枕下远外侧入路中颅外软组织结构的手术解剖研究

发布时间：2018-06-02 16:28

本文选题：枕下远外侧入路 + 枕下三角　；参考：《山西医科大学》2011年硕士论文

【摘要】：目的:对枕下远外侧手术入路中颅外软组织结构进行手术解剖,为临床工作提供更多的应用解剖学资料,以减少手术并发症。方法:先将10具(20侧)湿性成人头颈标本用彩色乳胶分别灌注动、静脉血管,然后在灌注好的头颈标本上模拟枕下远外侧手术入路,逐层解剖枕下区颅外软组织结构,观察肌肉、邻近血管和神经的形态、走行及相互结构关系。测量寰、枢椎横突孔之间的距离、枕下区椎动脉的直径、寰椎横突孔上缘至椎动脉穿寰枕筋膜处的距离和椎动脉穿寰枕筋膜处内侧缘至枕骨大孔后缘中点的距离。结果: 1.头上斜肌、头下斜肌和头后大直肌构成了枕下三角,椎动脉从此三角深面通过。 2.颈2神经的腹侧支恒定地跨过寰、枢椎段椎动脉的后方。 3.枕下区椎动脉旁静脉丛丰富且不规则,在寰椎横突孔至椎动脉穿寰枕筋膜处,越接近中线部位静脉丛越小,在寰、枢椎横突孔之间的椎动脉被静脉丛包绕,静脉丛由下向上越来越密集。 4.寰椎横突孔位于枢椎横突孔的上外方,二者之间的距离为(17.82±3.65)mm。 5.寰椎横突孔上缘至椎动脉穿硬膜处的距离为(33.29±7.79)mm。 6.枕下区椎动脉走行迂曲多变,椎动脉穿硬膜处内侧缘距枕骨大孔后缘中点的距离为(24.85±2.96)mm。 7.枕动脉绝大多数情况下走行于头最长肌的下方,当枕动脉沟缺如时,其走行于头最长肌的浅层头夹肌的下方。结论: 1.在枕下远外侧手术入路中,枕下三角、颈2神经腹侧支和椎动脉旁静脉丛是术中寻找椎动脉的重要标志。 2.在枕下远外侧手术入路中,可磨开寰椎横突孔及磨除至少半个寰椎后弓,分离并向内下方移动椎动脉,增加病变的显露范围,必要时可从后内方磨除部分枕骨髁和寰椎侧块。 3.对枕下远外侧手术入路中颅外软组织结构的手术解剖研究,可提高该手术入路的安全性和手术疗效,减少术后并发症的发生。
[Abstract]:Objective: to provide more applied anatomical data for the clinical work by dissecting the soft tissue structure of the middle cranial soft tissue via the suboccipital far-lateral approach in order to reduce the complications of the operation. Methods: 10 adult head and neck specimens were perfused with color latex respectively. Then the extracranial soft tissue structure of the suboccipital region was dissected layer by simulating the suboccipital distal approach on the perfused head and neck specimens. Observe the morphology of muscle, adjacent blood vessels and nerves, and the relationship between them. The distance between the transverse foramen of atlas and axis, the diameter of the vertebral artery in the suboccipital area, the distance between the superior margin of the transverse foramen of atlas and the transversed-vertebral artery through the atlantooccipital fascia and the distance between the medial margin of the vertebral artery and the posterior margin of the occipital foramen magnum were measured. Results: 1. Superior oblique, inferior oblique and posterior rectus constitute the inferior occipital triangle from which the vertebral artery passes. 2. The ventral branch of the cervical 2 nerve steadily crosses the posterior part of the atlas and axial vertebral artery. 3. The venous plexus near the inferior occipital artery is abundant and irregular. The venous plexus is smaller from the transverse foramen of the atlas to the place of the vertebral artery penetrating the atlantooccipital fascia, and the vertebral artery between the transverse foramen of the atlas and the foramen of the transverse process of the axis is surrounded by the venous plexus. The venous plexus is thicker and denser from the bottom up. 4. The transverse process foramen of atlas is located in the upper and outer side of transverse foramen of axis, and the distance between them is 17.82 卤3.65 mm. 5. The distance from the superior margin of transverse foramen of atlas to the point where the vertebral artery penetrates the dura is 33.29 卤7.79 mm. 6. The distance between the medial margin of vertebral artery through the dura and the middle point of posterior margin of foramen magnum is 24.85 卤2.96 mm.. 7. Most of the occipital arteries walk below the longissimus capitis muscle, and when the sulcus of the occipital artery is absent, the occipital artery runs below the superficial caput muscle of the longissimus capitalis muscle. Conclusion: 1. In the suboccipital far-lateral approach, the suboccipital triangle, the ventral branch of the cervical 2 nerves and the venous plexus adjacent to the vertebral artery are important signs for searching for the vertebral artery during the operation. 2. In the suboccipital far lateral approach, the transverse foramen of atlas and at least half of the posterior arch of atlas can be ground, and the vertebral artery can be separated and moved down to the medial and lower part of the vertebral artery to increase the exposure of the lesion, and if necessary, part of the condyle of occipital bone and the lateral mass of atlas can be removed from the posterior medial side. 3. The anatomical study of the soft tissue structure of the middle cranial soft tissue via the far lateral suboccipital approach can improve the safety and curative effect of the approach and reduce the incidence of postoperative complications.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322

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