椎—基底动脉应用解剖学研究及三维可视化

发布时间：2018-03-30 16:48

本文选题：椎-基底动脉　切入点：CMC/LO　出处：《南华大学》2012年硕士论文

【摘要】：目的： 1．观测椎-基底动脉及其主要分支行程、起始处外径及夹角，为临床介入术提供形态学依据。 2．探讨椎-基底动脉数字化方法，对椎-基底动脉与邻近骨性结构的毗邻关系进行三维可视化研究。材料和方法： 1．大体解剖：9例经股动脉灌注红色乳胶正常成人整尸标本，逐层解剖头颈部，记录椎-基底动脉的起始处外径及夹角、走行、分支、分布、吻合及伴行情况。 2．血管铸型：3例经颈总动脉加压注入红色过氯乙烯正常成人头颈部标本，经腐蚀后观察椎-基底动脉的起始处外径及夹角、走行、分支、分布、吻合及伴行情况。 3．三维重建：3例经股动脉灌注CMC/LO新鲜成人整尸标本，行整尸CT连续扫描，扫描数据导入Mimics软件，，对椎-基底动脉及分支与邻近的骨性结构进行三维重建可视化显示，观察它们的毗邻关系。结果： 1．椎-基底动脉及其分支、分布与外径、起始处夹角的测量 ⑴椎动脉起源于锁骨下动脉，穿第6-1颈椎横突孔进入颅内，两侧椎动脉于延髓脑桥沟处汇合成基底动脉。椎动脉按行程可分为4段。近段、横突段、远段这三段合称颅外段，第四段称颅内段。椎动脉起始处外径：左侧4.30±0.02mm，右侧3.60±0.05mm。椎动脉穿越第6颈椎横突孔下缘处外径左侧3.90±0.03mm，右侧2.90±0.05mm。锁骨下动脉与椎动脉夹角（外侧角）左侧91.70±0.90，右侧115.80±1.60°（P0.05）。小脑下后动脉是椎动脉颅内段最大分支，小脑下后动脉起始处外径：左侧1.50±0.10mm，右侧1.20±0.20mm，小脑下后动脉在向下走行过程中穿过舌下神经根上下束，9例标本中有2例从迷走、舌咽神经根上方走行的为14.1%。小脑下后动脉与椎动脉夹角，左侧118.50±3.80°，右侧77.60±7.90°（P0.05）。 ⑵基底动脉由两侧椎动脉在延髓脑桥沟处汇合形成，沿脑桥的基底动脉沟上行至脑桥腹侧面上缘，分为左、右大脑后动脉。基底动脉的长度为(27.10±2.50)mm，外径为(3.80±0.50) mm。 ①小脑下前动脉多起于基底动脉起始段，起始处外径左侧0.80±0.10mm，右侧2.10±0.10mm，小脑前下动脉走行于前庭蜗神经、面神经这两神经根之间下行，与面神经根接触占27.6%，小脑下前动脉与基底动脉夹角左侧91.60±2.40°，右侧27.20±2.70°。（P0.05） ②小脑上动脉在脑桥腹侧面处上缘自基底动脉近终点处发出，小脑上动脉起始处外径：左侧1.40±0.05mm，右侧1.20±0.05mm。小脑上动脉走行于大脑后动脉下方，与三叉神经根接触的比例为35.5%。小脑上动脉与基底动脉夹角左侧89.50±4.10°，右侧100.20±490°（P0.05）。 ③大脑后动脉是基底动脉终支，起始处外径：左侧2.30±0.20mm，右侧1.90±0.10mm，大脑后动脉与基底动脉夹角左侧93.90±3.40°，右侧130.80±3.20°（P0.05）。 2．不同研究方法显示血管的特点 ⑴巨微解剖：常规灌注后血管饱满，管道通畅，血管走行清楚，容易分离，便于追踪观测血管的分支、分布、外径大小。 ⑵血管铸型：椎-基底动脉及其分支显示完整，如：椎动脉、小脑下后动脉、基底动脉、小脑下前动脉、迷路动脉、小脑上动脉、大脑后动脉、后交通动脉等。 ⑶三维可视化：重建椎-基底动脉及其主要分支的三维可视化模型，显示了椎-基底动脉的空间位置与周围骨性结构的毗邻关系。结论： 1．椎动脉、小脑下前动脉起始处外径以及椎-基底动脉主要分支左、右起始处夹角呈不对称性，提示临床介入插管，需选择合适的导管、导丝，行个性化治疗。 2．椎-基底动脉的三维重建，可为椎-基底动脉疾病的诊疗提供立体直观的形态学方法。
[Abstract]:Purpose :

1 . Observation of the vertebral - basilar artery and its main branch stroke , the outer diameter and included angle of origin , provide morphological basis for clinical intervention .

2 . To investigate the digital methods of the vertebral - basilar artery , and to study the adjacent relationship between the vertebral - basilar artery and adjacent bony structures . Materials and Methods :

1 . Gross anatomy : 9 cases were perfused with red latex from femoral artery to normal adult body specimen , the head and neck were dissected layer by layer , the outer diameter and included angle , walking , branching , distribution , anastomosis and tracing were recorded at the beginning of the vertebral - basilar artery .

2 . Blood vessel casting : 3 cases of normal adult head and neck were injected with red perchloride through common carotid artery . After corrosion , the outer diameter and included angle , walking , branching , distribution , anastomosis and tracing of the vertebral - basilar artery were observed .

3 . Three - dimensional reconstruction : 3 cases were perfused with CMC / LO fresh adult corpse specimen , CT continuous scanning of whole body , scanning data were introduced into Mimics software , and three - dimensional reconstruction and visualization of vertebral - basilar artery and branch and adjacent bony structures were performed to observe their abutting relationship .

Results :

1 . Measurement of the included angle between the vertebral - basilar artery and its branches , distribution and outer diameter and origin

( 1 ) The vertebral artery originated from the lower artery of the clavian artery , the transverse process of the 6th - 1 cervical vertebra entered the intracranial , and the vertebral artery at both sides of the vertebral artery was merged into the basilar artery at the sulcus of the medulla .

The posterior femoral artery was the largest branch of the intracranial segment of the vertebral artery . The outer diameter of the posterior inferior cerebellar artery was 1.50 卤 0.10 mm on the left side , 1.20 卤 0.20 mm on the right side , and 14.1 % in 9 specimens . The included angle between the posterior and vertebral artery , the left side of the inferior cerebellar artery and the vertebral artery , the left side was 118 . 50 卤 3 . 80 掳 , and the right side was 77.60 卤 7.90 掳 ( P0.05 ) .

( 2 ) The basilar artery was formed by the confluence of two vertebral arteries at the medulla of the medulla and the basilar artery sulcus of the brain bridge to the upper margin of the ventral side of the brain bridge . The length of the basilar artery was ( 27.10 卤 2.50 ) mm and the outer diameter was ( 3.80 卤 0.50 ) mm .

( 1 ) The anterior inferior cerebellar artery originated from the initial segment of the basilar artery , the left side of the outer diameter was 0.80 卤 0.10 mm , the right 2.10 卤 0.10 mm , the anterior inferior cerebellar artery went down the anterior vestibular nerve , the facial nerve roots contact with the facial nerve root , the angle left 91.60 卤 2.40 掳 , the right side 27.20 卤 2.70 掳 . ( P0.05 )

On the ventral side of the brain bridge , the arterioles of the cerebellum originate from the proximal end point of the basilar artery , the outer diameter of the cerebellar artery is 1.40 卤 0.05mm , the right is 1.20 卤 0.05mm . The arterioles of the cerebellar artery follow the posterior cerebral artery , and the proportion of the superior cerebellar artery to the trigeminal nerve root is 35 . 5 % . The angle between the superior cerebellar artery and the basilar artery is 89.50 卤 4.10 掳 , and the right side is 100 . 20 卤 490 掳 ( P0.05 ) .

( 3 ) The posterior cerebral artery was the final branch of the basilar artery , the outer diameter of the artery was 2.30 卤 0.20 mm on the left side , 1 . 90 卤 0.10 mm on the right , 93.90 卤 3.40 掳 on the left side of the posterior cerebral artery and basilar artery , and 130 . 80 卤 3 . 20 掳 on the right side ( P0.05 ) .

2 . Different research methods show the characteristics of blood vessels

( 1 ) macro - micro anatomy : the blood vessel is full after the conventional perfusion , the pipeline is smooth , the blood vessel is clear and easy to separate , and the branch , the distribution and the outer diameter of the observation blood vessel can be tracked conveniently .

( 2 ) vascular cast : the vertebral - basilar artery and its branches are shown intact , such as vertebral artery , posterior inferior cerebellar artery , basilar artery , anterior inferior cerebellar artery , labyrinth artery , cerebellar superior artery , posterior cerebral artery , posterior communicating artery , etc .

( 3 ) Three - dimensional visualization : reconstruction of the three - dimensional visualization model of the vertebral - basilar artery and its main branches , showing the adjacent relationship between the spatial position of the vertebral - basilar artery and the surrounding bony structure .

CsA could cause PLT to decrease ;

1 . At the beginning of the vertebral artery , the beginning of the inferior cerebellar artery and the main branch of the vertebral - basilar artery , the included angle of the left and right angles is asymmetric , which suggests that the proper catheter , guide wire and individualized treatment should be selected .

2 . Three - dimensional reconstruction of the vertebral - basilar artery can provide a three - dimensional visual morphological method for diagnosis and treatment of vertebral - basilar artery disease .

【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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