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脊髓病变的解剖学和定位

Author
Andrew Eisen, MD, FRCPC
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD

引言

因为脊髓是连接大脑和周围神经系统的主要通路，所以影响脊髓的疾病在临床上表现明显。这些病变过程很多都有指向脊髓内特定区域或神经束的倾向。因此，了解脊髓的解剖学及认识典型的常见脊髓综合征对脊髓病变患者的评估非常有价值，且可进行更有指向性的诊断性评估。

脊髓的解剖学及其血管供应和常见脊髓综合征的临床特征将总结在此。影响脊髓的疾病将单独讨论。 (参见“影响脊髓的疾病”)

脊髓解剖学

脊髓有31个节段，每一节段均有一对腹侧(前侧)和背侧(后侧)脊神经根，分别介导运动功能和感觉功能。腹侧和背侧神经根在每一侧汇合形成脊神经，由椎间孔出脊柱(图 1)。

纵向结构 — 脊髓纵向被分为四个区域：颈髓、胸髓、腰髓及骶髓段。脊髓自颅底延伸，终止于第一腰椎椎体(L1)下缘附近。在L1水平以下，椎管容纳组成马尾的腰、骶及尾节神经根。

因为脊髓较脊柱短，椎骨和脊髓的节段水平未必相同。C1-C8脊髓节段位于C1-C7椎骨水平。T1-T12脊髓节段位于T1-T8椎骨水平。5个腰髓节段位于T9-T11椎骨水平，S1-S5脊髓节段位于T12-L1椎骨之间。C1-C7神经根出现在各自的椎骨上面；C8神经根出现于C7和T1椎体之间。其余的神经根出现在各自的椎骨下面(图 2)。

                       

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-18.
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References
Top
  1. REXED B. SOME ASPECTS OF THE CYTOARCHITECTONICS AND SYNAPTOLOGY OF THE SPINAL CORD. Prog Brain Res 1964; 11:58.
  2. REXED B. A cytoarchitectonic atlas of the spinal cord in the cat. J Comp Neurol 1954; 100:297.
  3. Rathelot JA, Strick PL. Subdivisions of primary motor cortex based on cortico-motoneuronal cells. Proc Natl Acad Sci U S A 2009; 106:918.
  4. Wagner R, Jagoda A. Spinal cord syndromes. Emerg Med Clin North Am 1997; 15:699.
  5. BAKER AB. SPINAL CORD LOCALIZATION. J Lancet 1965; 85:269.
  6. Abdel-Azim M, Sullivan M, Yalla SV. Disorders of bladder function in spinal cord disease. Neurol Clin 1991; 9:727.
  7. Seftel AD, Oates RD, Krane RJ. Disturbed sexual function in patients with spinal cord disease. Neurol Clin 1991; 9:757.
  8. Biglioli P, Roberto M, Cannata A, et al. Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries. J Thorac Cardiovasc Surg 2004; 127:1188.
  9. GILLILAN LA. The arterial blood supply of the human spinal cord. J Comp Neurol 1958; 110:75.
  10. Kawaharada N, Morishita K, Hyodoh H, et al. Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply. Ann Thorac Surg 2004; 78:846.
  11. Lasjaunias P, Vallee B, Person H, et al. The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg 1985; 63:235.
  12. McCormick PC, Stein BM. Functional anatomy of the spinal cord and related structures. Neurosurg Clin N Am 1990; 1:469.
  13. Skalski JH, Zembala M. Albert Wojciech Adamkiewicz: the discoverer of the variable vascularity of the spinal cord. Ann Thorac Surg 2005; 80:1971.
  14. HADDEN SB. Diagnosis of spinal cord disease. Med Clin North Am 1951; 35:1765.
  15. Miller DH, McDonald WI, Blumhardt LD, et al. Magnetic resonance imaging in isolated noncompressive spinal cord syndromes. Ann Neurol 1987; 22:714.
  16. Offenbacher H. The diagnostic impact of magnetic resonance imaging on the evaluation of suspected spinal cord disease. Wien Klin Wochenschr 1992; 104:589.
  17. Morse SD. Acute central cervical spinal cord syndrome. Ann Emerg Med 1982; 11:436.
  18. Dickman CA, Hadley MN, Pappas CT, et al. Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction. J Neurosurg 1990; 73:850.
  19. Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J 2006; 6:198S.
  20. Podnar S. Epidemiology of cauda equina and conus medullaris lesions. Muscle Nerve 2007; 35:529.
  21. Orendácová J, Cízková D, Kafka J, et al. Cauda equina syndrome. Prog Neurobiol 2001; 64:613.
  22. Valen B, Rolfsen LC. [The cauda equina syndrome]. Tidsskr Nor Laegeforen 2003; 123:643.
  23. Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009; 90:1964.
  24. Belinchón JM, Campos J, Merino J, et al. [Chronic spontaneous lumbar epidural hematoma]. Neurocirugia (Astur) 2005; 16:533.
  25. Cohen DB. Infectious origins of cauda equina syndrome. Neurosurg Focus 2004; 16:e2.
  26. Johnsson KE, Sass M. Cauda equina syndrome in lumbar spinal stenosis: case report and incidence in Jutland, Denmark. J Spinal Disord Tech 2004; 17:334.
  27. Kebaish KM, Awad JN. Spinal epidural hematoma causing acute cauda equina syndrome. Neurosurg Focus 2004; 16:e1.
  28. Lenehan B, Sullivan P, Street J, Dudeney S. Epidural abscess causing cauda equina syndrome. Ir J Med Sci 2005; 174:88.
  29. Wright MH, Denney LC. A comprehensive review of spinal arachnoiditis. Orthop Nurs 2003; 22:215.
  30. Baron EM, Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 2007; 60:S35.
  31. Do-Dai DD, Brooks MK, Goldkamp A, et al. Magnetic resonance imaging of intramedullary spinal cord lesions: a pictorial review. Curr Probl Diagn Radiol 2010; 39:160.