枕大孔区解剖学变异对其腹侧病变手术的指导意义

发布时间：2018-10-22 08:38

【摘要】： 目的:对成人头颅干性标本枕大孔区的相关解剖进行量化研究,为后外侧入路处理枕大孔腹侧病变手术中,是否磨除枕髁提供解剖学依据。方法:用游标卡尺测量枕大孔相关解剖数据:枕大孔纵径(FML)、枕大孔横径(FMW)、枕大孔前正中点与枕髁后缘连线垂直距离(AOCP),枕髁轴径(OCA),然后根据AOCP/FML比值将100例成人头颅标本分为三型(组)。结果: FML、FMW、AOCP、OCA分别为34.81±4.39mm、29.11±4.39 mm、15.99±3.25mm、24.07±4.78mm。100例成人头颅标本分为以下三组:I组(小枕髁型)占8%,II组(中枕髁型)占74%,III组(大枕髁型)占18%。结论:枕大孔区解剖结构变异较大。在处理枕大孔腹侧病变前,应明确枕大孔区分型,以选择合适的后外侧入路。目的:通过对成人头颅标本相关解剖进行测量和量化分析,为下斜坡及枕大孔腹侧病变手术入路的选择提供科学依据。方法:根据枕大孔的AOCP/FML比值将100例成人头颅标本分组,分析每组中采用不同手术入路时对枕大孔腹侧区显露角度的差异。结果: 100例成人头颅标本分为以下三组:I组(小枕髁型)占8%,II组(中枕髁型)占74%,III组(大枕髁型)占18%。I组中Angle A和Angle B之间无统计学差异,但II、III组中Angle A和Angle B之间存在显著差异。(angle A and B分别表示磨除枕髁后1/3前后的显露角度)。结论:枕髁大小变异较大,对于下斜坡及枕大孔腹侧病变,小型枕髁患者术中无需磨除枕髁,采用枕下外侧入路即可获得理想的显露。对于中、大型枕髁患者,磨除枕髁后可提供更大的观察视角,因此宜采用经髁入路。术前应用螺旋CT行三维骨性重建,明确枕髁类型对手术入路的选择具有指导意义。
[Abstract]:Objective: to quantitatively study the anatomy of occipital foramen region in adult cadaveric cadavers and provide anatomic basis for the treatment of occipital condyle by posterolateral approach in the operation of occipital foramen ventral lesion. Methods: the relative anatomical data of foramen magnum were measured with Vernier caliper: longitudinal diameter of foramen magnum (FML), transverse diameter of foramen magnum (FMW), anterior median point of foramen magnum and posterior edge of occipital condyle vertical distance from axis diameter of (AOCP), occipital condyle (OCA),. The specimens were divided into three types. Results: the FML,FMW,AOCP,OCA was 34.81 卤4.39mm and 29.11 卤4.39 mm,15.99 卤3.25mm 卤24.07 卤4.78mm.100 respectively. The head specimens were divided into the following three groups: group I (small occipital condyle) accounted for 8% of the occipital condyle type, and the middle occipital condyle group (middle occipital condyle type) accounted for 18 beats in the 74 occipital condyle group (large occipital condyle type). Conclusion: the anatomical structure of the foramen magnum region has great variation. Before dealing with the ventral occipital foramen, we should identify the type of the foramen magnum and select the appropriate posterolateral approach. Objective: to provide scientific basis for the choice of surgical approach for inferior Clivus and ventral occipital foramen by measuring and quantifying the related anatomy of adult head specimen. Methods: according to the AOCP/FML ratio of the foramen magnum occipitalis, 100 adult cranial specimens were divided into two groups, and the differences of the exposure angles of the ventral occipital foramen were analyzed in each group. Results: one hundred adult cranial specimens were divided into the following three groups: group I (small occipital condyle) accounted for 8% and group II (middle occipital condyle) accounted for 74.The third group (large occipital condyle) accounted for 18.I there was no statistical difference between Angle A and Angle B in group I. But there was significant difference between Angle A and Angle B in II,III group. (angle A and B indicated the exposure angle before and after 1 / 3 of occipital condyle removal. Conclusion: the size of occipital condyle varies greatly. For the inferior Clivus and ventral occipital foramen, the patients with small occipital condyle do not need to grind the occipital condyle during the operation, and the suboccipital lateral approach can obtain the ideal exposure. For medium and large occipital condyle patients, grinding occipital condyle can provide more visual angle, so transcondylar approach is appropriate. Three-dimensional bone reconstruction with spiral CT was performed before operation, and the determination of occipital condyle type was of guiding significance for the choice of operative approach.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R322.8;R739.4

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