神经根在牵位作用时的位移变化及其临床意义

作者对７具新鲜尸体在模拟间盘突出情况下，腰神经根受力时的位移变化进行了测量。结果：１００ｇ牵拉力的作用下，神经根袖位移在１ｃｍ以下者占１１．５９％，位移在１－２ｃｍ者占７８．２６％，位移在２ｃｍ以上者占１０．１４％。认为神经根在椎５管内松弛程度，可能是决定突出间盘在突出后是否引起临床症状的病理基础之一。     

食管癌向管壁浸润程度的CT与病理研究

３０例食管鳞癌病人术前测量ＣＴ扫描片的食管壁厚度，术后做相应部位管壁的病理组织学观察。两者对照研究发现：管壁厚度≤１ｃｍ时外侵率为６％，～２ｃｍ时为５１％；～３ｃｍ时为７９％；〉３ｃｍ者则无法手术切除。切除组平均食管壁厚为１．４５ｃｍ，其中≤１ｃｍ占５２％，～２ｃｍ占３７％，～３ｃｍ占１１％。探查组平均食管壁厚为２．８０ｃｍ，其中≤１ｃｍ占９％，～２ｃｍ占１６％，〉２ｃｍ占７５％。文章讨论了以ＣＴ     

胸小肌喙突骨瓣移位修复肩锁关节脱位的应用解剖

目的　为胸小肌喙突骨瓣移位修复肩锁关节脱位提供解剖学依据。　方法　３０ 侧经动脉内灌注红色乳胶的成人尸体标本, 对胸小肌的形态、血管、神经及喙突的形态结构进行解剖学观察。　结果　胸小肌中部长（１４９ ±１７）ｃ ｍ ,起始处宽（ ７２ ±１２）ｃ ｍ ,中部厚（５１ ±１９） ｍ ｍ ,附着部宽（１５±０４）ｃ ｍ 。营养动脉主要源于胸肩峰动脉的占８３３ ％ （ ２５ 侧） , 肌门距肌起、止点分别为（ ２２ ±１７）ｃ ｍ 、（５７ ±１４）ｃ ｍ 。胸小肌的神经９３３ ％ （ ２８ 侧） 由胸前内侧神经分支支配, 长（ ２９ ±２４）ｃ ｍ 。喙突长（４ ０ ±０３）ｃ ｍ 、宽（１６ ±０ ２）ｃ ｍ 、厚（０９ ±２ ）ｃ ｍ 。　结论　设计胸小肌喙突骨瓣移位修复肩锁关节脱位具有可行性     

电化学治疗中晚期肺癌的临床效果

应用电化学治疗不适宜手术切除的中晚期肺癌或经放、化疗无效的５９３例病人，包括年老体弱或有高血压、冠心病、糖尿病、肝肾功能不全者１５１例，经放化疗无效或未完成者１３８例，曾仅接受中医治疗但肿瘤继续增大者８３例，消化道癌术后肺内转移５２例，开胸探查手术１６９例。治疗方法为应用直流电治癌仪，将特制铂金电极针插入肿瘤内，针间距离以２ｃｍ为宜，电压调至８Ｖ左右，电流为６０～８０ｍＡ，按肿瘤直径每１ｃｍ给１００库仑（Ｃ）。结果１年内近期疗效显示获ＣＲ１５５例（２６１％），ＰＲ２６８例（４５１％），ＮＣ８９例（１５０％），ＰＤ８１例（１３０％）；ＣＲ和ＰＲ评为有效，占７１３％。远期随访结果示生存１年以上者共５０８例（８５６％），生存２年者４４０例（７４１％），生存３年者３３４例（５６３％），生存４年者２３２例（３９１％），生存５年者１６９例（２８４％）。结论：电化学治疗适应证为不能手术的中晚期肺癌或开胸后肿瘤不能切除者，放化疗无效者。尤其是对＞８ｃｍ的巨块肺癌，更宜采用电化学和放化疗相结合的综合方法。本疗法具有简便、安全、有效、创伤小、恢复快的优点。     

神经根鞘膜切开减压对腰椎间盘突出症术后神经功能恢复效果的探讨

目的：观察神经根鞘膜切开减压对促进腰椎间盘突出症术后神经功能恢复的效果。方法：自１９９２年４月～１９９７年４月对２６例腰椎间盘突出症病人行间盘切除的同时,将增粗的神经根鞘膜切开减压,并与同期３０例作比较。２组病人术前除腰腿疼痛外,患肢麻木症状重或伴趾背伸肌力减弱,术中均有神经根明显增粗,苍白表现。切开组自神经根出口０５ｃｍ向远侧切开鞘膜,长度约１ｃｍ左右,见神经纤维明显膨出。结果：切开组术后患肢麻木及趾背伸肌力恢复快,２组在术后２周及半年存在显著差异（Ｐ＜００１）。结论：神经根鞘膜切开减压,能迅速促进腰椎间盘突出症病人术后神经功能的恢复。     

神经根鞘膜切开减压对腰椎间盘突出症术后神经功能恢复效果

目的：观察神经根鞘膜切开减压对促进腰椎间盘突出症术后神经功能恢复的效果。方法：自１９９２年４月～１９９７年４月对２６例腰椎 间盘突出症病人行间盘切除的同时,将增粗的神经根鞘膜切开减压,并与同期３０例作比较。２组病人术前除腰腿疼痛外,患肢麻木症状重右伴趾背伸肌力减弱,订中均有神经根明显增粗,苍白表现。切开线自神经根出ｃｍ向远侧切开鞘膜,长度约１ｃｍ左右,风神经纤维明显膨出。结果：切七组术后患肢麻木及     

掌背动脉皮瓣在断指再植中的应用

我科１９９６年７月～１９９７年７月将掌背动脉皮瓣用于断指再植并皮肤缺损４例的修复,皮瓣及手指全部存活。临床资料本组男２例,女２例,年龄１６～３３岁,机器冲击伤２例,机器绞伤２例,离断部位均在近节,其中食指、环指各１例,分别伴掌指关节水平的指背及掌背皮肤缺损２５ｃｍ×２０ｃｍ及３０ｃｍ×２０ｃｍ;中指两例伴近节掌面及桡侧皮肤缺损分别为２８ｃｍ×１８ｃｍ和２５ｃｍ×１８ｃｍ,且并指动脉缺损３２ｃｍ和３０ｃｍ。手术方法：在臂丛麻醉下,断指再植手术处理,止血带下根据皮肤缺损的大小和形…     

腰骶神经根异常综合征(临床14例报告)

目的：报道临床所见腰骶神经根异常综合征。方法：５２３例诊断为腰椎间盘突出症而行手术治疗中发现１４例为腰骶神经根变异而致病，（占２６８％）。予以手术治疗。结果：通过手术所见，腰骶神经根变异，解剖上可分为：１腰骶神经根畸形，２腰骶神经后根节异位。结论：腰骶神经根异常综合征，临床不多见，术前影像学检查确诊率较低，术中应注意去除一切对异常神经根造成嵌压的因素，包括轻度的椎间盘突出，小关节内聚、增生、黄韧带肥厚、退变等可收到较好的临床治疗效果     

先天性髋脱位短缩截骨的疗效评价

随访１９７８～１９９５年治疗６岁以上先天性髋脱位患者１０４例、１４４髋，平均随访７．２年，治疗时平均年龄８岁。股骨短缩２２例、２８髋，平均脱位上移２．９ｃｍ，短缩１．６ｃｍ。未短缩者８２例１１６髋，平均脱位上移２．３ｃｍ。结果：前者优良率８５．７％，可差病例中半脱位１髋，关节僵１髋，肢体不等长２髋；后者优良率７５．９％。术后再脱位９髋（半脱位７髋，全脱位２髋）占７．８％，关节僵２６髋，占２２．４％，肢体不等长３０髋，占２５．９％。认为关节间残存的压力是引起各种并发症的关键所在，消除压力的有效途径是短缩截骨，单纯通过术前骨牵引难以达到这一目的     

腰椎间盘突出合并腰骶神经背根节嵌压（附12例报告）

目的：了解腰椎间盘突出合并腰骶神经背根节（ＤＲＧ）嵌压的机制。方法１２例腰椎间盘突出患者术中发现：髓核切除后神经根张力仍较大并固定,沿神经根探查发现腰骶神经ＤＲＧ充血并肿大,直径０．８－１．２ｃｍ,平均１．１ｃｍ。嵌压物为增生的上关节突和增生肥厚的关节囊韧带。１２例病人共探查１５个ＤＲＧ,其中位于椎间孔６例,椎管和椎间孔交界７例,椎间孔外２例同时合并腰神经在椎间孔外嵌压。结果术后腰腿痛完全缓解９例     

Location of the first and second sacral nerve roots in relation to pedicle screw placement

Dissection and measurements of the first 2 sacral nerve roots with regard to the commonly used entrance points for S1 and S2 pedicle screw placement were performed to determine the location of the first 2 sacral nerve roots in relation to the pedicle screw entrance points in the upper 2 sacral vertebrae. The sacral nerve roots, dural sac, and pedicles were exposed after laminectomy. The mean distance from the reference point to the adjacent nerve roots superiorly and inferiorly at the S2 pedicle level was smaller than those at the S1 pedicle level. The medial angle of the sacral nerve roots progressively decreased from L5 to S3. The nerve root passing through the next foramen formed an immediate medial relation to the sacral pedicle rather than the dural sac. Pedicle screw placement in the first 2 sacral vertebral pedicles has been recommended for lumbosacral fusion and internal fixation of sacral fractures. No anatomic study is available regarding the location of the sacral nerve roots relative to the entrance points of sacral pedicle screw placement. Violation of the sacral canal and foramina by a sacral pedicle screw may injure the sacral nerve roots, especially at the level of the S2 pedicle.     

产瘫与成人臂丛损伤发生机制差异的解剖学研究

目的研究产瘫较成人臂丛损伤更容易出现C7神经根撕脱的解剖学基础,以进一步了解产瘫的特殊性。方法1.解剖新生儿与成人尸体各6具( 12侧) ,观察并比较新生儿与成人C5～T1神经根在椎管内外的形态特点。具体指标为神经根分出角、前支分出角、前根长度、前根发出区长度、前根根丝数目。2 .解剖新鲜新生儿尸体6具( 12侧) ,采用HE染色及Mallory三色染色观察臂丛诸根与周围组织的关系并比较不同神经根之间的差异。结果新生儿C7神经根分出角小于其前支分出角,成人C7神经根分出角大于其前支分出角,其余指标未见显著性差异。新生儿C5 7神经根在椎间孔处的主要保护性结构为上半椎韧带,但C7神经根上半椎韧带内胶原纤维面积比小于C5、6神经根,且差异有统计学意义(P <0 .0 5 )。此外,在C5、6上半椎韧带与横突附着处常可见Sharpey纤维而C7上半椎韧带内几乎见不到Sharpey纤维。结论新生儿C7神经根在椎管内外走行方向的特点及其上半椎韧带较薄弱,可能是造成产瘫患儿C7常表现为根性撕脱的重要原因。     

应用T11～L1神经根修复S2、S3神经根的可行性

目的:研究T11到S3神经根的直径和神经纤维数,探讨胸-骶神经根吻合恢复膀胱功能的可行性。方法:24具成人脊柱标本,暴露T11平面以下脊髓神经根。测量T11到S3各神经前后根直径。取3具新鲜尸体脊神经根标本,切取T11到S3脊神经前后根各一段,进行免疫组化研究,统计比较骶神经根神经纤维数与胸或腰神经根的差别。结果:S3前根比任一神经根都细(P<0.05),S2前根与L2前根相近(P>0.05),比T11、T12、L1粗(P<0.05)。S3前根的神经纤维数比任一神经根都少(P<0.05),S2前根与T12、L1、L2神经根的神经纤维数相近(P>0.05),比T11神经根多(P<0.05)。神经根的神经纤维数与其直径呈正相关(rs=0.797)。结论:功能相对次要的T11、T12、L1神经根的神经纤维从数量上为修复S2、S3神经根提供了可行性。     

Intradural microanatomy of the nerve roots S1-S5 at their origin from the conus medullaris

OBJECT: The conus medullaris and the nerve roots from S-1 to S-5 regulate bladder function as well as movement and sensation of the lower extremities. This most caudal region of the spinal cord has not been studied in great detail anatomically despite its important regulatory role. The goal of this analysis is to characterize the normal intradural microanatomy of the sacral nerve roots at their origin from the conus medullaris. METHODS: The thecal sacs from 20 cadavers were fixated in formaldehyde and dissected under the operative microscope. RESULTS: More than 50 rootlets originated from the conus medullaris over a distance of < 3 cm. The rootlets were loosely organized into bundles by the arachnoid membrane with decreasing diameters. These diameters were 1.7 mm (ventral)/2.4 mm (dorsal) at S-1, and 0.17 mm (ventral)/0.4 mm (dorsal) at S-5. The roots were separated by neither the dentate ligament nor interradicular gaps. The number of rootlets decreased in the rostrocaudal direction with 2 ventral and 5 dorsal rootlets at S-1, but only 1 ventral (inconsistently found) and 2 dorsal rootlets at S-5. Typically, 1 nerve anastomosis was present between adjacent dorsal roots from S-1 to S-4. Nerve anastomoses between ventral roots or rootlets of the same root were less frequent. The dorsal segment of origin (linea radicularis) decreased in length from 7.2 mm at S-1 to 4.8 mm at S-5. CONCLUSIONS: The current study provides anatomical details and specific morphometric data of the intradural contents at the level of the conus medullaris. This information is valuable for intraoperative orientation, endoscopic navigation, and possible intradural nerve stimulation.     

Anatomical evidence for the anterior plate fixation of sacroiliac joint

Background

The iatrogenic injuries to the lumbar nerves during the fixation the sacroiliac (SI) joint fractures with anterior plates were often reported. No specific method had been reported to avoid it. This study was done to find a safer way of placing the anterior plates and screws for treating the sacroiliac (SI) joint fracture and/or dislocation.

肩胛背神经卡压的应用解剖学研究

观察并分析腱性纤维束是否为造成肩胛背神经卡压的主要因素。方法：在３２侧成人尸体标本上，观测肩肿背神经的起源、走行、分支、分布及其与中斜角肌的解剖关系。结果：肩胛背神经７５％（２４／３２）从Ｃ５神经根发出；由前内侧向后外侧从中斜角肌穿过，其长度为１．２±０．３ｃｍ，在其内侧缘有大部分键性纤维组织存在。该神经除发出２～５支肌支外，另有２５％（８／３２）还发出细小分支走向肩背部。结论：中斜角肌内侧缘的限性结构特点是造成肩胛背神经卡压的形态学基础。     

Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis

BACKGROUND CONTEXT: In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root compression is almost always seen on the concave side of the scoliosis, and L4 and L5 nerve roots are the most often involved. However, there are few reports on the relationship between nerve root compression and the pattern of scoliosis. PURPOSE: To investigate the factors that may contribute to radiculopathy in DLS and their association with the pattern of the scoliosis. STUDY DESIGN: Retrospective analysis. METHODS: Twenty-two consecutive patients with DLS with radiculopathy were examined. The symptomatic nerve roots were determined by pain distribution, neurological findings and nerve root infiltration using lidocaine. The compressive factors were diagnosed by magnetic resonance imaging or myelography, discography, computed tomography after myelography or discography and radiculography. The pattern of scoliosis was determined in plain radiographs. We evaluated the correlation between the affected nerve root and the compressive factors or the pattern of the scoliosis. RESULTS: The L3 root was affected in 23% of patients; L4 root in 68%, L5 root in 55% and S1 root in 18%. L3 and L4 roots were more compressed by foraminal or extraforaminal stenosis on the concave side of the curve, whereas L5 and S1 roots were commonly affected by lateral recess stenosis on the convex side. The Cobb angle and the lateral slip of the cases in which L3 or L4 root was affected were significantly larger than in cases in which L5 or S1 root was compressed. CONCLUSIONS: In the treatment of radiculopathy caused by DLS, it is important to bear in mind that L3 or L4 roots were more strongly compressed by foraminal or extraforaminal stenosis at the concave side of the curve, whereas L5 or S1 nerve roots were affected more by lateral recess stenosis at the convex side of the curve.     

Anomalies of the lumbosacral nerve roots with low backache and sciatica

Nine patients with lumbosacral nerve root anomalies (NRA) were reported. 36 cases were collected from reported papers in addition, seven types of NRA were classified by the author. They were: conjoined root (with the incidence of 31.11%), near roots (26.66%), two roots in same foreman (20%), anastomosis between roots (11.11%), double roots (4.44%), branch root and combined type (6.66%). The rate of finding of NRA by operation was 0.34%, that was far lower than by myelography and autopsy. Careful exploration can increase the finding rate. NRA can induce backache and sciatica by itself. Its clinical distinguishing features were severe symptoms, compression of multiple nerve roots slight or negative Lasegue sign. The principle of treatment of NRA was adequate decompression, but should be careful to avoid injury of displaced and tensile nerve roots. In this paper, the matters needing attention in operation was discussed as well.     

骶椎神经源性肿瘤的外科治疗

目的:观察Ⅰ期肿瘤切除手术治疗骶椎神经源性肿瘤的疗效及并发症,探讨手术相关的解剖学原理。方法:对2001年1月至2018年1月手术治疗的26例骶椎神经源性肿瘤患者进行回顾性分析,男16例,女10例;年龄21~69(39.3±10.9)岁;病程3~56(17.9±10.1)个月;骶前肿块直径3.3~19.6(8.7±4.1) cm;骶前肿块上缘高于和不高于L₅S₁间隙水平者分别为6和20例。手术均先取后入路,必要时附加前入路,Ⅰ期切除肿瘤,部分患者行腰椎-骨盆内固定重建,术中视情况决定是否保留载瘤神经根。记录患者的手术时间、术中出血量、疼痛缓解程度及并发症情况。术后随访评估腰骶椎稳定性和神经功能,并检查有无局部复发和远处转移。结果:26例均Ⅰ期完整切除肿瘤,手术时间(160.4±35.3) min,术中出血量(1 092.3±568.8) ml。单纯后入路21例,前后联合入路5例。前后联合入路者骶前肿块直径11.3~19.6(15.1±3.2) cm,单纯后入路者为3.3~10.9(7.2±2.4) cm。骶前肿块上缘高于L₅S₁间隙的6例患者中5例采取了前后联合入路,不超过L₅S₁间隙的20例均为单纯后入路。所有病例获得随访,时间6~82(45.4±18.2)个月。术后腰骶痛、下肢根性痛均明显缓解,感觉、肌力和二便功能也有不同程度改善。术后切口浅表感染1例,脑脊液漏2例。病理证实神经鞘瘤17例,神经纤维瘤7例,恶性神经鞘瘤2例。2例良性神经源性肿瘤局部复发,1例恶性神经鞘瘤术后20个月时死于肺转移。17例高位骶骨神经源性肿瘤有4例未行内固定重建,其中2例术后脊柱失稳。7例切除载瘤神经根,其中1例同时切除S₂和S₃神经根的患者术后出现膀胱和直肠功能异常,且未能完全恢复,另6例神经功能无明显损害或恢复良好。结论:后入路能直接显露病灶,处理神经根和血管也方便,手术时间、术中出血量、症状缓解程度、并发症率和复发转移率均能控制在适当水平,是安全有效的手术入路;但当骶前肿块上缘高于L₅S₁水平或骶前肿块直径达到10 cm以上时,应考虑附加前方入路。脊柱和骨盆之间应力较高,高位骶椎神经源性肿瘤切除术中应使用内固定重建脊柱-骨盆的力学连续性。载瘤神经根多已丧失功能,切除单根载瘤神经根不易引起严重神经功能障碍,而邻近神经根具有代偿功能,术中应尽量保留。     

Neurologic complications of shoulder surgery

Nerve injuries do occur during shoulder surgery. Studies of regional anatomy have defined the nerves at risk. The suprascapular nerve may lie no more than 1 cm from the glenoid rim. The axillary nerve may run no more than 3 mm from the inferior shoulder capsule and passes near the lower extent of the deltoid split used as an approach to the shoulder. The musculocutaneous nerve passes as near as 3.1 cm below the coracoid. Interscalene nerve block is not commonly implicated in nerve injuries. Three-dimensional knowledge of nerve anatomy is essential during arthroscopy for safe portal placement and trochar direction. Nerve injuries are reported to occur in 1% to 2% of patients undergoing rotator cuff surgery, 1% to 8% of patients undergoing surgery for anterior instability, and 1% to 4% of patients undergoing prosthetic arthroplasty. Surgical techniques for the shoulder are improving and nerves seldom are injured by direct laceration or incorporation in suture repair. Commonly, the nerve injuries occur secondary to traction or contusion. These are avoided best by careful attention to patient positioning, retractor placement, and arm manipulation during surgery. Because of the contemporary nature of these nerve injuries, observation is almost always the treatment of choice, with delayed electrodiagnostic testing should nerve recovery not occur within a 3 to 6-week period.