舌下神经管区外科解剖学和手术入路研究

发布时间：2019-01-20 16:37

【摘要】：第一部分舌下神经管区相关骨性结构的显微解剖研究目的:研究舌下神经管及其毗邻骨性结构的形态,大小及相互关系,为舌下神经管区的手术入路研究提供解剖学依据。材料方法:取成人颅底干性骨标本20个和寰椎干性骨标本15个,观察舌下神经管及其周围骨性结构的形态及相互关系,测量相关骨性结构的大小和间距。取成人湿性头颈标本14个,行轴位、冠状位薄层CT扫描,再次测量舌下神经管与周围结构的间距,以及不同重要结构到达舌下神经管不同位点的距离,并对双侧距离的差别进行统计学分析。结果:舌下神经管位于枕骨大孔的前外侧缘,藏于枕髁与颈静脉结节之间,居于颈静脉孔内下前方,其长度、宽度和高度左右分别为11.2±1.3mm、11.3±1.3mm,3.5±1.6mm、4.3±1.2mm,5.2±1.6mm、5.4±1.3mm,长轴与矢状面的夹角左右分别为41.1±4.6、40.5±6.0度;髁管出现率为60%,舌下神经管与髁管形成一夹角,左右分别为左47±2.7(42～51)~0,右47.7±2.7(43～53)~0,舌下神经管外口与髁管前口不相通,仅以一骨板相隔,厚约2～3mm;颈静脉结节上表面到达舌下神经管上壁的距离左右分别为5.3±1.8mm、4.8±1.6mm;枕髁后缘到达舌下神经管内口、中点和外口的距离左右为14.2±2.5mm、13.6±2.4mm,14.5±1.5mm、15.8±1.8mm,18.2±1.7mm、19.1±2.8mm;寰椎横突长度左右分别为15±1.9mm、15.6±1.4mm;寰椎横突与枕骨间距左右分别为7.6±4.1mm、5.8±2.5mm。以上结果左右两侧没有显著统计学差异。结论:舌下神经管位置深在,暴露困难,枕髁、颈静脉结节、颈静脉孔和寰椎横突是到达舌下神经管的主要骨性障碍。第二部分舌下神经管及其毗邻结构的外科解剖学研究目的:研究舌下神经管及其周围结构的神经血管显微解剖关系,为舌下神经管区的手术入路研究提供显微解剖学基础。材料与方法:取成人头颈标本15具,分别从后外侧和前外侧方向暴露颅颈交界区的颅外相关肌肉、神经血管,最后切除寰椎横突和枕鳞,磨除枕髁和颈静脉结节
[Abstract]:Part I: microanatomical study of bone structures related to hypoglossal nerve canal objective: to study the morphology, size and interrelation of the hypoglossal nerve canal and its adjacent bone structure. To provide anatomic basis for the study of the operative approach of hypoglossal nerve canal. Materials: 20 cadaveric bones and 15 atlas cadaveric bones were taken from adult skull base to observe the shape and relationship of osseous structures in hypoglossal nerve canal and its surroundings, and to measure the size and spacing of related bone structures. Fourteen adult wet head and neck specimens were examined by axial and coronal thin CT scanning. The distance between hypoglossal canal and surrounding structure and the distance between different important structures and different sites of hypoglossal nerve canal were measured again. The difference of bilateral distance was analyzed statistically. Results: the hypoglossal nerve canal was located at the anterolateral margin of foramen magnum and was located between the occipital condyle and jugular vein nodule. The length, width and height of hypoglossal canal were 11.2 卤1.3mm, 11.3 卤1.3mm and 3.5 卤1.6mm, respectively. The angle between the long axis and the sagittal plane was 41.1 卤4.6 卤40.5 卤6.0 degrees. The incidence of condylar canal was 60. The angle between hypoglossal nerve canal and condylar canal was 47 卤2.7 (42 / 51) ~ 0 on the left and 47.7 卤2.7 (43 / 53) ~ 0 on the right, respectively. The external orifice of the hypoglossal nerve canal was not connected with the anterior orifice of the condylar canal and was separated by one bone plate. The thickness is about 2? 3 mm; The distance from the superior surface of jugular nodule to the superior wall of hypoglossal canal was 5.3 卤1.8 mm and 4.8 卤1.6 mm, respectively. The distance from the posterior margin of the occipital condyle to the internal orifice of the hypoglossal canal was 14.2 卤2.5mm, 13.6 卤2.4mm, 14.5 卤1.5mm, 15.8 卤1.8mm, 18.2 卤1.7mm, 19.1 卤2.8mm; The length of transverse process of atlas was 15 卤1.9 mm and 15.6 卤1.4 mm respectively, and the distance between transverse process and occipital bone was 7.6 卤4.1 mm and 5.8 卤2.5 mm respectively. There was no significant difference between the left and right sides of the above results. Conclusion: the position of hypoglossal nerve canal is deep, difficult to expose, occipital condyle, jugular nodule, jugular foramen and transverse process of atlas are the main bone disorders to the hypoglossal nerve canal. The second part: surgical anatomy of the hypoglossal canal and its adjacent structures objective: to study the relationship between the neurovascular anatomy of the hypoglossal nerve canal and its surrounding structures. To provide the microanatomical basis for the study of the operative approach of hypoglossal nerve canal. Materials and methods: 15 adult head and neck specimens were collected and exposed from the posterolateral and anterolateral sides of the craniocervical junction region to the related muscles and nerve vessels respectively. Finally, the transverse processes and scales of the atlas were removed, and the occipital condyle and jugular nodule were removed.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2005
【分类号】：R651;R322

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