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目的明确胸腰骶部不同节段脊神经根鞘的解剖学和组织学结构及其分布特点,探讨其临床意义。方法取7例成人脊柱标本,解剖观察胸腰骶部不同节段神经根鞘的硬脊膜囊开口方式,并制成组织切片后显微镜下观察神经根鞘的结构。结果胸腰段神经根鞘存在单孔和双孔两种硬脊膜囊开口方式,而骶段神经根鞘只存在单孔开口方式;单孔根鞘又根据前、后根之间有无双层袖套结构分为Ⅰ型和Ⅱ型。较之神经根其他部位,神经节处硬脊膜袖套的胶原纤维层少且结合疏松。腰4/5和骶1~5节段神经节处的硬脊膜袖套的厚度比其他节段更薄(F=37.31,P<0.01)。神经根袖套下腔隙终止于神经节。结论Ⅰ型和Ⅱ型神经根鞘在各节段的分布规律,解释了腰骶部神经根受压时多表现为感觉和运动功能同时受累的现象;而神经节处的硬脊膜袖套在下腰骶节段最薄的特点,也和腰腿痛高发的现象相关系。脊神经节是脊神经根开始转化为脊神经的标志。
OBJECTIVE: To determine the anatomical and histological structures and distribution of the root sheath of spinal segments of different segments of the thoracolumbar and sacral region and to explore its clinical significance. Methods Seven adult adult spinal specimens were dissected and the dural sac openings of the nerve root sheath in different segments of the thoracolumbar and lumbosacral region were dissected. The structure of the nerve root sheath was observed under a microscope. Results Thoracolumbar nerve root sheath there are two kinds of single and double holes dural sac opening, and the sacral nerve root sheath exists only single hole opening way; single hole root sheath and according to the presence of double Layer cuff structure is divided into Ⅰ and Ⅱ type. Compared to other parts of the nerve root, the ganglion at the dura mater of the collagen fiber layer less and loose combination. The thickness of the dura cuff at the lumbar 4/5 and sacral 1-5 segments was thinner than the other segments (F = 37.31, P <0.01). Nerve root cuff lower lacuna terminates at the ganglia. Conclusions The distribution of type I and type II nerve root sheath in each segment explains the phenomenon that the lumbosacral nerve root compression is accompanied by the simultaneous involvement of sensory and motor functions. Lower lumbosacral segments of the thinnest, but also the phenomenon of high incidence of low back pain associated. Spinal ganglia are signs that the spinal roots begin to transform into spinal nerves.