颈后经硬膜囊手术入路的应用解剖学研究

Applied anatomical study of posterior cervical operation with transdural approach

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。

Objective To analyze the anatomy material of cervical vertebra dural sac and provide references for the transdural approach to the lower cervical vertebra. Methods Fifteen cadavers were used for dissection to investigate the anatomical character, morphological data and the relationship between cervical nerve root and the corresponding intervertebral disc. Results The number of posterior rootlets was less than that of the anterior ones. The descending angle of the anterior rootlets and the posterior ones tended to decrease in the lower cervical spinal cord. In 15 cadavers,DSW： （17.03±0.51）mm- （18.17±0.59）mm;SCW： （11.37±0.30） mm- （12.64±0.43）mm;SASW： （5.52±0.33）mm-（5.78±0.48 ）mm; ARI：（1.93±0.49）mm-（4.70±0.35）mm;PRI：（1.38±0.38）mm-（3.90±0.31）mm; NRI： （10.54±0.75）mm-（12.55±0.58）mm; NDDnt：（ -1.82 ± 0.40）mm-（4.70±0.39）mm. Conclusion Microsurgicaltransdural approach surgery has a relative surgical area in the cervical spine.