人体脊髓节段和脊神经节观测

成人尸体１５具,其中男尸６具,女尸９具,共３０侧,分别去其头、颈和四肢,取出胸腔器官,从背部人路进行解剖,直至切除椎弓,暴露硬膜囊和椎间孔,打开硬膜囊,并追随后根直至椎间孔处的脊神经节,剥去包膜,清理周围组织,用游标卡尺测量第１胸髓上缘至第５腰髓下缘长度,胸腰各脊髓节段的长度和横径,胸腰各脊神经节的长度和最大横径。数据经统计处理后列于附表。结果显示：（１）脊髓节段长度从Ｔ１向下逐渐变长到Ｔ９达到最高值,此后逐渐变短到Ｌ５达最低值;（２）脊髓节段的横径从Ｔ１向下逐渐变小,Ｔ７～Ｔ１０稳定在一个低水…     

颈后经硬膜囊手术入路的应用解剖学研究

目的分析颈椎硬膜囊内结构的解剖学资料,为颈后经硬膜囊手术入路提供参考依据。方法解剖15具成人尸体标本,观测颈椎硬膜囊内解剖形态结构与特征、颈神经根与相应椎间盘的关系。结果C3-C8后根所含根丝数目一般略少于相应节段前根根丝数目,但较前根粗大;各节段前、后根自脊髓相应节段的前、后外侧沟发出的角度由上往下逐渐减小;硬膜囊与脊髓横径分别在（17．03±0．51）mm-（18．17±0．59）mm和（11．37±0．30）mm-（12．64±0．43）mm之间;各平面蛛网膜下腔两侧间隙宽度为（5．52±0．33）mm-（5．78±0．48）mm;前、后根根丝间距分别在（1．93±0．49）mm-（4．70±0．35）mm和（1．38±0．38）mm-（3．90±0．31）mm之间;根间距在（10．54±0．75）mm-（12．55±0．58）mm;神经根与相应椎间盘后下缘的最短距离在（-1．82±0．40）mm-（4．70±0．39）mm之间。结论通过对颈椎硬膜囊内解剖形态结构的研究证实颈椎硬膜囊内存在显微镜下经硬膜囊入路的手术操作区。     

臂丛后根脊髓入区的显微外科解剖

目的:为临床应用后根入区破坏法治疗臂丛根性撕脱伤后疼痛提供基础。方法:在20例成年人尸体上充分暴露C5～T1脊髓节段和相应神经后根区需切除椎板的长度和宽度,测量各神经根根丝的数目、与脊髓的角度和相应各脊髓节段前正中沟至后外侧沟的距离,各脊髓节段的定位和相应神经后根区的精细定位。取下脊髓,在显微镜下测量各节段脊髓后脚在横截面上的长度、宽度和后角纵轴与脊髓矢状面的夹角,确定术中需要损伤后根区的范围和角度。结果:切除C4～C7的脊突和椎板可暴露C5～T1神经后根。C5～T1各神经后根的根丝平均为7.76条,C6的后根根丝最多。各神经后根最下缘的根丝与脊髓纵轴的夹角从C5的65.6°逐渐变小到T1的19.8°。脊髓后外侧沟(神经后根根丝进入脊髓处)到后正中沟的距离平均为2.95 mm。脊髓后脚底至后外侧沟的长度平均为3.47 mm,宽度平均为1.35 mm。后脚的纵轴与脊髓矢状面的夹角平均为35.9°,自C5至T1逐渐变小。结论:(1)用破坏臂丛脊髓后根入区的方法治疗臂丛根性撕脱伤后疼痛需切除C4～C7的棘突和椎板;(2)损伤时器械应与脊髓矢状面大约成30°～40°角;(3)在横截面上损伤的宽度不能超过1.2 mm,损伤的深度不能超过3.1 mm。     

蛛网膜下隙内脊神经根的形态学观察

脊神经硬膜外部的形态学研究报道较多,蛛网膜下隙内脊神经前、后根及其根丝的研究报道较少.为积累国人体质资料和为椎管内手术提供形态学基础,在30具(男24,女6)60侧成人尸体上,自正中线依次切开皮肤、皮下组织、肌肉.去除椎管后壁,切开硬脊膜与蛛网膜,暴露脊髓及其神经.在手术显微镜下(×10)观察测量了蛛网膜下隙段神经根的长度,测硬膜处的前、后根的前、后径,以及对应脊髓节的高度.自枕骨大孔处横断脊髓及其被膜,在椎间孔外侧切断所有脊神经根,取出脊髓后沿前正中线切开硬膜及其蛛网膜,用测量后根的相同方法测量前根及其根丝,其结果分三部分.     

与胸12,腰1椎骨对应的腰骶神经根的应用解剖

在２０具（男１６，女４）成人尸体上，对胸１２、腰１椎骨对应的蛛网膜下隙内脊髓节、脊神经前、后根进行了应用解剖学研究。结果胸１２椎骨多与腰２￣５脊髓节、胸１２￣腰５神经根对应；腰１椎骨与骶１￣尾脊髓节、腰１￣尾脊神经根对应，据此，损伤时利于定位诊断。腰１￣３脊神经根远侧段与腰４￣骶３的近侧段之间常有一定长度的重叠，重叠的长度供神经缝接参考。文内还对神经根排列位置，前、后根的数目、长度和外径等进行了观     

胸腰骶段脊神经根鞘结构的解剖学和组织学研究

目的　明确胸腰骶部不同节段脊神经根鞘的解剖学和组织学结构及其分布特点,探讨其临床意义。 方法　取7例成人脊柱标本,解剖观察胸腰骶部不同节段神经根鞘的硬脊膜囊开口方式,并制成组织切片后显微镜下观察神经根鞘的结构。 结果　胸腰段神经根鞘存在单孔和双孔两种硬脊膜囊开口方式,而骶段神经根鞘只存在单孔开口方式;单孔根鞘又根据前、后根之间有无双层袖套结构分为Ⅰ型和Ⅱ型。较之神经根其他部位,神经节处硬脊膜袖套的胶原纤维层少且结合疏松。腰4/5和骶1~5节段神经节处的硬脊膜袖套的厚度比其他节段更薄（F=37.31,P<0.01）。神经根袖套下腔隙终止于神经节。 结论　Ⅰ型和Ⅱ型神经根鞘在各节段的分布规律,解释了腰骶部神经根受压时多表现为感觉和运动功能同时受累的现象;而神经节处的硬脊膜袖套在下腰骶节段最薄的特点,也和腰腿痛高发的现象相关系。脊神经节是脊神经根开始转化为脊神经的标志。     

椎管内臂丛前后根的显微解剖及其临床意义

目的:研究臂丛椎管内前后根的显微解剖,为臂丛撕脱伤的诊治提供解剖学基础。方法:在15例防腐灌注红色乳胶的成人尸体的颈胸段标本上,对椎管内臂丛前后根的位置、形态和血供进行观察和测量。结果:臂丛前后根之间有齿状韧带相间隔;前根起始处与脊髓中线的距离从上至下由C5的2.2mm逐渐增大到T1的3.1mm,后根则从C5的4.2mm逐渐减小到T1的2.7mm;前后根与脊髓纵轴的夹角从C5的51.4°、54.8°逐渐减小到T1的21.7°、19.9°;前后根的长度从C5的14.9mm、13.9mm逐渐增大到T1的21.1mm、19.0mm;前后根的直径均以C6最为粗大,分别为2.1mm、3.3mm,后根比相应前根粗;前后根的血供来自椎动脉、颈深动脉和颈升动脉发出的节段性动脉。结论:熟悉臂丛椎管内前后根的显微解剖有助于临床臂丛根性撕脱伤的诊治。     

脊神经根的解剖学观测及临床意义

<正>为了全面探索脊神经根的正常与异常,及其与临床神经根性症状复杂多变的可能关系,我们对35具(男27具女8具)防腐固定的成人尸体进行解剖.从脊柱后正中全程打开椎管及椎间孔.以观察脊神经根的全貌,并测量70侧的每条脊神经前后根的横径及前后根解剖汇合点到硬膜囊出口处的距离.在观测的过程中,发现     

国人脊髓的观察

本文解剖了成年尸体25具(男19具,女6具)。测量了脊髓各节段长,左脊神经根长以及脊髓颈、腰膨大部和胸髓最小部的矢状径、冠状径和周径,并且还测量了骶前脊柱长和脊柱全长。发现脊髓各节段长的曲线有两个高峰。第1高峰在第7胸髓另一高峰在第5颈髓。脊神经根的长度,以腰、骶脊神经根最长,其次是胸脊神经根,而以颈脊神经根最短。还见到上、下脊神经后根间有交通支,这一交通支以颈部最多,其次是腰部,再次是骶部,而以胸部最少。在25 例左侧 C_1的脊神经后根中,发现17例无 C_1后根,缺如率占68.00%。     

颈椎侧块的应用解剖及其在后路钢板螺钉内固定术中的意义

目的 :为经颈椎后路侧块和椎弓根螺钉在颈椎的应用提供解剖学基础。方法 :对 10套成年C3～ 7段 5 0节防腐颈椎标本的颈椎侧块和椎弓根的高度、宽度、长度、椎弓根轴线的角度及进钉点定位等作了三维形态学观测。结果 :颈椎侧块的斜径线为 (10 .5 7± 1.41)mm、其倾斜角为 5 .14°± 0 .82° ,后表面中心点距椎动脉距离为 (13 .99± 1.63 )mm ;颈椎椎弓根的高为 (6.77± 0 .61)mm、宽为 (5 .18± 0 .5 9)mm、侧块后表面经椎弓根至椎体前缘间距为 (3 1.70± 1.44 )mm、椎体矢状面与经椎弓根轴线的夹角为 42 .90°±3 .2 1°。颈椎经侧块和经椎弓根螺钉内固定术在进钉的深度、方向、以及螺钉的选择上均有明显的区别。结论 :根据不同节段颈椎后侧路侧块和椎弓根的解剖特点 ,合理设计经颈椎侧块和椎弓根螺钉的直径和长度 ,准确选择相应的进钉点和进钉方向 ,可以保证颈椎后路侧块和椎弓根螺钉内固定在下颈椎的安全应用。     

Microsurgical anatomy of the denticulate ligaments and their relationship with the axilla of the spinal nerve roots

The denticulate ligaments (DL), 20 or 21 pairs of meningeal extensions, spread from the lateral aspect of the spinal cord to the internal aspect of the spinal dura mater. The aim of this study is to define the specific relationship of the DL with adjacent axilla of the spinal nerve roots and to investigate the anatomical features of the DLs and their variations. The topographical anatomy of the DLs and their relationships with the adjacent axilla of the spinal nerve roots was examined on 16 formalin‐fixed adult cadaveric spinal cords. The distances from the dural attachment of the DL to the axilla of the superior and inferior spinal nerve roots were measured bilaterally at every spinal level. Also the distances from the dural attachment of the DL to the lateral aspect of the spinal cord were measured bilaterally. Cervical DLs showed a triangular shape, while in the thoracic segment the ligament changes the shape to “Y.” Also the most caudal DL was identified to be at the L1–2 level. Our study revealed that the distances from the dural attachment of the DL to the superior and inferior spinal nerve root axilla were different at the cervical, upper thoracic and the lower thoracic segments. Both distances to the superior and inferior spinal nerve root axilla were shown to increase from cervical to lower thoracic segments. This study provides a detailed anatomy of the DLs and their relationship with the adjacent spinal nerve root axilla. Clin. Anat. 27:733–737, 2014. © 2013 Wiley Periodicals, Inc.     

Dorsal root projections in the clawed toad (Xenopus laevis) as demonstrated by anterograde labeling with horseradish peroxidase

Horseradish peroxidase was applied to the proximal stumps of severed cervical, thoracic and lumbar dorsal roots in the clawed toad, Xenopus laevis, in order to study the course, distribution and site of termination of dorsal root fibers in the spinal cord and brain stem. The anterograde transport of horseradish peroxidase as applied in the present study proved to be a useful and reliable technique. Results show that on entering the spinal cord, dorsal root fibers segregate into a medially placed component entering the dorsal funiculus and a more laterally situated bundle in the dorsal part of the lateral funiculus. As regards its position the latter bundle presumably represents the anuran homologue of the mammalian tract of Lissauer. Moreover, a small intermediate bundle of fibers directly enters the spinal gray matter. The labeled fibers entering the dorsal funiculus and the tract of Lissauer ascend and descend in the spinal cord, displaying a longitudinal arrangement resembling that of higher vertebrates.In the spinal gray, dorsal root fibers terminate in the dorsal, central and lateral fields of Ebbesson, 25 with the last field being a major terminus for dorsal root fibers originating in the limb-innervating segments. No dorsal root fibers were found to project to the motoneuron fields. A dorsal column nucleus, which is divisible into medial and lateral compartments, is present in the obex region and extends from the level of the second spinal nerve to that of the entrance of the vagus and glossopharyngeal nerves. Dorsal root fibers from the lumbar and all thoracic segments project to the medial compartment of the dorsal column nucleus, whereas those of the cervical enlargement project to the lateral compartment.Although the anuran dorsal column nucleus appears to be less differentiated than that of higher vertebrates, its medial and lateral compartments can be considered to be the forerunners of the mammalian nucleus gracilis and nucleus cuneatus, respectively.     

家兔前庭核与脊髓的联系——HRP法研究

将HRP注入家兔颈、胸或腰髓的一侧灰质内,追踪前庭四核内的逆行标记细胞和顺行标记终支。发现同侧外侧核内标记细胞数量甚多,且具有体部定位规律。内侧核及降核的尾段标记细胞也较多,内侧核者甚为密集,它们投射到双侧脊髓的颈、胸、腰段,对侧多于同侧,无体部定位关系。降核的头段及在此平面的内侧核内也有一定数量的标记细胞,也投射到颈、胸、腰髓,同侧为主,无体部定位关系。上核内只有极少量标记细胞,主要投射到对侧颈髓。顺行标记终支于降核、内侧核的见端小范围内及外侧核的尾端背面较为恒定,颈、腰注射例在降核和内侧核的尾端尤为密集。     

移植大鼠脊神经前后根重建脊髓白质纤维束的形态学*

目的：观察移植脊神经前后根重建脊髓白质纤维束的形态学情况。方法：取4 周龄SD 大鼠,分为移植组、 损伤组和假手术组。移植组损伤第10 ～ 12 胸段脊髓,然后切取脊髓损伤区废用的脊神经前根和后根,并将前根 移植到脊髓损伤区域的皮质脊髓束位置,再将后根移植到薄束位置,脊髓与移植的神经根进行显微吻合,同时切 取第12、13 肋间神经连接损伤节段上下的脊神经,留置导管给予胶质细胞源性神经营养因子（GDNF）、轴突生 长相关蛋白（GAP-43）、突触分化诱导基因产物1（SynDIG1）。损伤组仅损伤第10 ～ 12 胸段脊髓。假手术组仅 切开皮肤和分离肌肉,不损伤脊髓。术后7、30、60、90 d,行斜板实验、BBB功能运动评分、神经电生理检测 方法检测3 组大鼠运动功能。免疫荧光染色显示移植区脊髓组织吻合段神经组织结构变化及神经细胞的活性。结 果：肉眼观察损伤组脊髓组织缺损、断端出现萎缩现象,移植组脊髓吻合段组织光滑圆润,没有明显萎缩现象, 吻合段在显微镜下可见神经纤维排列整齐、走行一致。移植组斜板实验、BBB功能运动评分明显高于损伤组,体 感电位、运动诱发电位潜峰时较损伤组明显缩短。结论：移植脊神经前后根重建脊髓白质纤维束,神经组织结构 吻合修复良好,有利于神经信号传递,促进下肢运动功能的恢复。     

A multiplanar anatomic study of the cervical proximal nerve roots and spinal nerves

An anatomic study focused on the proximal cervical spinal nerves has not been reported. Therefore, we dissected the cervical spinal nerves of three cadavers and examined stained sections in parasagittal and axial planes through the proximal cervical spinal nerves and root sheaths. These studies documented distinct segments of the spinal nerve which had not been completely described in the previous anatomic studies. The sheath originates from the dural sac as a common sleeve, divides into two sleeves, one containing the ventral root and one the dorsal root, and then distal to the dorsal root ganglion fuses again into one sleeve. A space, the interradicular cleft, separates the dorsal and ventral portions of the sleeve. The proximal segment of the spinal nerve proper distal to the dorsal root ganglion is composed of multiple small fascicles surrounded by a dense epineurium. The presence of an interradicular cleft in the cervical nerve root sheath and of fascicles in the cervical spinal nerve has significance for imaging of the cervical spinal nerves and for the pathogenesis of symptoms in cases of partial compression. © 1992 Wiley-Liss, Inc.     

大白鼠脊髓向延髓外侧网状核投射的体部定位——HRP顺行法研究

向大白鼠脊髓的颈、腰膨大和胸髓右侧半分别注入HRP或WGA—HRP,研究了脊髓向延髓外侧网状核的投射。 1.双侧的三叉神经下亚核同时接受颈、胸和腰髓来的投射。 2.大白鼠脊髓主要投射于外侧网状核的尾侧半,有一定的体部定位关系。颈髓投射于双侧大细胞亚核的外侧2/3及与共相邻接的一部分小细胞亚核内,以同侧投射为主。胸髓投射于双侧的大细胞亚核的内侧2/3和与之相邻接的一部分小细胞亚核内,两侧无明显差別。腰髓投射于双侧小细胞亚核和与之相邻接的部分大细胞亚核内,以对侧投射为主。它们相互间有部分重叠。 3.颈、胸和腰髓内外侧网状核投射的神经元位于从背角至腹角的灰质内,越边投射的神经元比不越边投射的神经元位置更靠腹侧。     

Hemorrhages of dorsal root ganglia and spinal cord in congenitally hydrocephalic HTX rat

The effects on the brain caused by hydrocephalus have been examined in detail. However, only little attention has been paid to the possibility that hydrocephalus may affect the spinal cord and the spinal ganglia via the spinal canal. Therefore, the present study focused on the pathological changes seen in the spinal cord and the dorsal root ganglia. A total of 651 congenitally hydrocephalic HTX rats were used in this study. The age ranged from postnatal day 0 to postnatal day 520. All of the HTX rats were from littermates raised in our laboratory. Macroscopic and microscopic investigations demonstrated hemorrhages of the dorsal root ganglia in 134 rats among the 235 affected HTX rats. The hemorrhages of the dorsal root ganglia were observed most frequently in the lumbar ganglia and, less frequently, in the cervical ganglia. Of the 134 rats with hemorrhages in the dorsal root ganglia, 34 rats had hemorrhages both in the spinal cord and in the dorsal root ganglia. The spinal cord hemorrhages were distributed mainly around the central canal and in the ventral parts of the posterior funiculus at the lower thoracic and upper lumbar cords. These hemorrhages were seen only in those rats having progressive hydrocephalus. These findings suggest that increased cerebrospinal fluid pressure can cause congestion of the radicular veins, leading to hemorrhages of the spinal cord and the dorsal root ganglia.     

Innervation of the canine thoracolumbar vertebral column

The pattern of innervation of the caudal thoracic and cranial lumbar vertebral column of the dog is described. Frozen sections stained with Schofield's silver impregnation method show that the dorsal longitudinal ligament is profusely innervated, while the anulus fibrosus contains a few nerves limited to its outermost layers; no nerves are present in the nucleus pulposus. Following injection of horseradish peroxidase (HRP) into the anulus fibrosus of the thoracolumbar intervertebral disc and subsequent removal and staining of dorsal root ganglia, the reaction product is found in ganglia as far as two segments cranially as well as caudally, demonstrating that the disc is innervated by nerves arising from several spinal cord segments. A meningeal ramus, which innervates the discs of man, could not be found by gross dissection. Dissections show each vertebral articular facet innervated by the medial branches of two contiguous spinal nerves, a pattern further confirmed by injections of HRP into facet joints with subsequent staining of dorsal root ganglia. The dorsal rami of spinal nerves often divide into medial, intermediate, and lateral branches rather than the traditionally described division into only medial and lateral branches.     

维生素D依赖性钙结合蛋白-D28K样阳性神经元在人胎儿和新生儿脊髓和背根神经节内的表达和分布

目的 :观察 2 4～ 2 7w人胎儿和新生儿的脊髓和背根神经节 (DRG)内维生素D依赖性钙结合蛋白 D2 8K(CB)样阳性神经元的表达和分布。方法 :采用免疫细胞化学ABC法对 2 4～ 2 7w人胎儿和新生儿进行观察。结果 :( 1 )CB样阳性产物的表达在胎儿DRG和脊髓灰质的神经元胞体及树突内可观察到。在脊髓各段有不同分布 ;( 2 )新生儿脊髓和DRG内CB样阳性胞体的数量、大小及染色强度均有所增加 ,但在空间分布上无大的变化。结论 :人胎儿的脊髓和DRG在发育的 2 4～ 2 7w至出生时 ,CB样阳性神经元的表达在定位分布上无差异 ,但随年龄增长 ,CB样阳性神经元的数量、大小和染色强度均有所增加。     

Termination patterns of calcitonin gene-related peptide-immunoreactive nerve fibers in the dorsal horn of the human spinal cord

Summary CGRP-immunoreactive varicose nerve fibers displayed three kinds of termination patterns in the cervical, thoracic and lumbar segments of the human spinal cord. Bundles of immunoreactive fibers formed a loose network in lamina I. A homogenous band of immunoreactive fibers filled lamina II. Multiple bundles of CGRP-positive fibers coursed through the superficial laminae towards deep portions of the grey matter. In the lumbar segments, in contrast to the cervical and thoracic segments, the bundles could be followed deep into the dorsal funiculus. Bundles of varicose immunoreactive fibers were seen to twine around the dendrites of neurons located in lamina I, in the dorsal funiculus of the lumbar segments and deep in the dorsal horn (laminae III–V). The corresponding types of large and medium-sized neurons were found in silver impregnated adjacent spinal cord sections. It is suggested that neurons in the above locations preferentially receive multiple contacts from CGRP-containing nerve fibers along their extensive dendritic arborizations (CGRP-target neurons).