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背景:高选择性脊神经后根部分切断术中前后根的神经分束应达到神经小束水平,分束越多越利于电刺激选择,利于准确地切断阈值低的引起痉挛的Ia类神经纤维,也越可能最大限度地保留后根中的感觉神经纤维。目的:根据限制性和高选择性脊神经后根切断术的要求,对脊神经前后根进行显微解剖,确定神经小束的分束标准和数目,为临床手术提供可靠的依据和新的手术标准。设计:以成人尸体标本为观察对象,单一样本实验。单位:锦州医学院附属第一医院骨科和锦州医学院解剖教研室。对象:实验于1999-12在锦州医学院解剖学实验室进行。以志愿捐献的15具成人尸体标本为观察对象,男11具,女4具,生前均签署志愿捐献书。方法:①在15具(30侧)成人脊柱标本上,对L1～S2节段的脊神经前后根进行形态学观察和显微测量。②取新鲜尸体的L5脊神经前后根进行免疫组化染色,将脊神经后根起始部、中间部和椎间孔外部3个部位切片,分别测定神经纤维总数、引起痉挛的Ia类神经纤维的数目及其占神经纤维总数的百分率,比较3个部位Ia类神经纤维的分布规律和数量。主要观察指标:①脊神经根神经分束情况及神经小束的直径。②脊神经后根起始部、中间部和椎间孔外部计数100μm2神经纤维总数及Ia类神经纤维占神经纤维总数的百分率。结果:①脊髓圆锥部脊神经根是由根丝逐步汇合而成。应用显微外科技术,后根一般可分为10～18小束,前根一般分为6～11小束,其小束的直径是基本一样,数值较为恒定。②脊神经后根起始部、中间部和椎间孔外部计数100μm2总的神经纤维数为(3243±143)根,Ia类神经纤维为(1702±85)根,占总神经纤维数的52.5%。Ia类神经纤维在后根内呈均匀分布,没有集中分布区。结论:改良脊神经后根部分切断术的最大特点即脊神经前后根的分束标准应尽量细,这样有利于准确切断Ia类神经纤维,一般前根达到6～11小束,后根达到10～18小束,切断最大比例应不超过后根神经纤维总数的1/2。
Background: The nerve bundle before and after root excision of the high selective posterior root segment of the spinal nerve should reach the level of the nerve bundle. The more the splitting bundle is, the more conducive to the selection of the electrical stimulation, which will help to cut off the type Ia nerve fibers with low threshold and cause spasticity. The more likely it is to preserve the sensory nerve fibers in the posterior root. OBJECTIVE: To dissect the anterior and posterior roots of the spinal nerves according to the requirements of restrictive and highly selective posterior rhizotomy, to determine the standard and number of the splitting of the nerve bundles, and to provide a reliable basis and a new surgical standard for clinical surgery. Design: adult cadaver specimens for the observation object, a single sample experiment. SETTING: Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical College and Department of Anatomy, Jinzhou Medical College. Subjects: The experiment was performed at the Department of Anatomy, Jinzhou Medical College from December 1999 to December 1999. Volunteer donations of 15 adult cadaver specimens for the observation of objects, 11 males and 4 females, during their lifetime signed a voluntary donation book. Methods: ① Fifteen (30 sides) adult spine specimens were examined morphologically and microscopically on the anterior and posterior roots of the spinal nerves in segments L1 ~ S2. ② Fresh corpses were taken from the anterior and posterior roots of the L5 spinal nerve for immunohistochemical staining. The three parts of the posterior root of the dorsal root root, middle part and intervertebral foramen were sliced to determine the total number of nerve fibers, the number of Ia nerve fibers causing spasm And its percentage of the total number of nerve fibers, compared with the distribution of three parts of Ia nerve fibers and the number of rules. MAIN OUTCOME MEASURES: ① Spinal nerve root nerve splitting and nerve bundle diameter. ② The total number of 100μm2 nerve fibers and the percentage of type Ia nerve fibers to the total number of nerve fibers in the beginning, middle and intervertebral foramen of the posterior root of the spinal nerve were counted. Results: ① spinal conical spinal roots are gradually formed by the convergence of roots. The application of microsurgical techniques, the posterior root can be divided into 10 to 18 beamlets, the first root is generally divided into 6 to 11 beamlets, the beam diameter is basically the same, the value is more constant. ② The number of total nerve fibers of 100μm2 was (3243 ± 143) and the number of type Ia fibers was (1702 ± 85), accounting for 52.5% of the total number of nerve fibers in the beginning, middle part and intervertebral foramen of spinal dorsal root. . Ia nerve fibers were evenly distributed in the posterior root, there is no concentrated distribution area. Conclusions: The most important characteristic of partial posterior rhizotomy, that is, the splitting standard of root anterior and posterior spinal nerves should be as fine as possible, which is conducive to accurately cut type Ia nerve fibers. The average number of anterior roots is 6-11 and the number of posterior roots is 10-18 Small bundle, cutting the maximum ratio should not exceed the total number of nerve fibers of the posterior root of 1/2.