椎管内臂丛前后根的显微解剖及其临床意义

Microanatomy and clinical significance of nerve roots of brachial plexus within the spinal canal

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。

Objective： To provide anatomical basis for diagnose and treatment of roots avulsion of brachial plexus. Methods： The position, morphology and blood supply of nerve roots of brachial plexus within the spinal canal were observed and measured on 15 cervicothoracic segment specimens of adult cadaver perfused with red latex. Results： The ventral roots lay in front of the denticulate ligament, while the dorsal one behind it. The distance from the origin of the ventral roots to the midline of spinal cord was 2.2 mm for C5 and 3.1 mm for T1, and the length of roots were 14.9mm, 13.9mm for C5 and 21.1 mm, 19.0 mm for T1 respectively, from up to down, all data increased gradually. On the contrary, the distance from the origin of the dorsal roots to the midline of spinal cord were 4.2mm for C5 and 2.7mm for T1, and the angle from the roots to the spine of C5～T1 spine segments were 51.4°, 54.8° for C5 and 21.7°, 19.9° for T1, from up to down, all data decreased gradually. At the same segment, the diameter of the dorsal roots was bigger than the ventral one. C6 was the most. The blood supply of the roots came from segmental arteries of vertebral artery and deep cervical artery and ascending cervical artery. Conclusions： Having an intimate knowledge of microanatomy about brachial plexus roots in the spinal canal will be favorable to diagnose and treat brachial plexus roots avulsion.