颈椎硬脊膜后方膜椎韧带的解剖学研究
Anatomy study about the meningovertebral ligaments in the posterior cervical epidural space
目的 研究颈椎硬脊膜后方膜椎韧带的解剖学特征，探讨其临床意义。 方法 内窥镜下观测13具成人防腐标本颈椎硬脊膜后方膜椎韧带的形态学特点，随后打开椎管，肉眼及手术显微镜下对膜椎韧带进行观测，记录其起止点、走行方向。用游标卡尺测量膜椎韧带的长度、宽度、厚度或直径。对膜椎韧带进行HE染色、Masson三色法染色，观察其组织形态结构特点。 结果 13例颈椎标本中硬脊膜后方均有膜椎韧带出现，膜椎韧带将硬脊膜向后连于椎板或黄韧带。膜椎韧带与黄韧带连接较紧密且数量居多，占72.4%。膜椎韧带在C1/2、C4/5黄韧带出现率为100%，C1/2黄韧带处膜椎韧带厚度最大,为（1.04±0.61）cm(0.3~2.01 cm)。膜椎韧带多呈前上后下走行。根据形态特点可将膜椎韧带分4型：条带型、条索型、网格型、薄片型。光镜下观察膜椎韧带由大量密集排列的胶原纤维构成。 结论 颈椎硬脊膜背部膜椎韧带是将硬脊膜连于椎管后壁的正常结构，其两端分别与硬脊膜背侧及椎管后壁尤其是黄韧带连接紧密，膜椎韧带可牵拉固定硬脊膜，从而维持脊髓在椎管中的相对位置。另外膜椎韧带可能是颈椎后路手术中硬脊膜撕裂及硬脊膜外出血的解剖学因素，建议相关手术中先予辨认并切断。
Objective To study the meningovertebral ligaments in the posterior cervical epidural space, and discuss their clinical significance. Methods First, the dorsal meningovertebral ligaments in cervical region were observed endoscopicly on 13 adult embalmed cadavers，and then the spinal canal was open，the morphology，orientation，attachment sites and distribution of the ligaments were observed by naked eyes and a surgical microscope. The length，width and thickness or diameter of the ligaments under the surgical microscope were measured using vernier caliper. Finally，H&E staining and Massons trichrome staining was adopted to find out the morphological and histological characteristics of meningovertebral ligaments. Results The meningovertebral ligaments can be found in all of 13 cervical specimens, being located between the dura and the ligamenta flava or lamina. Most of the meningovertebral ligaments attach to the ligamenta flava. The occurrence rate of the meningovertebral ligaments is 100% at C1/2、C4/5 ligamenta flava（72.4%）. The greatest thickness of the meningovertebral ligaments can be observed at the C1/2 ligamenta flava, which is (1.04±0.61)cm(0.3～2.01cm). The orientation of the ligaments mostly is craniocaudal. the morphology of the ligaments can be classified into four types: strip type, cord type, grid type, and thin slice type. Histologic examination of the meningovertebral ligaments revealed collagen fibrous connective tissue. Conclusion The meningovertebral ligaments originate from the dura and attach to the ligamentum flavum or lamina. The meningovertebra can immobilize the dual, and maintain the spinal cord at the right place. Moreover, the meningovertebral ligaments is an important structure that can pose a potential risk for inadvertent dural cervical surgery. Dissecting the meningovertebral ligaments before cervical flavectomy or laminectomy may be an important step in reducing postoperative cerebrospinal fluid leaks and epidural hematoma, which may result in significant benefits for patients and health care organizations.
Cervical / The meningovertebral ligaments / Cerebrospinal fluid leaks / Anatomy
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