应节段与骨骼肌或肌群的支配关系是恒定的,只是由于在胚胎发生上臂丛组合的不同,使脊神经的分支到所支配的骨骼肌间的行径出现差异。上述研究结果,对臂丛中、下干损伤准确定位诊断有重要意义。     

Afferent projections of the rat major occipital nerve studied by transganglionic transport of HRP

The central projection fields of cutaneous neurons of the rat's major occipital nerve have been investigated using the method of transganglionic transport of horseradish peroxidase (HRP), with tetramethylbenzidine according to Mesulam (1978) as the chromogen. Furthermore, the course of the nerve, diameter distribution of myelinated axons, and diameter distribution of HRP-labeled perikarya of spinal ganglion cells belonging to this nerve, diameter distribution of myelinated axons, and diameter distribution of HRP-labeled perikarya of spinal ganglion cells belonging to this nerve have been studied. Following HRP application to the proximal stump of the cut nerve, labeled structures were found ipsilaterally in the cervical spinal cord and in the medulla oblongata. In the spinal cord, reaction product was mainly concentrated in the lateral parts of laminae I-III of the dorsal horn in segments C2 and C3. In C1, primary afferent terminals were more sparsely distributed and restricted to laminae I and II. Reaction product was also seen in the tract of Lissauer in segments C1-C4. In the medulla oblongata HRP labeled structures were observed in the medial cuneate nucleus, in the rostral part of the external cuneate nucleus, and in the nucleus of the spinal tract of the trigeminal nerve. A possible somatotopic arrangement of central terminals of cutaneous neurons within the cervical dorsal horn, as well as differences between the projection fields of muscle and skin afferents within the upper cervical cord and caudal medulla are discussed.