小儿腰骶神经与脊柱椎板的对应关系及在SPR手术中的应用

Corresponding relationship between the lumbar sacral nerve and spinal lamina in children and its application in SPR

目的了解不同年龄段小儿脊神经硬膜内出孔走行的规律,以提高神经选择的准确性并减小创伤及手术对脊柱稳定性的影响。方法 2011年3月~2014年3月收治的痉挛型脑瘫患者共132例,均采用选择性脊神经后根切断术(selective posterior rhizotomy,SPR)治疗,术中观察并记录L5、S1神经硬膜内出孔位置与脊柱椎板的对应关系。结果 10岁以下年龄组L5、S1神经硬膜内出孔位置位于同序数上一位椎板1/2位置上方的比率为28.0%和24.0%,14岁以上组L5、S1神经硬膜内出孔位置位于同序数上一位椎板1/2位置上方的比率均为4.8%。结论小儿的脊柱处于生长发育阶段,其腰骶神经在硬膜内的出孔位置与椎板的对应关系较成年人明显偏高,对于SPR手术中更精确定位及减小对脊柱稳定性影响具有临床意义。

Objective To study the regularity of the epidural space of the spinal nerve in different age groups in order to improve the accuracy of the neural selection and reduce the impact of trauma and surgery on the stability of the spine. Methods From Mar 2011 to Mar 2014, 132 patients with spastic cerebral palsy were treated. SPR (selective posterior rhizoto-my) were applied in all cases. The relationship between the position of the L5 and the epidural space of S1 and the spinal lami-na were observed and recorded during operation. Results The ratio of L5 and S1 to the epidural space in the upper ordinal number on the upper part of the lamina 1/2 was 28.0%and 24.0%in under 10 years of age group , and the ratio of L5 and S1 to the epidural space in the upper ordinal number on the upper part of the lamina 1/2 was 4.8%in over 14 years old group. Con-clusion Children's spine is at the stage of growth and development, the position of the lumbar sacral nerve in the epidural space relative to the vertebral lamina is obviously higher than the adult. More accurate positioning in the SPR surgery has clini-cal significance to reduce the impact on the stability of the spine.