颈椎后纵韧带和椎内前静脉丛镜下形态学及其临床意义

目的:手术显微镜和光学显微镜下观察尸体颈椎后纵韧带和椎内前静脉丛形态学,探讨硬膜外型颈椎间盘突出症(ECDE)发生的解剖学原因。方法:采集10具经甲醛泡过的尸体和维内前静脉丛颈段脊柱标本,手术显微镜下观察后纵韧带分层、起止点和走行;观察颈椎椎内前静脉丛的位置和分布。光镜下观察后纵韧带中椎内前静脉丛的组织学结构。结果:颈椎后纵韧带分3层,浅层纤维跨越数个椎间隙,分为中央纵向走行部分和两侧扩张部分;中层为纵行纤维,跨越单个椎间盘,起于上一椎体静脉孔下方,止于下一椎体静脉孔的上方;深层纤维起于与间盘相邻的椎体后缘。颈椎间盘后方中央区有3层后纵韧带纤维覆盖,旁中央区只有2层纤维覆盖,椎内前静脉丛纵行于其间。结论:颈椎椎间盘后方旁中央区是薄弱区,这可能是部分ECDE发生的解剖学因素,正确认识椎内前静脉丛的解剖学特点有助于临床医生术中止血,减少神经副损伤。

Morphology of cervical posterior longitudinal ligament and anterior intervertebral venous plexus under microscope and their clinical significances

Objective To explore the anatomic cause of the epidural cervical disc extrusion (ECDE) by observing the morphology of cervical posterior longitudinal ligament(PLL) and anterior intervertebral venous plexus under surgical microscope and light microscope. Methods Whole cervical spinal columns from C2 to C7 were collected from 10 formalin-fixed human adult cadavers of Chinese origin.In 10 columns,the block laminectomy was done.The layers,orientation and distribution of the cervical PLL were observed and the cervical anterior intervertebral venous plexus was observed under surgical microscope and light microscope. Results The cervical PLL was made up of three layers.There were the fibers of superficial layer on the back of the vertebral bodys across several intervertebral spaces.The superficial layer were divided into two portions,logitudinal and oblique fibers.The logitudinal fibers covered on the back central section of the intervetebral disk annulus fibrosus.The deep fibers exposed from the back lower edge of one vertebral body to the back superior edge of inferior adjacent vertebral body,covering on the back of the intervertebral disk.Between the superficial fibers and the deep fibers, there were the middle part of longitudinal fibers,which crossed a single disc,arising from the bottom bone of one vertebral body veins hole,inserting in the top bone of the inferior adjacent vertebral veins hole.All of the three layers coverd over the back middle part of the posterior annulus fibrosus,otherwise there were only two layers covering on the back lateral-middle part of the posterior annulus fibrosus.The cervical anterior intervertebral venous plexus was embedded between the superficial and deep layers of the cervical PLL in the lateral-middle area on the back of the cervical intervertebral disc which was relatively weaker than the middle area. Conclusion There is a weak area behind the paracentral area side of the cervical intervertebral disc,which may constitute a part of anatomic factors producing ECDE.Understanding the vertebral venous plexus anatomical features could help clinical doctors control intraoperative bleeding and reduce the rate of nerve damage.