后颅窝枕下区颈部肌群、颅骨及静脉窦的显微解剖及其在枕下乙状窦后入路中的应用

发布时间：2018-11-17 16:16

【摘要】：本课题采用显微解剖技术等方法在5个经福尔马林固定的尸体头标本和5具成人干颅骨上，以枕下入路后颅窝开颅为重点，对颈部肌群及后颅窝骨瓣的相关结构设计进行解剖研究。探讨经枕下乙状窦后入路开颅过程中相关的显微解剖结构，提高后颅窝开颅过程中的安全、有效性，并总结了临床上采用在枕下乙状窦后手术入路中后颅窝骨瓣开颅，深部肌群分层缝合技术的应用实例，验证该项手术技术的临床应用的效果和实际意义。第一部分后颅窝枕下区颈部肌肉、颅骨及静脉窦的显微解剖 1．目的获得后颅窝枕颈交界处肌肉、颅骨的正常解剖结构有关资料，为桥小脑角区肿瘤、小脑半球肿瘤的手术治疗提供更优化的手术入路。 2．材料与方法应用5例福尔马林固定的成人头颅标本，和5例干颅骨标本，在放大5～25倍显微镜下，对后颅窝枕颈交界处的深部肌群进行逐层显微解剖、观察及分析。 1) 分层切开深部各肌群，观察后枕部枕下入路中深部肌群及枕动脉的解剖结构及走行特点； 2) 显露整个乳突及乳突上，乳突根部及枕骨上项线以下区域； 3) 后颅窝侧方区颅骨解剖标志的测量； 4) 根据骨性结构标志确定后颅窝骨瓣位置，设计安全设计颅骨钻孔形成骨窗的方法。 3．结果四层依次解剖第一层斜方肌，第二层头夹肌，第三层头半棘肌，头长肌，第四层上斜肌，头后大直肌，头小直肌。四层肌肉纵横交叉，相互重叠，各司其职，使头部可自由旋转，向各方向活动，同时较厚肌肉也对后颅窝起保护作用。枕动脉是颈外动脉的分支，从乳突内下的枕动脉沟内向后走，行在头半棘肌的表面，，头夹肌的深部，有时行走在头长肌的表面，分为两个分支，供应枕部的头皮血
[Abstract]:In this study, 5 cadaveric head specimens fixed by formalin and 5 adult dry skulls were treated with microdissection technique, with the focus on the craniotomy of the posterior cranial fossa via the suboccipital approach. The related structures of cervical muscle group and posterior cranial fossa bone flap were anatomically studied. In order to improve the safety and effectiveness of posterior craniotomy, we discussed the microanatomical structure of craniotomy via suboccipital retrosigmoid sinus approach, and summarized the clinical application of posterior cranial fossa craniotomy via posterior suboccipital sigmoid sinus approach to middle posterior cranial fossa craniotomy. The application example of deep muscle suture technique is used to verify the clinical effect and practical significance of this technique. The first part is the microanatomy of the cervical muscles, cranial bones and venous sinuses in the suboccipital region of the posterior cranial fossa. Objective to obtain the muscles at the occipitocervical junction of the posterior cranial fossa. The normal anatomical structure of the skull provides a more optimal approach for the surgical treatment of cerebellopontine angle tumors and cerebellar hemispheric tumors. 2. Materials and methods five formalin fixed adult skull specimens and 5 dry skulls were used under a microscope of 25 times magnified. The deep muscle groups at the occipitocervical junction of the posterior cranial fossa were dissected layer by layer, observed and analyzed. 1) to observe the anatomical structure and the characteristics of the deep muscles and the occipital artery in the suboccipital approach. 2) exposure of the whole mastoid process and the mastoid process, the root of the mastoid process and the area below the superior occipital line, 3) the measurement of the anatomical marks of the skull in the lateral part of the posterior cranial fossa; 4) to determine the position of posterior cranial fossa bone flap according to the mark of bone structure, and to design the method of safely designing the hole of skull to form bone window. 3. Results: the first layer of trapezius muscle, the second layer of scalp clamp, the third layer of semicephalus, the long muscle of the head, the fourth layer of superior oblique muscle, the posterior rectus major of the head and the rectus capitatum muscle were dissected in turn. The four layers of muscle cross, overlap and perform their duties, allowing the head to rotate freely and move in all directions, while the thicker muscles also protect the posterior cranial fossa. The occipital artery is a branch of the external carotid artery that runs backward from the sulcus of the occipital artery below the mastoid process and runs on the surface of the scalp muscle, the deep part of the caput muscle, and sometimes walks on the surface of the longus cephalocephalus, and is divided into two branches that supply blood to the scalp of the occipital region.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R322;R651

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