Xiang Jian-Ping, Liu Xiao-Ling, Xu Yang-Bing, Wang Jian-Yun, Hu Jun
Department of Microsurgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Microsurgery. 2008;28(1):17-20. doi: 10.1002/micr.20438.
The purpose of this study was to describe microsurgical anatomy of the dorsal root entry zone (DREZ) and provide an anatomic basis for the approach of DREZ lesion in treating radiculopathy of brachial plexus avulsion injuries. We studied 100 dorsal cervical roots and DREZ/posterior horn complexes in 20 adult cadavers. At each root level the following data were recorded: widths of laminectomy, numbers of posterior rootlets, angle of the inferior rootlets with the spinal cord, and distance from posterior median sulcus to posterolateral sulcus. On cross-sectional plane, the length and width of dorsal horn and the angle between longitudinal axis of dorsal horn and sagittal plane of spinal cord were measured. The results showed that the spinal cord segment and the entry of dorsal roots from C5 to T1 were exposed clearly after laminectomy from C4 to C7. The average number of roolets of C5-T1 roots was about 7.76 and C6 has the most. From up to down, the angle from the inferior rootlet to spinal cord of C5-T1 diminished gradually. The average distance from posterior median sulcus to posterolateral sulcus was 2.95 mm. The average length, width, and angle of posterior horn were 3.47 mm, 1.346 mm, and 35.9 degrees , respectively. Our study demonstrated that the spinous process and lamina of the C4 to C7 vertebrae should be resected to expose the C5-T1 when DREZ lesions are employed to treat pain after brachial plexus avulsion. The lesion-making apparatus should be inserted at an angle of 30 degrees -40 degrees , the width of lesion should be less than 1.2 mm and the lesion depth less than 3.1 mm.
本研究的目的是描述背根入髓区（DREZ）的显微外科解剖结构，并为DREZ损伤治疗臂丛神经撕脱伤所致神经根病的手术入路提供解剖学依据。我们对20具成年尸体的100条颈背根及DREZ/后角复合体进行了研究。在每个神经根水平记录以下数据：椎板切除宽度、后根丝数量、下根丝与脊髓的夹角以及后正中沟至后外侧沟的距离。在横断面上，测量后角的长度和宽度以及后角纵轴与脊髓矢状面的夹角。结果显示，从C4至C7进行椎板切除后，C5至T1脊髓节段及背根入髓情况清晰可见。C5 - T1神经根的根丝平均数量约为7.76条，其中C6的根丝最多。自上而下，C5 - T1下根丝与脊髓的夹角逐渐减小。后正中沟至后外侧沟的平均距离为2.95 mm。后角的平均长度、宽度和夹角分别为3.47 mm、1.346 mm和35.9度。我们的研究表明，采用DREZ损伤治疗臂丛神经撕脱伤后疼痛时，应切除C4至C7椎体的棘突和椎板以暴露C5 - T1。致伤器械应呈30度 - 40度角插入，损伤宽度应小于1.2 mm，损伤深度应小于3.1 mm。
