损伤区上下神经根吻合对大鼠损伤脊髓神经元的影响

目的：探讨损伤区上下神经根吻合对防止成鼠脊髓轴突损伤后引起神经元萎缩和凋亡的作用。方法：采用改良的Ａｌｌｅｎ‘ｓ打击法致伤大鼠脊髓,将实验动物分为单损伤组（Ａ组）,损伤＋上下神经根吻合组（Ｂ组）。手术后应用这和电生理检查,观察大鼠功能恢复情况;应用尼氏染色方法观察神经元的大小,采用计算机图像分析技术,进行定量分析。结果：损伤区上下神经根吻合,可以防止成鼠脊髓轴突损伤后引起的神经元萎缩,图像分析发现     

胚胎脊髓移植和损伤区上下神经根吻合对损伤大鼠脊髓神经元的影响

近年来实验方法治疗脊髓损伤取得了许多进展 ,如实验性胚胎脊髓移植、周围神经移植、神经细胞移植、大网膜移植、神经营养因子的应用等治疗脊髓损伤取得了较好的效果 ,但实验结果仍然不能令人满意[1 ,2 ] 。我们拟采用胚胎脊髓移植和损伤区上下神经根吻合的方法 ,观察手术后对防止成鼠脊髓轴突损伤引起的神经元萎缩的作用。材料与方法一、动物分组 :Wistar成年大鼠 ,体重 180～ 2 5 0 g,雌雄不拘 ,每个时相点每组 6只动物 ,正常对照组 6只动物 ,共 10 2只大鼠。随机将动物分为 A组 ,单损伤组 ;B组 ,损伤加损伤区上下神经根吻合组 ;C组 ,损…     

吻合血管同种异体桡骨下段移植的解剖学研究

目的为施行吻合血管同种异体桡骨下段移植提供解剖学依据。方法在40侧经动脉灌注红色乳胶的成人上肢标本,重点解剖观测了桡骨下段滋养血管和骨膜血管的来源和分布;50根干燥成人桡骨标本,观察桡骨下端滋养孔。结果桡骨下端前、后及外侧平均有(15.5±4.3)（11～30）个滋养孔。骨间前动脉外径平均为2.3mm,循骨间膜的前份下行,本干穿行旋前方肌深面,沿途分出1～3支肌骨膜支,分布桡骨下端前面。腕背支的桡侧骨皮支和外侧终支,沿桡骨远段背侧下行,分别分出（3.1±0.7）支和（1.2±0.5）支骨膜支分布桡骨下段背侧。上述骨膜支均发细支进入滋养孔。结论选用骨间前血管为蒂的桡骨远段移植,以重建桡腕关节。     

手指滑车的应用解剖学研究

目的为滑车重建提供形态学依据。方法于手术显微镜下对３０只尸手标本,进行滑车系统的形态学观察,测量手指伸直位时各滑车之间的间距,手指在屈曲过程中各滑车间距的变化。结果Ａ２滑车最宽,达１６．８ｍｍ,Ａ２远端部和Ａ４中间部是腱鞘最厚的部位,约１ｍｍ厚。滑车间距：中间部位的滑车（Ｃ１～Ａ３～Ｃ２）间距较大,两端部位的滑车（Ａ１～Ｃ０～Ａ２～Ｃ１、Ｃ２～Ａ４～Ｃ３）间距较小;Ａ２远端缘和Ａ４近端缘分别位于近节指骨近端３／５～２／３和中节指骨近端１／４以远,其间距平均为２０．８ｍｍ。结论Ａ２的远端部分和Ａ４近端部分滑车的作用最为重要,滑车应重建在该两部位。     

吻合血管的足背三叶皮瓣的解剖学研究

目的对足背动脉进行解剖学研究，为设计并应用足背三叶皮瓣提供依据。方法１０只新鲜成人足标本，用乳胶灌注后对胫前动脉→足背动脉在足内侧区、第一跖背区、足外侧区的分支进行解剖学观察。结果足内侧区皮肤的血供由足背动脉发出内踝前动脉或跗内侧动脉支配，足外侧区皮肤的血供由足背动脉发出外踝前动脉或跗外侧动脉供应，第一跖背区皮肤的血供由足背动脉－第一跖背动脉的皮支营养，各区域供养血管互有代偿。结论以足背动脉及伴行静脉为血管蒂的足背三叶皮瓣，血供可靠，可用于修复多指皮肤缺损。     

骶岬周围血管的应用解剖学研究

目的明确骶岬周围血管(bloodvesselsofperisacralpromontory,BVPSP)的解剖学特点,为与其相关的手术提供应用解剖学资料。方法成人尸体37具,观测BVPSP的组成,骶中血管的来源、走行、直径以及骶岬距骶1横干静脉的距离。结果BVPSP由左右髂总动静脉和髂内动静脉,骶中动静脉上段和骶1横干静脉组成;骶中动脉均来自腹主动脉;骶中静脉变异较大,管壁薄、缺乏瓣膜;在骶岬水平,骶中动、静脉的直径平均是1.02mm和2.53mm;骶中血管少在左侧近骶岬段经过。骶岬平面距骶1横干静脉的平均距离为5.75mm。结论BVPSP组成复杂,特别是骶中静脉变异多,骶1横干静脉距骶岬平面较近、与周围血管吻合丰富是造成与骶岬相关手术出血的解剖学基础。     

脊神经前根吻合重建脊髓损伤大鼠神经反射通路的形态学研究

目的:观察利用脊神经前根吻合重建脊髓损伤大鼠股四头肌神经反射通路的形态学情况。方法:取4周龄SD大鼠20只,体重120～150g;将左侧L1神经前根与支配股四头肌的优势脊神经(L3)前根通过尾神经桥接吻合,右侧不作任何处理。神经吻合术后6个月,手术分离神经吻合段。将能分离神经吻合段的大鼠在L2脊髓水平左半侧切断脊髓制备大鼠脊髓半切损伤模型,饲养4周后左侧股神经注射Trueblue(TB)染色剂进行逆行荧光染色,观察L1脊髓前角是否有TB标记的阳性细胞;同时解剖分离神经吻合段进行HE染色及电镜观察。结果:饲养过程中大鼠死亡4只。成功分离出10只大鼠的神经吻合段。吻合段神经肉眼观察光滑圆润,无萎缩;HE染色光镜下吻合段神经纤维排列整齐,走行一致,为典型的有髓神经纤维结构;电镜下吻合段神经纤维具有明显神经轴突特征。TB荧光逆行示踪左侧L1脊髓前角可见荧光标记阳性的神经元,而右侧无标记阳性细胞。结论:L1与L3脊神经前根吻合可成功建立L2脊髓半切损伤大鼠的股四头肌脊髓旁神经反射通路。     

后腹腔镜进路应用解剖学研究

目的　探讨后腹腔镜手术的应用解剖学基础。　方法　选择国人成人尸体 2 0具 ,男性12具 ,女性 8具。对其侧腹壁神经、血管和后腹膜间隙结构与后腹腔镜进路之间的距离进行测量。结果　髂嵴距腰下三角顶点的距离 :男性 :左侧 (4 0 2± 1 2 6)cm ,右侧 (3 83± 0 90 )cm ;女性 :左侧(3 90± 0 3 7)cm ,右侧 (3 87± 0 3 7)cm。髂腹下神经距髂嵴的距离 :男性 :左侧 (0 82± 0 13 )cm ,右侧(0 84± 0 0 8)cm ;女性 :左侧 (0 94± 0 0 6)cm ,右侧 (0 93± 0 10 )cm。肋下神经距肋缘下的距离 ,在腋后线和腋中线 :男性 :左侧分别为 (0 79± 0 2 6)cm、(1 65± 1 12 )cm ,右侧分别为 (0 78± 0 3 0 )cm、(1 5 9± 1 0 7)cm ;女性 :左侧分别为 (0 61± 0 14)cm、(1 3 7± 0 89)cm ,右侧分别为 (0 64± 0 13 )cm、(1 3 2± 0 95 )cm。肾下极水平输尿管距腰大肌外缘的距离 :男性 :左侧 (2 2 4± 0 67)cm ,右侧 (2 19±0 73 )cm ;女性 :左侧 (2 0 0± 0 2 3 )cm ,右侧 (1 91± 0 13 )cm。输尿管髂血管交界处距腰大肌外缘的距离 :男性 :左侧 (3 91± 0 5 9)cm ,右侧 (3 76± 0 5 3 )cm ;女性 :左侧 (3 43± 0 3 1)cm ,右侧 (3 85±0 43 )cm。　结论　临床上选择髂嵴上 2cm腰下     

完全经口内镜下甲状腺切除术的解剖学研究

目的 确定经口路径的解剖通路、层次和相关的神经、血管结构,为舌下联合口腔前庭的完全经口内镜下甲状腺切除提供一个安全可行的经口入路.方法 2009年11月至2011年5月,在25具固定标本上,行颈前部、下颌骨表面、口底解剖,确定经口路径的解剖通路、层次和相关的神经、血管结构.在20具冰冻新鲜标本上,模拟经口内镜甲状腺切除术,术后解剖标本,观察有无神经、血管的损伤.结果 内镜通道为自舌下中线处开口,经颏舌骨肌、下颌舌骨肌、二腹肌前腹,至颈阔肌下.操作通道为口腔前庭处,第一磨牙根部纵行矢状切口,于面动脉、面静脉、面神经下颌缘支深面,颏神经外侧,紧贴下颌骨骨膜面,进入颈阔肌下.颏神经与下颌骨正中线的距离为(25.8±0.9)mm,颏神经与面动脉的距离为(29.4±0.9)mm.20例模拟手术,术后解剖观察,无神经、血管和口底肌的损伤.完全经口内镜通路中,可切除的甲状腺长径达50 mm.结论 舌下联合口腔前庭的完全经口入路具有解剖学的可行性,可安全到达甲状腺区并完成甲状腺的切除.     

Implantation of cauda equina nerve roots through a biodegradable scaffold at the conus medullaris in rat

Background contextTraumatic injuries occurring at the conus medullaris of the spinal cord cause permanent damage both to the central nervous system and to the cauda equina nerve roots.PurposeThis proof-of-concept study was to determine whether implanting the nerve roots into a biodegradable scaffold would improve regeneration after injury.MethodsAll experimental works involving rats were performed according to the approved guidelines by the Mayo Clinic Institutional Animal Care and Use Committee. Surgical procedures were performed on 32 Sprague-Dawley rats. Four ventral cauda equina nerve roots were reimplanted either directly into the ventral cord stump or through a poly(lactic-co-glycolic acid) (PLGA) scaffold. These experimental groups were compared with a control group in which the nerves were inserted into a muscle fascia barrier that was placed between the spinal cord and the nerve roots. Animals were sacrificed at 4 weeks.ResultsThere was no difference in motor neuron counts in the spinal cord rostral to the injury in all treatment groups, implying equal potential for the regeneration into implanted nerve roots. One-way analysis of variance testing, with Tukey post hoc test, showed a statistically significant improvement in axon regeneration through the injury in the PLGA scaffold treatment group compared with the control (p<.05, scaffold n=11, control n=11).ConclusionsThis pilot study demonstrated that a PLGA scaffold improved regeneration of axons into peripheral nerve roots. However, the number of regenerating axons observed was limited and did not lead to functional recovery. Future experiments will employ a different scaffold material and possible growth factors or enzymes to increase axon populations.     

Electrodiagnosis of compression of individual nerve roots of the cauda equina

Summary Segmental electrodiagnosis of compression of individual nerve roots of the cauda equina has been attempted in 45 patients, including cases of disc hernia, spondylosis and spondylolisthesis. The needle electrode was inserted into the nerve root either just lateral to the intervertebral foramen or through the posterior sacral foramen. The recordings made on stimulating a single nerve root were somatosensory evoked potential, the cauda equina action potential and the M and H waves. Mixed spinal nerve root action potentials were also recorded by stimulating the sciatic, peroneal and tibial nerves. It was shown that a diagnosis could be made from the somatosensory evoked potential, the H wave and root pain reproduction, and also the diagnosis of a subclinical compression involvement.In other words, the neurophysiological state of dysfunction of individual roots in each aspect of compression can be expressed.

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Résumé L'électrodiagnostic segmentaire de la compression des racines de la queue de cheval a été tenté chez 45 malades, comprenant des cas de hernie discale, de spondylarthrite et de spondylolisthésis. L'électrode est insérée dans la racine soit en dehors du trou de conjugaison, soit à travers le canal sacré postérieur. Les enregistrements consécutifs à la stimulation d'une seule racine sont le potentiel évoqué somatosensoriel, le potentiel d'action de la queue de cheval et les ondes M et H. Des potentiels d'action mixtes des racines nerveuses de la moelle sont également enregistrés en stimulant les nerfs sciatique, sciatique poplité externe et interne. On en déduit qu'un diagnostic est possible à partir du potentiel évoqué somatosensoriel de l'onde H et de la reproduction de douleur radiculaire et qu'ainsi peut être reconnue une compression infra-clinique.Autrement dit, l'état neurophysiologique du dysfonctionnement de chacune des racines dans chaque aspect d'une compression peut être exprimeé.

     

手术治疗腰椎间盘突出症合并马尾神经损伤

腰椎间盘突出症伴马尾神经损伤如果不能得到及时诊断和治疗,其病变发展的后果是十分严重的,常常导致大小便及性功能障碍,给患者带来终身的痛苦。本院自1997年6月至2007年10月手术治疗的腰椎间盘突出症224例中,合并马尾神经损伤49例,占21．8％,根据本组随访疗效提出分析讨论如下。     

Nerve fibre counts for an intercostal nerve to cauda equina nerve root anastomosis

Mean nerve root diameters of thoracal, lumbal and sacral roots have been determined and the corresponding cross section areas calculated. The myelinated axons of these roots have been counted and the axon densities calculated. The myelinated axons of 3 lower intercostal nerves have also been counted. One intercostal nerve has with about 9,000 myelinated fibres enough axons for the regeneration of the ventral (3,000) and dorsal (16,000) myelinated fibres of the sacral roots 3 and 4 together. One intercostal has enough nerve fibres to reconstruct urinary bladder and bowel function on one side. The importance of performing a nerve anastomosis which considers functional aspects has been emphasized.     

Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study

Background

Anatomical study of the relationship among the cervical nerve roots, intervertebral disc, and lateral mass is important for the neurosurgeon to avoid complications of posterior cervical foraminotomy.

Methods

Six adult cadavers were studied. The muscles of the back of the neck were removed to expose the cervical vertebrae posteriorly from C3 to C7. We measured the length, height, extent, and angulations of the nerve roots from the medial point of the facet (MPF) after a total laminectomy, then after one-half facetectomy. The height, width, anteroposterior diameter of the lateral mass, then the height and anteroposterior diameter of the neural foramen were also measured.

Results

After total laminectomy from C3 to C7, all measures were taken from MPF showed that the mean length of the exposed root was 6.5–8.8 mm while vertical distance was 4–5.4 mm and the horizontal distance was 5.1–7.1 mm. Following a medial one-half facetectomy; the mean length of the exposed root was 8.9–12.3 mm, the vertical distance was 5.5–7.3 mm while the horizontal distance was 7.1–9.8 mm. The mean angulations of the nerve roots were 50.9–53.3º. There was a significant difference after total laminectomy and medial one-half facetectomy.

Conclusion

Anatomic and morphologic study of the cervical nerve roots and their relationships to the lateral mass and the intervertebral disc are useful landmarks to reduce the operative complications of the posterior foraminotomy.     

健侧C7神经经椎体后通路治疗臂丛神经根性撕脱伤的解剖学研究

目的通过解剖学研究,探讨健侧C7神经经椎体后通路移位治疗对侧臂丛神经根性撕脱伤的可行性。方法取10具甲醛固定的成人尸体标本,其中男7具,女3具,标本均无明显畸形,组织无缺损,颈部中立位。模拟臂从神经损伤手术探查方式,将C₇神经根的前、后股向远端行干支分离使其长度增加后再切断,同时测量C₇神经根自椎间孔发出至分股处长度及其前、后股长度;模拟颈椎后路手术入路,充分暴露C₇颈椎及T₁棘突,并于其间靠近椎体侧钻孔,测最经椎体后通路达对侧臂丛神经上干与下干距离。结果 C₇神经根长度为（58.62±8.70）mm,加后股长度为（65.15±9.11）mm,加前股长度为（70.03±10.79）mm。经椎体后通路C₇神经根至对侧臂丛神经上干距离为（72.12±10.22）mm,至对侧臂丛神经下干距离为（95.21±12.50）mm。结论健侧C₇神经可以经椎体后通路移位至对侧,不需要或仅需一小段桥接神经,该通路能有效避免经椎体前路损伤血管、神经等并发症,可能成为治疗臂丛神经根性撕脱伤的有效入路。     

大鼠周围神经移植修复马尾神经损伤的早期形态学观察

目的：探讨坐骨神经移植修复马尾神经损伤的可行性,观察马尾神经再生情况。方法：将30只雌性Wistar大鼠分为三组,实验组：将20只大鼠马尾在L2水平行半侧切除,将对侧坐骨神经移植到马尾切除侧,近端接马民行断端,移植的坐骨神经远端与马尾切除侧坐骨神经吻合,分别于术后4、6、8周在光镜及电镜下观察马尾再生情况。实验对照组：5只大鼠,仅切除部分马尾。正常对照组：5只大鼠,不做处理。结果：实验对照组坐骨神经的轴突及髓鞘均崩解,无再生轴突形成。实验组术后4周HE及固蓝染色偶见髓鞘及轴突形成,雪旺细胞数目少,有世噬细胞吞噬现象;术后6周较4周再生髓鞘及神经轴突数目增多,雪旺细胞大量增生,巨噬细胞吞噬现象减少;术后8周高倍镜下可见再生的典型形式,即胶质基质中的退变纤维中有大量簇状细小的有髓神经纤维,电镜下可见含较多细的有髓和无髓神经纤维,内含较多线粒体等管状结构,雪旺细胞核大而明显,胞浆丰富,粗面内质网及高尔基体、线粒体增加明显。结论：周围神经移植修复马尾神经是可能的,马尾神经损伤后有再生的可能性。     

腰神经根受压变性的实验研究

目的:探讨神经根受压后纤维变性与转化生长因子-β1(TGF-β1)表达的关系。方法:SD大鼠50只,参照Kawakami方法,显露左右侧L4-L6神经根及背根神经节,左侧用4/0肠线于背根神经节头侧端结扎神经根(两道打两个结),线与神经根相距3mm;自身右侧相应神经根作为对照。术后1、2、4、8、12周,分别取L4-L6神经根标本,进行组织学观察,并借助免疫组化方法测定TGF-β1表达程度。结果:术后1周神经根TGF-β1开始表达,术后2周趋明显,术后4周达高峰,其表达与神经根受压后纤维形成过程相一致。结论:TGF-β1参与神经根受压后纤维化形成过程,合理调控TGF-β1表达有望减轻受压神经根粘连、变性的程度。     

The value of nerve root infiltration for leg pain when used with a nerve stimulator

Randomized comparative study of the efficacy of nerve root infiltration (NRI) guided by neurostimulator to find the value of nerve stimulators in nerve root infiltration was undertaken. The response to nerve root infiltration using local anaesthetics and steroid is unpredictable, partly because the exact nerve root giving rise to pain may not be truly infiltrated. The nerve stimulator is advocated to identify the nerve root of concern prior to infiltration. The current study assessed the results of NRI with and without the nerve stimulator. Ninety-six patients with leg pain awaiting selective nerve root infiltration using long acting local aesthetic, were prospectively randomized into two groups, in the first one, the nerve root block was carried out without nerve stimulator (n = 39) and in the second group the block was carried out with the guidance of a nerve root stimulator (n = 57). Seventy-seven of the patients who had lateral canal stenosis (a total 81) responded to NRI; within this group nerve stimulator was used for 50 patients. Nerve root infiltration was used to relieve post-discetomy leg pain (ten), post-disc prolapse (four) and in one patient post-nucleotomy leg pain. Overall 89% of the patients were responders of NRI. Responders of around 65% had the NRI performed with the aid of stimulator. The response rate to pain was 96% when NRI was guided by a neurostimulator and 79% when no neurostimulator was used. When responded there was no significant statistical difference using the Oswestry disability score between both groups. After excluding disc bulge in patients who respond partially to NRI, it is worthwhile repeating the injection. There was a significant difference in response rate when NRI was done under guidance of a nerve stimulator, the stimulator is safe to use and increases the specificity of the block.     

选择性颈_7神经根移位与膈神经移位术疗效比较的实验研究

目的　以大鼠为动物模型 ,比较选择性颈 7神经根移位术与膈神经移位术的疗效。　方法　 SD大鼠 12 0只 ,随机分成 2组。 A组 :肌皮神经与膈神经缝合 ;B组 :肌皮神经与同侧颈 7神经根的前股前外侧束组缝合。术后肱二头肌电生理学、组织学、肌生理功能检测评价两组疗效。　结果　术后各时间组 ,选择性颈7神经根移位与膈神经移位各检测指标相比 ,差异无显著性 (P>0 .0 5 ) ,但前者在多项指标上优于后者。　结论　选择性颈 7神经根移位术与膈神经移位术疗效无明显差异 ,在臂丛上干根性撕脱伤合并膈神经损伤时 ,前者是较为理想的可选方法。