颈7神经根的组化研究及其临床意义

目的：了解臂丛神经颈７神经根内运动及感觉纤维的分布，为健侧颈７神经根移位术时最大限度利用运动纤维及减少术后感觉障碍提供理论依据。方法：健侧颈７神经根移位术者１２例．Ｋａｒｎｏｖｓｋｙ－Ｒｏｏｓ法ＡｃｈＥ组化染色，ＴＪＴＹ－３００图像分析系统测定。结果：颈７神经根神经纤维数２７２１３±５４１７；后股运动纤维含量多于前股，感觉纤维主要分布在前股，其又以前内侧占优。结论：健侧颈７神经根移位术时，保留前内侧感觉纤维将最大限度地降低术后感觉障碍，而达到充分利用运动纤维的目的。     

坐骨神经桥接颈7神经根二期移位重建截瘫下肢功能的应用解剖

目的:为带血供的坐骨神经桥接颈7神经根二期移位重建截瘫下肢功能提供解剖学依据。方法:在动脉内灌注红色乳胶30侧成人下肢标本上,解剖观测坐骨神经营养血管的来源、分布和吻合;坐骨神经与自身躯干长度比例;选择性臀下动脉墨汁注射。结果:坐骨神经臀段营养血管来自臀下动脉,由前内侧进入,外径(1.5±0.7)mm(0.6～3.8mm);股后段来自股深动脉穿支,由前外侧进入;小腿段胫神经来自胫后动脉分支。上述节段血管在神经干表面分出升支和降支,彼此吻合,形成一个纵贯神经全长和供血丰富纵向的吻合血管链。自梨状肌下缘至内外踝连线,神经长(79.3±3.6)cm(70.0～86.0cm),梨状肌下缘至锁骨上缘中点距离为(60.6±3.1)cm(51.0～66.0cm)。选择性臀下动脉墨汁注射显示胫神经远端有墨染。结论:臀下动脉坐骨神经营养支是带血供坐骨神经移位桥接重要的供血途经。     

颈7神经根的皮肤感觉支配及其临床意义

作者根据50例健侧颈_7神经根移位病例检查术后患者的手指皮肤感觉异常的变化发现示指发生感觉异常最多占74％(37例),中指58％(29例),拇指38％(19例),环指20％(10例),小指2％(1例),无任何感觉异常者14％(7例).故提出以示指为中心的拇指与中指为颈_7神经根皮肤感觉代表区.     

颈椎间盘与脊髓和神经根的对应关系及其临床意义

目的：弄清颈椎间盘与脊髓及神经根的对应关系，探讨颈椎间盘突出症的致病机理。方法：对１４例成人颈椎标本的椎间盘、脊髓及神经根进行了解剖观测。结果：纵向上，各椎间盘对应低２～３个序数的脊髓节；横向上，椎间盘后缘位于两侧钩椎关节后内缘之间且窄于所对脊髓。结论：各间盘对应低２～３个序数的脊髓节，不与神经根相邻，其间隔有钩椎关节     

桡侧腕屈肌H反射的可行性及其在颈7神经根疾病中的临床应用

H反射是在1918年由Hoffmann首次发现，由于它是一个真正的反射，因此可以用来检验反射弧的传入、传出通路及神经元的兴奋性。当神经传导速度等检查主要针对周围神经病变时，它对于判断近端神经损伤，尤其是神经根疾病起到重要作用。作为一个单突触反射，理论上，H反射可以在任何肌肉中记录到，只要有一根确定的神经和一块确定的肌肉。     

颈7神经根与桥接尺神经缝合断面的解剖学研究

目的：对臂丛颈７ 神经根及桥接尺神经的显微解剖研究,为选择性颈７ 神经根移位术的建立提供理论依据。方法：常规防腐尸体标本１４ 具（２８ 侧） ,在显微镜下暴露自颈７ 神经根椎间孔处至干股交界处,测量其长度、两端神经直径。测量豌豆骨处尺神经主干及手背支的直径。结果：颈７ 神经根自椎间孔至干股交界处的根干长度：左４８ ．２ ±７ ．４ ｍ ｍ ;右４４ ．０ ±５ ．８ ｍ ｍ ;出椎间孔处神经横、纵径分别为：左５ ．８±０ ．４ ｍ ｍ ,５ ．２ ±０ ．４ ｍ ｍ ;右５ ．８ ±０ ．４ ｍ ｍ ,５ ．０ ±０ ．５ ｍ ｍ ;干股交界处：左６ ．０ ±０ ．５ ｍ ｍ ,５ ．２ ±０ ．６ ｍ ｍ ;右５ ．５±０ ．４ ｍ ｍ ,５ ．２ ±０ ．５ ｍ ｍ 。尺神经（ 豌豆骨近侧水平） 主干横径与纵径：左３ ．６ ±０ ．３ ｍ ｍ ,３ ．２ ±０ ．３ ｍ ｍ ;右３ ．８±０ ．３ ｍ ｍ ,３ ．０ ±０ ．２ ｍ ｍ ;手背支横径与纵径为２ ．５ ±０ ．２ ｍ ｍ ,１ ．４ ±０ ．２ ｍ ｍ ;右２ ．６ ±０ ．２ ｍ ｍ ,１ ．３ ±０ ．２ ｍ ｍ 。结论：选择性地保留部分颈７ 神经根前股前内侧部分纤维,既能解决尺神经与颈７ 神经根的周径匹配问题,又对健侧肢体感觉影响最小。     

大鼠副神经及其分支和膈神经主干运动纤维含量的研究

目的:采用组织化学方法研究大鼠副神经及其分支和膈神经主干起始部的运动纤维数量,为副神经移位膈神经重建高位颈髓损伤后呼吸功能提供理论依据。方法:在16倍手术显微镜下解剖30只健康雄性SD大鼠双侧副神经及其分支和膈神经主干起始部,用亚铁氰化铜法进行乙酰胆碱酯酶(AChE)组织化学染色,通过VIDS-Ⅲ型图像分析仪进行运动纤维计数。结果:大鼠副神经起始段运动纤维数为(451±43)根、胸锁乳突肌支运动纤维数为(182±12)根、锁骨上段运动纤维数为(279±29)根、副神经锁骨下水平发出内、外支之前其运动神经纤维为(209±32)根。膈神经主干起始部运动神经纤维数为(237±41)根。结论:副神经锁骨下水平发出内、外支之前其运动神经纤维数与膈神经主干起始部运动神经纤维数较为接近。可作为动力神经移位膈神经重建高位颈髓损伤后呼吸功能。     

Morphologic study of the connections between the accessory nerve and the posterior root of the first cervical nerve

The purpose of this study was to evaluate the anastomotic relationships between the accessory nerve and the posterior root of the first cervical nerve and to determine the course of the posterior root nerve fibers after anastomosis. The relationships between these two nerves were studied in 100 sides of the spinal cord and then classified into four types. In the most common type of anastomosis (38% of cases), either a branch from the posterior C1 root was seen to course cranially and join the accessory nerve, or the posterior root and accessory nerve fused as they coursed orthogonal to one other. In the second most common type (36% of cases), the accessory nerve anastomosed with a posterior C1 root that had no direct connection with the spinal cord; the nerve fibers of the posterior root were observed in stained samples to course caudally along the accessory nerve and join the posterior C2 root. In the least common type (6% of cases), no connection was observed between the accessory nerve and the posterior C1 root. In the next least common type (20% of cases), the posterior C1 root was absent and a connecting branch was sometimes observed between the accessory nerve and the anterior C1 root.     

正中神经前臂段浅层肌支的应用解剖

目的测量正中神经前臂段浅层肌支的解剖学数据,为正中神经的创伤修复提供形态学依据。方法采用解剖剥离测量方法,对30侧10%甲醛固定的成人上肢标本正中神经发出的前臂段浅层肌支进行解剖学观察。结果正中神经前臂段浅层肌支的分支类型有1支型、2支型、3支型和4支型。其中,旋前圆肌支以3支型(87%),指浅屈肌支(90%)以4支型,桡侧腕屈肌支(96.7%)和掌长肌支(96.7%)以1支型出现率最多。正中神经前臂段浅层肌支主要集中于前臂的4%～65%。结论确定了正中神经前臂段浅层肌支在前臂的危险区间;讨论了有利于开展带神经血管蒂肌瓣移植的肌支类型。     

脊神经根的形态变异观测及其临床意义

目的：为临床脊神经根性疾患的诊治提供解剖学基础。方法：对３５具（７０侧）成人尸体的全部脊神经前后根形态、位置、解剖汇合点和前后根的横径进行观测。结果：①脊神经后根有复根现象，双根的占２４．３％（双侧），三根占０．４％（双侧），而且有１．３２％的前根位于后根上方的变异；②前后根解剖汇合点８０％位于脊神经节的远端，２０％位于节的中部；③前后根横径之比在１１．５～２．５之间。结论：脊神经存有形态和位置上的变异，在临床手术治疗中应加以注意。     

Connections between the accessory nerve and the posterior root of the first cervical nerve

The aim of this study was to demonstrate the incidence of absence of the posterior root of the first cervical nerve, and the relation between the accessory nerve and the posterior root of the first cervical nerve in Turkish population. Dissections of the accessory nerve and the posterior root of the first cervical nerve were performed in 49 specimens from 27 formalin fixed cadavers (25 male and 2 female). The type of the connections between the accessory nerve and the posterior root of the first cervical nerve was classified into four types. Type III was the most common type in present study (30.6%). There was a connection between the accessory nerve and the posterior root of the first cervical nerve in this type. The connections demonstrated in this study are important in the etiology and surgical treatment of the spasmodic torticollis.     

Sympathetic fiber origin of the superior laryngeal nerve and its branches: an anatomic study

An anatomic study of 50 fresh adult human cadavers was carried out to classify the nervous anastomoses between the ipsilateral cervical sympathetic chain (CSC)/superior cervical sympathetic ganglion (SCSG) and the superior laryngeal nerve with its branches (SLNwb). Following the pattern of a prospective randomized study, the necks were dissected bilaterally to identify the SLNwb, CSC and SCSG. The nervous connections between the CSC/SCSG and the SLNwb were grouped according to Sun and Chang's (1991, Surg. Radiol. Anat. 13:175-180) types as well as according to a new classification, tie, based on the location and number of connections between the CSC/SCSG and the SLNwb. Connections between the CSC/SCSG and the SLNwb were found in 95 of 100 dissections. According to our tie classification, the results demonstrated that the e(n) was the most frequent tie group in the sample (59%), followed by t(n) (15%), i(n)e(n) (11%), t(n)e(n) (8%), no nervous anastomosis (5%), and i(n) (2%), where t, i, e represent nervous connections between the CSC/SCSG and the trunk, external branch, and internal branch of the SLN, respectively, and n represents the number of connections. Therefore, the nervous communications between the CSC/SCSG and the SLNwb were frequent and could easily be classified by the origin and number of nervous connections. Although their physiologic role remains unclear, the SLNwb may be an important pathway for nerve fibers from the CSC/SCSG to reach the larynx.