内窥镜下经口咽入路处理枕颈区病变中寰椎横韧带的应用解剖学研究

发布时间：2018-03-25 21:16

本文选题：寰椎　切入点：韧带　出处：《中南大学》2007年硕士论文

【摘要】： 目的:为内窥镜下经口咽入路处理枕颈区病变中寰椎横韧带手术提供解剖学支持,并探讨内窥镜下经口咽入路处理寰椎横韧带手术的可行性和方法学。方法:①选取50套完整寰椎骨性标本,测量寰椎前弓长度和寰椎横韧带结节间距。②选取20套带软组织的寰枢椎复合体标本,测量寰椎横韧带及其毗邻结构的相关解剖学数据。③将20具完整头颈部标本分为两组(传统组与内窥镜组),分别按传统及内窥镜下经口咽入路方法处理寰椎横韧带,探讨内窥镜下经口咽入路处理寰椎横韧带手术的可行性及处理寰椎横韧带的方法。结果:①寰椎前弓的长度为18.78±2.4mm。②寰椎横韧带结节间距为17.82±1.9mm。③寰椎横韧带呈弓形凸向后方,长度为19.67±2.4mm,其厚薄不均匀,中部薄而宽,两端厚而窄。左右寰椎横韧带附着点处的宽度分别为6.39±1.2mm和6.49±1.3mm;左右寰椎横韧带附着点处的厚度分别为3.50±0.8mm和3.6±0.8mm。中点处的宽度和厚度分别为10.34±1.8mm和1.96±0.3mm。④覆膜中点处的厚度为0.93±0.2mm,左右两端的厚度分别为2.48±0.7mm和2.52±0.7mm。⑤寰椎横韧带中点及左右两附着点处后缘与硬膜囊的最小距离分别为1.7±0.2mm、4.5±0.8mm和4.5±0.8mm。⑥寰椎横韧带中点及左右两附着点处后缘与脊髓的最小距离分别为4.0±0.5mm、8.1±1.2mm和8.0±1.2mm。⑦寰椎横韧带两附着点处与两侧椎动脉的最小距离分别为11.8±0.9mm和11.9±1.0mm。⑧寰椎横韧带在齿突切除以后,自身可发生形变,其中点在矢状位上可发生的最大位移,大小为5.62±1.3mm;切断其一侧附着点以后,中点在矢状位上移动的距离最大可达到11.70±1.6mm。结论:1、本研究认为内窥镜下经口咽入路处理寰椎横韧带在技术上是可行的,不仅能达到传统手术入路的术野范围,而且对寰椎横韧带显露更为清晰,操作更为方便和精确。 2、内窥镜下寰椎横韧带的处理可采用紧贴一侧寰椎横韧带结节,自上而下,垂直切断其附着点的方法,一般只切断一侧附着点即可达到减压的目的;切断寰椎横韧带的操作深度不能超过“安全深度”。 3、齿突切除后,寰椎横韧带后方存在一个“缓冲空间”。对临床上判断病理状态下寰椎横韧带是否需要处理有一定帮助。
[Abstract]:Objective: to provide anatomical support for the operation of transverse ligament of atlas in occipitocervical region by oropharyngeal approach under endoscope, and to explore the feasibility and methodology of transoropharyngeal approach for the treatment of transverse ligament of atlanto vertebrae. Methods the length of anterior arch of atlas and the distance between tubercle of transverse ligament of atlas were measured in 50 intact atlantoaxial bone specimens. Twenty specimens of atlantoaxial complex with soft tissue were selected. The anatomical data of atlas transverse ligament and its adjacent structures. 3. 20 intact head and neck specimens were divided into two groups (traditional group and endoscope group). The transverse ligaments of atlas were treated by traditional and endoscopic oropharynx approach, respectively. To explore the feasibility of transoropharyngeal approach for the treatment of transverse ligament of atlas under endoscope and the method of management of transverse ligament of atlas. Results the length of anterior arch of atlas was 18.78 卤2.4mm.2. The distance of transverse ligament nodule of atlas was 17.82 卤1.9mm.3 and the length was 19.67 卤2.4 mm. The length of the transverse ligament of atlas was not uniform and the middle part was thin and wide. The width of the insertion point of the transverse ligament of the left and right atlas is 6.39 卤1.2mm and 6.49 卤1.3mm, the thickness of the insertion point of the transverse ligament of the left and right atlas is 3.50 卤0.8mm and 3.6 卤0.8mm. the width and thickness of the midpoint are 10.34 卤1.8mm and 1.96 卤0.3mm.4, respectively. The minimum distance between the posterior edge of the transverse ligament of atlas and the dural sac is 1.7 卤0.2mm, 4.5 卤0.8mm and 4.5 卤0.8mm.6, respectively, and the minimum distance between the posterior edge and the spinal cord of the transverse ligament of atlas and the posterior edge of the left and right attachment points is 2.48 卤0.7mm and 2.52 卤0.7mm.5, respectively. The minimum distance between the insertion point of transverse ligament of atlas and bilateral vertebral artery was 11.8 卤0.9mm and 11.9 卤1.0mm.8 respectively after odontoidectomy. The maximum displacement of the point in sagittal position is 5.62 卤1.3mm, and the maximum distance of midpoint moving in sagittal position is 11.70 卤1.6mm. Conclusion 1. This study suggests that endoscopic transoropharyngeal approach is technically feasible for the treatment of transverse ligaments of atlas, which can not only reach the range of the operative field of the traditional approach, but also reveal the transverse ligament of the atlas more clearly, and the operation is more convenient and accurate. 2. The treatment of transverse ligaments of atlas under endoscope can be done by sticking to one side of transverse ligament nodule of atlas and cutting its attachment point vertically from top to bottom. The purpose of decompression can be achieved only by cutting off the attachment point of one side. The operating depth of transection of transverse ligament of atlas should not exceed "safe depth". 3. After odontoidectomy, there is a "buffer space" behind the transverse ligament of atlas.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R687.3;R322

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