颅颈交界腹侧区手术入路的显微解剖学研究

发布时间：2018-02-27 06:33

本文关键词： 颅颈交界腹侧区经下颌下-咽后入路显微解剖颅颈交界腹侧区枕下极外侧入路显微解剖　出处：《山东大学》2006年博士论文　论文类型：学位论文

【摘要】：第一部分：经下颌下—咽后入路的显微解剖学研究目的：虽然在国内外已有少数神经外科医生将经下颌下—咽后入路应用于临床，但是该手术入路在应用的过程中极易造成舌下神经、椎动脉等重要结构的损伤，从而在很大程度上限制了其在临床上的应用。本研究模拟手术入路进行显微外科解剖，测量相关解剖数据并观察手术的显露范围，旨在提供精确的解剖学资料以期指导临床手术安全顺利地进行。方法： 1．标本材料及仪器设备：完整颅底骨性标本30例；完整寰、枢椎骨性标本各50例；15例(30侧)经福尔马林充分固定的国人成人带颈(均保留至C_4水平以上)头颅湿性标本，为准确区分动、静脉，维持血管正常粗细和提高照片的拍摄质量，所有标本均在动、静脉系统内分别灌注混有红色和蓝色染料的乳胶。 2．解剖步骤：模拟经下颌下—咽后手术入路逐层进行显微外科解剖，用数码相机拍摄解剖过程并测量有关的解剖数据。①尸头取仰卧位并向非手术侧旋转大约30°，，颈过伸头架固定。②皮肤切口：与下颌骨平行并在其下缘约2cm处做横行的皮肤切口，起自乳突尖，于下颌角下方约2cm处转向中线，止于舌骨上方。③切开皮肤，显露并充分游离颈阔肌，与皮肤切口平行，横行切断颈阔肌，显露并充分游离下颌下腺。④向上牵开下颌下腺，沿肌腱方向切断固定于舌骨大翼上的筋膜索带，使二腹肌肌腱游离，将其牵向上方，显露舌下神经。⑤将舌下神经牵向上方，沿舌骨行径打开筋膜直至颈动脉鞘，进入咽后间隙。⑥用手指触摸，确定寰椎前结节，将椎前间隙内的头长肌、颈长肌及筋膜全部清除，显露寰枢椎表面。⑦磨除寰椎前弓及枢椎齿状突，显露枕骨大孔前缘和下斜坡。⑧磨除下斜坡骨质，去除寰椎十字韧带及覆膜，“工”形切开硬膜，显露和观察硬膜下方的结构。⑨截断下颌骨，将其翻向上方，观察显露范围的扩大程度。
[Abstract]:Part one: microanatomical study of transmandibular subpharyngeal approach. Objective: although a few neurosurgeons at home and abroad have applied the submandibular retropharyngeal approach to clinical practice, it is easy to cause damage to the hypoglossal nerve, vertebral artery and other important structures in the course of application. This study simulates the surgical approach for microsurgical anatomy, measures the related anatomical data and observes the exposure range of the operation. The aim is to provide accurate anatomical data to guide the clinical operation safely and smoothly. Methods:. 1. Specimen materials and instrumentation: 30 cases of intact skull base bone specimens, 50 cases of intact atlas and 50 cases of axial bone specimens, 15 cases with 30 sides or 30 sides of intact atlas and axial bone specimens. Adult adult cadaveric specimens with neck (all above C4 level) were fully fixed by formalin. In order to accurately distinguish the arteries and veins, maintain the normal thickness of the blood vessels and improve the quality of the photographs, all specimens were perfused with red and blue dyestuffs respectively in the arteriovenous system. 2. Anatomical steps: the microsurgical anatomy was performed layer by layer by simulated submandibular retropharyngeal approach. The anatomical process was photographed with a digital camera and measured. 1 the cadaveric head took the supine position and rotated about 30 掳to the non-operative side. The cervical extension head frame fixed the 2. 2 incision of the skin: a skin incision parallel to the mandible and transversing about 2 cm below the lower margin. Starting from the mastoid tip, turning to the midline at about 2cm below the mandibular angle, ending at 3. 3 incision above the hyoid, exposing and fully disengaging the latissimus cervicalis, parallel to the incision of the skin, transecting the latissimus cervicalis laterally. Exposing and fully dissociating the submandibular gland from the submandibular gland upward, cutting off the fascial cord band fixed on the great pterygoid of the hyoid bone along the direction of the tendon, leading the tendon of the bicentric muscle to the top, exposing the hypoglossal nerve, leading the hypoglossal nerve to the top, The fascia was opened up to the carotid sheath along the hyoid approach, and the posterior pharyngeal space 6. 6 was touched with the finger to determine the atlas anterior tubercle. The head longus, the cervical longus and the fascia in the prevertebral space were completely removed. Exposure of atlantoaxial surface .7 abrasion of anterior arch and odontoid process of atlas, exposure of anterior margin of occipital foramen and lower Clivus, removal of inferior Clivus bone, removal of cruciate ligament and membrane of atlantoaxial vertebrae, "working" incision of dura, The subdural structure 9. 9 truncated the mandible, turned it over, and observed the extent of the exposure.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R322

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