远外侧锁孔入路的显微解剖学研究

发布时间：2018-05-01 21:27

本文选题：远外侧入路 + 枕髁　；参考：《苏州大学》2006年博士论文

【摘要】：第一部分远外侧枕髁后锁孔手术入路设计的显微解剖学研究目的：遵循微创化的原则，将锁孔手术理念融入传统远外侧入路，设计出一种新颖的枕髁后锁孔手术入路，观察显露的相关解剖结构，探讨其可行性，为临床应用提供依据。方法：选用8具经10％福尔马林固定、颅内动静脉乳胶灌注的湿性连颈头颅标本。为探索最适当的切口长度及肌肉分离方法，实验对比观察了两种不同形状的切口(直切口、“S”形切口)、两种切口长度(5cm和7cm)以及两种不同的枕下肌肉分离方法(纵行切开分离法和游离翻转法)。暴露枕骨的远外侧后，做一直径3cm的枕髁后类圆形骨窗，显微镜下观察显露的解剖结构。总结上述各方法的优缺点并予以优化组合，设计出一种新颖的、重复性好、可行性强的锁孔入路。结果：乳突后纵向“S”形7cm长的头皮切口(上缘起自乳突中点向后2cm处，下界至C_2水平)是该锁孔入路的最佳手术切口；采用分层翻转法处理枕下肌群明显优于纵行切开分离法。通过调整头位和显微镜角度，，枕髁后直径3cm的微骨窗同样可显露同侧椎动脉、小脑后下动脉、小脑前下动脉、面听神经、后组颅神经、延髓腹外侧等传统远外侧入路所能显露的解剖结构。结论：实验设计的枕髁后锁孔入路具有临床应用可行性，可以很好地显露上述结构。应用现代显微外科技术，可在不磨除枕髁的情况下进行椎动脉瘤、小脑后下动脉瘤、较小体积的舌下神经鞘瘤、延髓腹外侧肿瘤等病变的手术。
[Abstract]:Part I: microanatomical study on the design of the surgical approach to the posterior keyhole of the far lateral occipital condyle Objective: to follow the principle of minimally invasive keyhole operation and integrate the concept of keyhole operation into the traditional far lateral approach to design a novel approach for posterior occipital keyhole surgery. To observe the revealed anatomical structure and to explore the feasibility of keyhole operation, and to provide the basis for clinical application. Methods: 8 specimens of cervical head fixed with 10% formalin and infused with intracranial arteriovenous emulsion were selected. In order to explore the most appropriate incision length and muscle separation method, two different types of incision (straight incision) were observed and compared. "S" incision, two kinds of incision length (5 cm and 7 cm) and two different methods of suboccipital muscle separation (longitudinal incision separation and free turnover method). After exposure of the far-lateral occipital bone, a round posterior condylar bone window with diameter of 3cm was made, and the exposed anatomical structure was observed under microscope. The advantages and disadvantages of the above methods are summarized and optimized, and a novel, reproducible and feasible locking approach is designed. Results: the long scalp incision (from the midpoint of mastoid to the backward 2cm, from the middle of mastoid to the level of C2) was the best incision for the keyhole approach. The treatment of suboccipital muscle group by delamination and inversion was superior to that by longitudinal incision. By adjusting the angle of head position and microscope, the microbone window of posterior occipital condylar diameter 3cm can also reveal the ipsilateral vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery, facial auditory nerve, posterior cranial nerve, and posterior cranial nerve. The anatomical structure revealed by the traditional far-lateral approach such as ventrolateral medulla oblongata. Conclusion: the experimental retrocondylar keyhole approach is feasible in clinical application and can be well exposed. Using modern microsurgical techniques, we can perform surgery on vertebral aneurysms, posterior inferior cerebellar aneurysms, smaller hypoglossal neurilemmomas, ventrolateral tumors of medulla oblongata without grinding the occipital condyle.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R322

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