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1.
颈椎脊神经沟及其沟内段脊神经形态学观察   总被引:4,自引:1,他引:3  
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 )。  相似文献   

2.
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)。  相似文献   

3.
对30例成年男性颈椎颈2到胸1间的348个椎间孔和相应神经根形态位置进行了观察,对其径线进行了测量。测量结果:椎间孔平均值:前后径5.17±0.81mm,上下径为7.58±1.15mm。神经根平均值:前后径为4.01±0.65mm,上下径为5.60±0.93mm。颈4到颈7间榷间孔与相应神经根之间的间隙较小。本文结合临床和有关文献进行了讨论。  相似文献   

4.
目的 基于三维重建技术分析定点侧屈旋扳整颈手法治疗神经根型颈椎病(cervical spondylotic radiculopathy, CSR)患者椎间孔形态的变化,为手法治疗的有效性提供依据。方法 对40例CSR患者给予定点侧屈旋扳整颈手法治疗,隔日1次,共治疗7次,2周为1个疗程。利用多功能CT、Mimics 21.0、Geomagic、SolidWorks 2017软件对患者治疗前后CT数据进行三维重建分析,分别测量患者治疗前后椎间孔面积、椎间孔前后径、椎间孔上下径以及双侧颈肩部、上肢前侧、上肢后侧红外热成像温差值,并观察患者治疗前以及治疗7、14 d和1月随访时的VAS评分。结果 40例患者治疗后椎间孔面积、前后径、上下径较治疗前均得到改善,治疗前后患者红外热成像温差值均具有统计学意义。患者VAS评分呈逐级递减式下降。结论 定点侧屈旋扳整颈手法可以显著改善CSR患者的椎间孔形态,以此达到解除神经压迫的治疗目的。  相似文献   

5.
颈椎病微创手术相关的显微解剖   总被引:1,自引:0,他引:1  
目的:阐明颈椎病患者颈髓、颈神经根症状的解剖基础,以改进颈椎病临床责任病灶的定位诊断,提高微创手术的安全性,减少并发症.方法:取国人成人颈部标本15例(30侧),去除颈部软组织,切除椎板及后部硬膜,暴露颈3~7颈神经根丝,沿神经根丝探察至椎间孔,显微镜下进行观察测量.结果:颈椎椎间孔长度为5.4~6.5 mm,且椎间孔长度和椎间孔内神经根的各径从上到下逐渐增加;神经根与椎间孔径的比值亦由上至下逐渐增大;神经根丝自颈髓附着点到椎间孔的距离从颈3到颈7逐渐增加,倾斜角度逐渐增大;神经根间的吻合支普遍存在,且颈5~6和颈6~7吻合支较颈3~4和颈4~5更多见.结论:神经根与椎问孔径比值由上至下增大是临床上神经根受压多发生在下颈段的解剖学基础;神经根丝在椎管内走行距离和倾斜角的依次增大以及吻合支的存在是颈椎病临床表现复杂且互相重叠的解剖学基础;颈椎病经后路施行神经根减压术时,切除椎间关节可显露椎问孔、有效减压且能保持颈椎稳定性.  相似文献   

6.
目的 :观察C7横突前结节与第 1肋颈间异常韧带与C8颈神经前支的关系 ,为临床诊治提供解剖学基础。方法 :3 2具成人尸体标本 ,解剖观察C7横突前结节与第 1肋颈间异常韧带及其与第 1肋颈上面及中小斜角肌内缘所围成的三角形结构与C8颈神经前支的关系。结果 :C7横突前结节与第 1肋颈间异常韧带的出现率为 15 .63 % ,其长度为 ( 0 .98± 0 .18)cm ,宽度为 ( 0 .3 9± 0 .11)cm ,厚度为 ( 0 .0 6±0 .0 2 )cm。C8颈神经前支出椎间孔后经此异常韧带的深面进入三角形结构内 ,然后跨过中小斜角肌的内缘进入斜角肌间隙。结论 :C8颈神经前支经过此三角形结构时周围结构的压迫是导致胸廓出口综合征的原因之一。  相似文献   

7.
目的观察C7横突前结节与第1肋颈间异常韧带与C8颈神经前支的关系,为临床诊治提供解剖学基础.方法32具成人尸体标本,解剖观察C7横突前结节与第1肋颈间异常韧带及其与第1肋颈上面及中小斜角肌内缘所围成的三角形结构与C8颈神经前支的关系.结果C7横突前结节与第1肋颈间异常韧带的出现率为15.63%,其长度为(0.98±0.18) cm,宽度为(0.39±0.11) cm,厚度为(0.06±0.02) cm.C8颈神经前支出椎间孔后经此异常韧带的深面进入三角形结构内,然后跨过中小斜角肌的内缘进入斜角肌间隙.结论C8颈神经前支经过此三角形结构时周围结构的压迫是导致胸廓出口综合征的原因之一.  相似文献   

8.
目的探讨基于2D/3D配准技术测量离体颈椎标本椎间孔形态学的精度。方法获取16具颈椎离体标本的螺旋CT影像,通过三维重建获得相应标本的三维模型。然后改变标本的体位,再次行CT扫描并分别拍摄各具离体标本正侧位X线平片,采用2D/3D图像配准技术还原拍摄平片时颈椎的三维位置。利用Rapidform XOR3软件测量配准前与配准后C_(2/3)至C_(6/7)双侧的椎间孔面积、前后径和上下径。结果共测得椎间孔的面积、前后径和上下径各158个,经配对样本t检验,配准后椎间孔的面积、前后径、上下径与配准前相比较,结果无显著性差异(P0.05);椎间孔面积的准确度为96.77%、精确度为(1.27±1.16)mm~2,前后径的准确度为94.35%、精确度为(0.30±0.27)mm,上下径的准确度为96.14%、精确度为(0.32±0.28)mm。结论应用2D/3D配准技术测量颈椎间孔的形态学参数具有较高的准确度和精确度。  相似文献   

9.
目的 探讨神经根型颈椎病发病的形态学依据。方法 使用游标卡尺测量 5 0例成人干燥颈椎的脊神经沟及相关数据 ,应用foxpro 5 .0建立数据库 ,EPI软件单因素分析。结果 ①在脊神经沟中部 ,第七脊神经前支最不易受横突孔影响。②外口沟深值两侧均以第 5、6颈椎大 ,两侧均以第 3、4和 7颈椎相对小。③脊神经沟内口、中部和外口均为脊神经易受损伤处。结论 脊神经沟的内口、中部、外口为神经根型颈椎病的好发部位  相似文献   

10.
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  相似文献   

11.
The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR.  相似文献   

12.
The accessory nerve is traditionally described as having both spinal and cranial roots, with the spinal root originating from the upper cervical segments of the spinal cord and the cranial root originating from the dorsolateral surface of the medulla oblongata. The spinal rootlets and cranial rootlets converge either before entering the jugular foramen or within it. In a recent report, this conventional view has been challenged by finding no cranial contribution to the accessory nerve. The present study was undertaken to re-examine the accessory and vagus nerves within the cranium and jugular foramen, with particular emphasis on the components of the accessory nerve. These nerves were traced from their rootlets attaching to the spinal cord and the medulla and then through the jugular foramen. The jugular foramen was exposed by removing the dural covering and surrounding bone. A surgical dissecting microscope was used to trace the roots of the glossopharyngeal nerve (CN IX), vagus nerve (CN X) and accessory nerve (CN XI) before they entered the jugular foramen and during their travel through it. The present study demonstrates that the accessory nerve exists in two forms within the cranial cavity. In the majority of cases (11 of 12), CN XI originated from the spinal cord with no distinct contribution from the medulla. However, in one of 12 cases, a small but distinct connection was seen between the vagus and the spinal accessory nerves within the jugular foramen.  相似文献   

13.
腰骶部脊神经根的临床解剖学   总被引:7,自引:8,他引:7  
通过临床选择性脊神经后根切断术中观察与测量,为临床提供了重要的参考数据。腰骶神经前、后根解剖会合点至椎间孔距离平均为1.5~2.0cm。前后两根相比,后根明显较前根粗,其中以L_5后根最粗、L_2~S_1各后根内小束的数目为4~18束,平均为7束,临床分离后根时可分为7束,以便进行电刺激选择。这些资料为腰骶部选择性脊神经后根切断术和马尾神经的手术提供了重要依据。  相似文献   

14.
It has been suggested that in addition to motor axons, which extend directly into the spinal accessory nerve (SAN), ventral rami-associated motor fibers of cervical nerves also innervate the trapezius muscle. Using fluorescent dye labeling and 3D reconstruction in adult rats, this study clarifies the localization of motoneurons, which extend axons either directly through the SAN or through the ventral rami of cervical nerves to innervate the trapezius. DiI or DiI and DiO were used to label the ventral rami of cervical nerves entering the SAN, as well as branches of the SAN. We show that motoneurons whose axons pass through the ventral rami of cervical nerves and then enter the SAN, and those extending axons directly through the SAN are distributed within the same area. The neurons that extend axons through the SAN had a greater diameter than those axons that pass through the cervical nerves en route to the trapezius muscle. In addition, the axons that ultimately extend through the SAN exit the spinal cord dorsolaterally, while those that pass through the cervical nerves extend out the spinal cord through the ventral roots. We presume that the neurons that extend axons through the SAN are mainly alpha-motoneurons and that those projecting axons through the cervical nerves to the trapezius are mainly gamma-motoneurons. Taken together, these results could explain why patients in whom the SAN was used to treat brachial plexus injury retain some control of the trapezius muscle.  相似文献   

15.
Purpose  The aim of this study was to demonstrate the connection types and frequency between the accessory nerve and the posterior roots of the C2–C6 cervical nerves. Methods  The cranial cervical regions of 49 specimens from 27 human cadavers were used for the present study under an operating microscope. Results  Five different connection types between the accessory nerve and the posterior roots of the cervical nerves were recorded and photographed (types A–F). One of these types was not described previously in literature (type F). All connections between the posterior roots of the C2–C6 spinal nerves and the accessory nerve were at the level of the C2 segment. Type B was the most frequently seen type in our series. One of the rootlets of the cervical posterior root joined the accessory nerve without a connection to the spinal cord in type B. Conclusions  The clinical importance of these connections is especially noticed during the radical neck dissection as it may lead to the development of the shoulder-arm syndrome.  相似文献   

16.
This study was performed to identify the anastomoses between the accessory nerve and the posterior roots of cervical nerves below the level of C1 segment, and to evaluate their clinical significance. One hundred spinal cord sides of Koreans were studied under the surgical microscope. In order to trace the posterior root of a cervical nerve after anastomosis with the accessory nerve, or the bridging fibers between the accessory nerve and the cervical posterior roots, the accessory nerves with the posterior roots and the bridging fibers were stained with osmium tetroxide. The anastomosis was classified into five types, according to whether the accessory nerve and the cervical posterior root crossed each other, and also according to the site of the bridging fiber between them. The bridging fibers in the most common type of anastomoses were observed to connect the posterior roots of a cervical nerve with the spinal rootlet of the accessory nerve. The possibility that the motor fibers of accessory nerve from the spinal cord may innervate the trapezius muscle through the cervical nerve, was discussed.  相似文献   

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