内窥镜下颈椎前路手术应用解剖学研究及初步临床应用

发布时间：2018-08-23 15:04

【摘要】：目的：对颈椎前路进行应用解剖学研究，为内窥镜下颈椎前路手术提供解剖学依据；并探讨其可行性和初步临床疗效。方法： 1、标本测量对25具中国正常成年人头颈部标本进行解剖学测量；对头颈部标本进行毗邻结构的解剖学观察。 2、尸体模拟研究及置管训练使用椎间盘镜手术系统，共对7具尸体C1-7椎体间的14个间隙进行内镜下的颈椎前路减压操作。通过颈右前外侧约2cm的皮肤横切口，经血管鞘与内脏鞘间放入直径18mm的工作套筒并将其通过可曲自由臂固定在手术床边。内镜固定在工作套筒上。在内镜下行颈椎盘切除及椎体后缘骨质刮除术。 3、临床初步应用在临床工作中选择合适病例应用内窥镜下颈椎前路手术并评价其初步临床疗效。结果： 1、标本测量结果 (1)喉上神经分为三段：第1段(从发出至甲状舌骨膜)长(24.2±4.2)mm；第2段(位于甲状舌骨膜内)长(7.0±1.2)mm；第3段(出甲状舌骨膜至喉)(13.4+1.6)mm。(2)颈交感干由外上行向内下。距前正中线和颈长肌内缘的距离从C3-C7依次减少，C3(25.1±4.5)mm，，(20.5±5.8)mm；C7分别为(19.4±2.9)mm，(12.9±3.7)。在C6、7平面距前正中线及颈长肌内缘最近，在以上部位手术时颈交感干易于损伤。(3)喉返神经的分支有喉支和喉外支，前者在入喉前多分为前支、后支。87％的喉返神经分支呈树枝状，13％的喉返神经分支之间或分支与颈交感干之间相互吻合呈袢状.94％的喉返神经的喉支多在距甲状腺下角尖端(16.9±7.6)mm处。喉返神经与甲状腺下动脉的关系分为4种类型。
[Abstract]:Objective: to provide anatomic basis for anterior cervical surgery under endoscope, and to explore its feasibility and preliminary clinical effect. Methods: 1. The head and neck specimens of 25 normal Chinese adults were measured. Anatomical observation of adjacent structures on head and neck specimens. 2. Cadaveric simulation study and catheterization training using discectomy system, A total of 14 intervertebral spaces between C 1-7 vertebrae in 7 cadavers were treated with anterior cervical decompression under endoscope. Through the transverse incision of the skin of the right anterolateral neck about 2cm, a working sleeve with diameter 18mm was inserted between the vascular sheath and the visceral sheath and fixed on the side of the operation bed through the flexible free arm. The endoscope is fixed to the working sleeve. Endoscopic resection of cervical vertebrae disc and bone curettage of posterior edge of vertebral body. 3. Clinical preliminary application in clinical work To evaluate the primary clinical effect of anterior cervical surgery under endoscope. Results: 1. Results: (1) the superior laryngeal nerve was divided into three segments: the length of the first segment was (24.2 卤4.2) mm; The length of the second segment (located in the thyrohyoid membrane) was (7.0 卤1.2) mm, and that of the third segment (the thyroglossal periosteum to the larynx) (134.1.6) mm. (2) was upward and inward from the outside. The distance from the anterior median line to the inner margin of the longus cervicalis decreased from C3-C7 to C3 (25.1 卤4.5) mm, (, 20.5 卤5.8), and the C7 was (19.4 卤2.9) mm, (, 12.9 卤3.7), respectively. At the level of C6 ~ (7), the cervical sympathetic trunk is easily damaged during the operation of the anterior median line and the inner margin of the longus cervicalis. (3) the branches of the recurrent laryngeal nerve are the branch of the laryngeal branch and the external branch of the laryngeal nerve, and the former is divided into the anterior branch before entering the larynx. The posterior branch of recurrent laryngeal nerve (RLN) was dendriform in 13% of the branches of the recurrent laryngeal nerve, or the anastomosis between the branches and the cervical sympathetic trunk was loop. 94% of the branches of the recurrent laryngeal nerve were mostly located at (16.9 卤7.6) mm from the tip of the lower thyroid horn. The relationship between recurrent laryngeal nerve and inferior thyroid artery is divided into four types.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R687.3;R322

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