神经嫁接术治疗脑外伤、脊髓伤后痉挛性瘫痪的神经干内显微解剖与嫁接位点的选择

Incision choice of nerve transfer graft surgery based on microanatomy of main nerve tracks to treat spastic paralysis caused by brain and spinal cord injury

目的：通过分析常用神经嫁接术之神经根、主要神经干的干内神经显微解剖,确定神经束或束组的解剖定位及走行规律,为选择嫁接神经切口位置、切开深度、范围提供解剖学依据,探讨依据该解剖学规律标定切口的可行性。方法：选用成人尸体标本8具,16侧,分离出主要神经,进行测量对照及术中验证,按照腕表表针刻度法进行标记,确认不同平面神经束或神经纤维分布位点。结果：主要神经根、干内神经束解剖位置具有规律性,如无明显变异,可根据各神经不同平面神经束、纤维分布定位,确定切开受体神经的位点。根据神经嫁接术中电刺激及术后效果评估反证显示,按该方法选择定位可达到70%~80%的准确率。结论：通过神经干内显微解剖,确定受体神经楔形切口嫁接位置是可行的。

Obj ective ：The characteristics within main nerve roots and nerve tracks used for nerve transfer graft surgery were microanatomically analyzed to localize the nerve tracts and nerve tracts groups and then identify their course patterns,in order to provide morphological basis for identifying the position,depth and extension of incisions in nerve transfer graft surgery and to explore the feasibility of localizing incisions based on the above-mentioned anatomical characteristics.Methods ：Main nerves from 8 cadavers were dissected and their anatomical parameters were measured and verified during operations.The locations of nerve fibers or nerve bundles at different planes were recorded according to the scales of watch hands of wrist-watches. Results ：The anatomical locations of nerve bundles within main nerve roots and nerve tracks showed definite regularity.Thus, unless obvious variations occurred,the incision position of the host nerve could be selected according to the locations of nerve bundles at different planes.The intraoperative electric stimulation and postoperative judgment of therapeutic effects showed that the accuracy rate was up to 70%-80% based on the above-mentioned method.Conclusion：It is feasible to identify the incision of host nerves during nerve transfer graft surgery according to microanatomical characteristics of main nerve tracks.