第7颈神经通过椎体隧道治疗对侧臂丛神经根性损伤的可行性

Feasibility of contralateral C7 transfer for treatment of brachial plexus root avulsions through C7 vertebrae channel

目的:通过椎体隧道通路方式治疗对侧臂丛神经根性损伤,为臂丛神经根损伤的外科治疗提供新的术式。方法:利用20具成人尸体,模拟椎前通路术式和隧道通路术式进行对比,观测两种术式下可供移植神经根的有效长度。选取30例成年人对颈部(涵盖C6～T1椎骨)进行CT扫描,测量其轴向旋转角及侧屈角,观测颈椎活动对移植后第7颈神经的牵拉影响。36组新鲜椎体试件(C5～C7)随机分成对照组和实验组,实验组打孔,然后用万能试验机进行轴向载荷压缩试验,检验椎体打孔后形成的椎体隧道对椎体生物力学稳定性的影响。结果:经过椎体隧道通路到达对侧下干所需长度为69.19mm,比经过椎前通路缩短25.14mm。C7对T1椎体之间轴向旋转角为9.4°±0.3°,旋转产生的前后牵拉范围为2.44mm;C7对T1椎体之间侧屈角为0.6°±0.2°,侧屈造成的上下牵拉范围为0.156mm;C7对T1之间的前屈后伸运动幅度非常小,所造成的影响可以忽略不计。椎体压缩实验结果:实验组比对照组的极限载荷仅下降了14.89%,组间比较差异无显著性(P>0.05)。结论:与椎前通路术式比较,椎体隧道通路术式能提供较充足的神经长度;椎骨旋转角度对移植神经的牵拉幅度影响小;椎骨生物力学几乎无改变。

Objective Through C7 vertebrae channel to treat contralateral C7 brachial plexus root avulsions to provide a new method to treat brachial plexus root avulsions.Methods 20 corpses were used to compare the lengths of the prespinal and retropharyngeal way and C7 vertebrae channel way.30 CT scan pictures of adult human neck were selected to measure the maximum angel of cervical vetebrae and lateral maximum angel of cervical vetebrae.36 isolated fresh vertebrae of C5-C7 were chosen as test pieces,and were divided into control group and experimental group which was perforated.A axial ultimate load compression was performed in all subjects.A comparison was made to figure out the biomechanical difference between the intact and perforated vertebrae.Results The length through vertebrae channel to contralateral inferior trunk was 69.19 mm,25.14 mm shorter than the average length of C7 nerve.T1 and C7 angle of vertical was 9.4°±0.3°.T1 and C7 drag amplitude of vertical was 2.44 mm.T1 and C7 drag amplitude of lateriflection was 0.156 mm.The maximum load of cervical vetebrae construction test in experimental group was decreased by 14.89% compared with control group,but there was no significant difference（P 0.05）.Conclusion Through C7 vertebrae channel enough length of brachial plexus is obtained to treat brachial plexus root avulsions of contralateral.