咽旁间隙的相关侧颅底应用解剖研究
发布时间：2018-11-02 12:43
【摘要】： 目的:从咽旁间隙肿瘤手术进路的角度观察测量侧颅底区骨性结构的有关解剖数据,为手术中准确定位颅底相关重要解剖结构,保全脑神经和重要血管提供较详实的依据;通过对尸头模拟经颈侧进路及经咽侧壁进路,明确手术进路中穿经的解剖结构以及重要血管神经的相互毗邻关系,加以保护,减少手术并发症。 方法: 1.在30具(60侧)成人颅骨上,对茎突根部、乳突、鼓乳裂最下点与咽旁间隙相关的侧颅底骨性标志的最短直线距离及与正中矢状面的前夹角等进行测量,并测量侧颅底区重要孔道直径。 2.研究观察咽旁间隙相关侧颅底区的范围及周围毗邻结构,测量咽旁间隙颅底区的长度和宽度。 3.在10具(20侧)成人湿性尸头(包含上颈部),应用颈侧进路及咽侧壁进路,对咽旁间隙及毗邻结构进行外科解剖研究,着重对茎突隔、后四组颅神经、颈内动脉等结构进行观测。 结果: 1.获得了茎突根部、乳突、鼓乳裂最下点分别与有关骨性结构的距离和角度数据,显示左侧与右侧比较有显著差异。 2.侧颅底区重要孔道测量(最大径)显示左侧与右侧比较有显著差异。 3.咽旁间隙颅底区测量:长度:左、右侧分别为33.11±2.95mm,34.88±2.36mm(P0.01);宽度:左、右侧分别为17.31±2.22 mm,17.15±1.65 mm(P0.05)。 4.乳突尖至下颌骨升支、乳突前缘至下颌骨升支、第一颈椎横突至下颌骨升支等的最短距离分别为22.94±3.08 mm,14. 50±3.57mm,20.34±9.03mm。 5.20侧标本中有30%副神经位于第一颈椎横突外侧走行,其余位其前面经过;有20%舌下神经弓形向前下走行时位于二腹肌后腹下缘下0.5~1.0cm。 结论: 1.乳突尖、鼓乳裂及茎突根部等骨性标志在手术中易于触摸、定位。对所选测量点间的距离及角度进行测量,可定位重要结构位置,明确手术进路的深度,估测其方位。 2.茎突根部是咽旁间隙的关键解剖标志,手术宜保护其后方的颈内动脉、颈内静脉、后组脑神经和其浅面的颈外动脉、面神经等重要结构。 3.以破裂孔内缘与茎突根部的连线作为咽旁前、后间隙在颅底区的分界线。蝶骨翼突内侧板、茎突、蝶骨大翼及颞骨岩部、破裂孔等作为茎突前间隙的标志;颈静脉孔及附近骨质、枕骨的外侧、枕骨髁等作为茎突后间隙的标志。以翼突内侧板根部至颈静脉窝外后缘的距离作为咽旁间隙颅底区的长度,蝶棘至颈静脉窝内后缘的距离作为其宽度。 4.第一颈椎横突在手术中易于触摸,可作为寻找、保护副神经的重要骨性标志;部分舌下神经弓形向前下走行时位于二腹肌后腹下缘下,在颈清扫术中注意避免伤及。 5.咽旁间隙的手术入路空间狭小,如何充分暴露术野是非常重要的。切除颌下腺、腮腺下极、茎突或乳突骨质,切断二腹肌、茎突肌肉组织、茎突下颌韧带,行下颌骨半脱位等,可获得充分的视野。
[Abstract]:Objective: To observe the anatomical data of the bone structure of the lateral skull base region from the perspective of the operative route of the parapharyngeal space tumor, and provide a more detailed basis for the accurate positioning of the important anatomical structures in the skull base, preserving cranial nerves and important blood vessels in the operation. Through simulating the cervical side route and the pharynx side wall route, the anatomical structure and the adjacent relationship between the important vascular nerves in the surgical approach are clearly identified, so as to protect and reduce the complications of the operation. Methods: 1. On the 30 (60-side) adult skull, the shortest straight distance between the root of the stem, the mastoid, the lowest point of the drum and the lateral clearance of the lateral skull base and the anterior included angle of the sagittal plane were measured. in ord to measure that diameter of the major pore canal in the lateral skull base region. and the length and width of the skull base region of the parapharyngeal space are measured. 3. An adult wet corpse head (including an upper neck) on 10 (20 sides) is applied, a cervical side approach and a pharyngeal wall route are applied, the parapharpharyngeal space and the adjacent structure are carried out anatomy of the family The structure of the posterior four groups of cranial nerves and internal carotid artery were observed. The distance and angle data of the root, mastoid and drum of the stem are respectively related to the bone structure. There was a significant difference between the left and right sides of the display. 2. Significant differences were noted on the left and right sides of the lateral skull base area (maximum diameter). 3. Interpharyngeal clearance skull base area measurement: length: left, right, 33. 11, 2.95mm, respectively The width: the left and right sides were 17. 31, 2.22 mm, 17. 15 and 1.65 mm respectively (P0. 01). 05). 4. The mastoid tip to the mandibular ascending branch and the shortest distance of the leading edge of the mastoid to the mandibular ascending branch, the first cervical vertebra transverse process to the mandible ascending branch, and the like are 22. 94, 3.08 mm, 14.50, 3.57mm, 20.34 and 9.03mm respectively. 5. 30% of the secondary nerves in the 20-side specimen are located outside the first cervical transverse process. and 20% of the hypoglossal nerve arch is positioned at the lower edge of the abdominal lower abdomen of the second abdominal muscle 0.5 -1. 0c. Conclusion: 1. The bone markers, such as mastoid tip, mastoid process and root, are easy to touch and locate in the operation. The distance between the selected measurement points and the position of the important structure can be positioned, the depth of the operation route can be determined, and the orientation of the operation route can be estimated. 2. The root of the stem is the key anatomical marker of the parapharacular clearance. It is advisable to protect the internal carotid artery, the internal jugular vein, the posterior cerebral nerve and the external carotid artery and the facial nerve of the posterior internal carotid artery, the internal jugular vein, the posterior group and the superficial cervical artery. Structure. 3. The line connecting the inner edge of the rupture hole to the root of the stem and the root of the stem is taken as the boundary between the skull base region and the posterior gap at the boundary of the skull base region. A sign of the anterior clearance of the stem as a marker of the anterior clearance of the stem; the jugular foramen and the nearby bone, the outer side of the occipital bone, the occipital condyle and the like as the sign of the posterior clearance of the stem; and the root of the medial plate of the wings to the jugular fossa. The distance from the outer trailing edge is taken as the length of the skull base region of the parapharyngeal space, and the distance between the butterfly spine and the posterior edge of the jugular fossa The first cervical transverse process is easy to touch during the operation and can be used as an important bone marker for finding and protecting the secondary nerve; and a part of the hypoglossal nerve
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R323.1
本文编号：2306045
[Abstract]:Objective: To observe the anatomical data of the bone structure of the lateral skull base region from the perspective of the operative route of the parapharyngeal space tumor, and provide a more detailed basis for the accurate positioning of the important anatomical structures in the skull base, preserving cranial nerves and important blood vessels in the operation. Through simulating the cervical side route and the pharynx side wall route, the anatomical structure and the adjacent relationship between the important vascular nerves in the surgical approach are clearly identified, so as to protect and reduce the complications of the operation. Methods: 1. On the 30 (60-side) adult skull, the shortest straight distance between the root of the stem, the mastoid, the lowest point of the drum and the lateral clearance of the lateral skull base and the anterior included angle of the sagittal plane were measured. in ord to measure that diameter of the major pore canal in the lateral skull base region. and the length and width of the skull base region of the parapharyngeal space are measured. 3. An adult wet corpse head (including an upper neck) on 10 (20 sides) is applied, a cervical side approach and a pharyngeal wall route are applied, the parapharpharyngeal space and the adjacent structure are carried out anatomy of the family The structure of the posterior four groups of cranial nerves and internal carotid artery were observed. The distance and angle data of the root, mastoid and drum of the stem are respectively related to the bone structure. There was a significant difference between the left and right sides of the display. 2. Significant differences were noted on the left and right sides of the lateral skull base area (maximum diameter). 3. Interpharyngeal clearance skull base area measurement: length: left, right, 33. 11, 2.95mm, respectively The width: the left and right sides were 17. 31, 2.22 mm, 17. 15 and 1.65 mm respectively (P0. 01). 05). 4. The mastoid tip to the mandibular ascending branch and the shortest distance of the leading edge of the mastoid to the mandibular ascending branch, the first cervical vertebra transverse process to the mandible ascending branch, and the like are 22. 94, 3.08 mm, 14.50, 3.57mm, 20.34 and 9.03mm respectively. 5. 30% of the secondary nerves in the 20-side specimen are located outside the first cervical transverse process. and 20% of the hypoglossal nerve arch is positioned at the lower edge of the abdominal lower abdomen of the second abdominal muscle 0.5 -1. 0c. Conclusion: 1. The bone markers, such as mastoid tip, mastoid process and root, are easy to touch and locate in the operation. The distance between the selected measurement points and the position of the important structure can be positioned, the depth of the operation route can be determined, and the orientation of the operation route can be estimated. 2. The root of the stem is the key anatomical marker of the parapharacular clearance. It is advisable to protect the internal carotid artery, the internal jugular vein, the posterior cerebral nerve and the external carotid artery and the facial nerve of the posterior internal carotid artery, the internal jugular vein, the posterior group and the superficial cervical artery. Structure. 3. The line connecting the inner edge of the rupture hole to the root of the stem and the root of the stem is taken as the boundary between the skull base region and the posterior gap at the boundary of the skull base region. A sign of the anterior clearance of the stem as a marker of the anterior clearance of the stem; the jugular foramen and the nearby bone, the outer side of the occipital bone, the occipital condyle and the like as the sign of the posterior clearance of the stem; and the root of the medial plate of the wings to the jugular fossa. The distance from the outer trailing edge is taken as the length of the skull base region of the parapharyngeal space, and the distance between the butterfly spine and the posterior edge of the jugular fossa The first cervical transverse process is easy to touch during the operation and can be used as an important bone marker for finding and protecting the secondary nerve; and a part of the hypoglossal nerve
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R323.1
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