颈椎前路减压手术界标及颈椎血供的应用解剖学研究

发布时间：2018-03-05 05:30

本文选题：前路减压手术　切入点：界标　出处：《福建医科大学》2006年硕士论文　论文类型：学位论文

【摘要】： 目的:明确硬膜囊、颈神经根及椎动脉与颈长肌、钩状突及横突孔等相互间的位置关系,为颈椎前路减压手术在有限显露术野中达到安全、有效减压提供更科学的减压界标。阐明颈椎体血供分布的特点,以促进手术技巧的改进,减少术野出血。方法:在15具经福尔马林防腐的和动脉内灌注红色乳胶的成人尸体标本上,解剖观测C_3～C_7节段:(1)颈长肌内侧缘至正中矢状面的距离(MLPD)、(2)颈长肌间距(MLD)、(3)钩状突前脚至正中矢状面的距离(AUPD)、(4)钩状突前脚至颈长肌内侧缘的距离(AULD)、(5)钩状突前脚至横突孔内侧缘的距离(AUTD)、(6)钩状突前脚间距(AUD)、(7)硬膜囊宽度(DSW)、(8)硬膜囊外侧缘至正中矢状面的距离、(9)钩状突后脚至正中矢状面的距离(PUPD)、(10)钩状突后脚间距(PUD)、(11)钩状突与神经根最近点至钩状突后脚的距离(UNPD)和(12)C_3～C_7椎体前后部血供的起源、走行、分支及吻合。以所测量的数据为基础,计算:(1)钩状突前脚至颈长肌内侧缘的距离/颈长肌内侧缘至正中矢状面的距离(AULD/MLPD)、(2)钩状突前脚至横突孔内侧缘的距离/钩状突前脚至颈长肌内侧缘的距离(AUTD/AULD)、(3)钩状突前脚至硬膜囊外侧缘的垂直距离/钩状突后脚至硬膜囊外侧缘的距离(AUDD/PUDD)和(4)钩状突与神经根最近点和钩状突前脚的垂直距离/钩状突前后脚的垂直距离(UNAD/APUD)。结果:(1) MLPD左右两侧测量值在C_3、C_7差别有显著性,右侧左侧(P0.05),而在C_4～C_6差别无显著性;(2)MLD在C_3的平均值为7.57mm,C_4为9.40mm,C_5～C_7为13.40mm;(3)DSW的平均值为16.52mm;(4)AUD的平均值为17.34mm,AUDDSW(P0.05);(5)PUD的平均值为8.49mm;(6) AULD/MLPD在C_3的平均值为0.83,在C_4的平均值为0.55,在C_5的平均值为0.20,在C_6的平均值为0.34,在C_7的平均值为0.27;(7)男性的AUTD的平均值为5.14mm,女性的AUTD为3.93mm;(8) AUTD/AULD的平均值为2.71;(9) AUDD/PUDD的平均值为0.28;(10) UNPD的平均值为5.01mm,UNAD/APUD的平均值为0.34;(10)椎体前部血供起自颈升动
[Abstract]:Objective: to determine the relationship between epidural sac, cervical nerve root, vertebral artery and the longus cervicalis, uncinate process and transverse foramen, so as to ensure the safety of anterior cervical decompression in the field of limited exposure. Effective decompression provides a more scientific boundary marker for decompression. The characteristics of blood supply distribution in cervical vertebrae are elucidated in order to promote the improvement of surgical techniques and reduce the bleeding in the surgical field. Methods: 15 adult cadaveric cadavers with formalin embalmed and intraarterial red latex were used. Anatomical observation of the distance between the medial margin and median sagittal plane of C _ 3 / C _ 7) the distance between the medial margin and the median sagittal plane of the longus cervicis and the distance between the anterior foot of the uncinate process and the median sagittal plane; the distance between the anterior foot of the uncinate process and the median sagittal plane; the distance between the anterior foot of the uncinate process and the medial margin of the longus cervicalis muscle; and the distance between the anterior foot of the hook process and the medial margin of the longus cervicalis muscle; and the distance between the anterior foot of the uncinate process and the foramen transverse process. Distance from medial margin to midsagittal surface (distance between anterior foot of uncinate protrusions and the distance between the anterior foot and the anterior foot of the uncinate protrusions and the distance between the width of the dural sac and the median sagittal plane of the dural sac / dural sac / dsd / dsv / 7)) the distance from the lateral edge of the dural sac to the median sagittal plane / from the posterior foot of the uncinate process to the median sagittal plane / to the median sagittal plane / / / UPD10) the distance between the uncinate posterior foot and the proximal point of the nerve root. The origin of the blood supply in the anterior and posterior parts of the vertebrae: the distance to the posterior foot of the uncinate process and the origin of the blood supply in the anterior and posterior parts of the vertebrae. Walk, branch, and match. Based on the measured data, Distance from anterior foot to medial margin of longus cervicalis / distance from medial margin of longus cervicalis to medial sagittal plane / distance from anterior foot of uncinate process to medial margin of transverse foramen / distance from anterior foot of uncinate process to medial margin of longus cervicis / distance between anterior foot of uncinate protrusions and medial margin of longus cervicis / distance between medial margin of longus cervicalis and medial margin of longus cervicalis / distance between anterior foot of uncinate process and medial margin of foramen longus. Vertical distance from anterior foot to lateral margin of dural sac / distance from posterior foot of uncinate process to lateral margin of dural sac (AUDDR / PUDDD) and 4) vertical distance between uncinate process and the nearest point of nerve root and anterior foot of uncinate process / vertical distance of anterior and posterior feet of uncinate process. Results: 1) there was a significant difference between the measured values of MLPD on the left and right sides in C _ 3s / C _ s _ 7, On the right side, there is no significant difference between C _ 4mm and C _ S _ 6. The average value of MLD in C _ 3 is 7.57 mm / C _ 4 is 9.40 mm / C _ 7 and 13.40 mm / C _ 7 is 16.52 mm respectively. The average value of C _ 3 is 17.34 mm / d (8.49 mm / d).) the average value of AULD/MLPD in C _ 3 is 0.83, in C _ 4 is 0.55, in C _ 4 is 0.55, in C _ 5 is 0.20, in C _ 5, it is 0.20 mm in C _ 5, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 4, in C _ 5, The average value of AUTD in C6 is 0.34, in C7 is 0.27) the average of AUTD in men is 5.14 mm, the average of AUTD in women is 3.93 mm) the average of AUTD/AULD is 2.71%) the average of AUDD/PUDD is 0.28%) the average of UNPD is 5.01 mm UNAD / APUD is 0.34 mm) the mean of blood supply in anterior vertebral body is 0.34 mm)
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R687;R322

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