椎管内神经根吻合治疗截瘫的应用解剖

Applied Anatomy of Nerve Root Anastomosis in Vertebral Canal on Paraplegia

目的 :研究胸 1 2 椎体下缘平面以上可利用的腰骶神经根数目 ,及其与脊髓圆锥下极位置的关系 ,为腰 1 椎骨骨折脱位所致截瘫的椎管内神经根吻合术提供解剖学依据。方法 :取 2 4例成人脊柱标本 ,暴露胸 1 1 节段以下脊髓和神经根。观测腰1 -骶 3各神经根根丝穿出相应脊髓节的中点与胸1 2 椎体下缘之间距离 ,及脊髓圆锥下极位置变异。结果 :腰 1～ 4 神经根近端主要位于胸 1 2 椎体下缘平面以上 ,该平面以下主要为骶神经根 ;脊髓圆锥位置越高则该平面以上神经根数目越多。结论 :胸 1 2 椎体下缘平面以上腰神经根数目与脊髓圆锥下极位置呈正相关 (具有显著性 ) ;椎管内神经根吻合术须考虑两者关系。

Objective: In order to provide anatomical b asis for n eve root anastomosis in vertebral canal to the paraplegia patients with fracture and dislocation of the 1st lumbar vertebra, and to investigate the number of av ailable lumbosacral nerve roots above the level of lower edge of T 12 verte bra, and its correlation to the terminal position of conus medullaris. Methods:Spinal cord and nerve roots under T 11 segment were exp o sed on 24 adult spinal specimens. The distance from the inferior edge of T 12 vertebral to every middle point of T 11 S 3 spinal cord segment was me sured separately. The variation of terminal position of conus medullaris was als o noted. Results: The proximal extremity of L 1-4 nerve roots was above th e level of lower edge of T 12 vertebra. That of sacral nerve roots was belo w the level. The higher the terminal position of conus medullaris was, the more the nerve roots was above the level. Conclusion: Positive correlation is significant between the terminal p osition of cornus medullaris and the number of lumbar nerve roots above the leve l of infterior edge of T 12 vertebra. This should be kept in mind at perfor min operation on nerve root anastomosis in vertebral canal.