椎动脉V2段显微解剖与临床应用的相关研究

发布时间：2018-05-17 22:30

本文选题：椎动脉 + 甲状腺上动脉　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的1、通过对椎动脉V2段及其毗邻结构的解剖学研究,探究其解剖结构与毗邻关系在椎动脉疾病病因学中的意义,并为临床上行颈前外侧入路、颈总动脉-椎动脉搭桥及颈外动脉-椎动脉搭桥手术提供解剖学依据,探讨如何安全有效的在颈前区暴露椎动脉V2段;2、通过研究颈外动脉分支--甲状腺上动脉与椎动脉V2段的解剖关系,探讨颈外动脉分支与颈总动脉作为供血动脉在后循环血流重建手术中的优劣,以及甲状腺上动脉-椎动脉V2段搭桥在后循环血流重建中的应用前景。对象和方法1、选择灌注有彩色硅胶的带颈部成人尸头湿标本10例(共20侧),模拟颈前外侧入路显露椎动脉V2段,记录解剖时经过的具体步骤及途径的层次结构;2、选择头颈部CTA带颈椎三维重建影像资料20例(40侧),观察并记录椎动脉V2段走行、长度、管径、分支、变异;3、根据尸头标本以及三维重建影像资料总结椎动脉V2段与周围组织的毗邻关系;4、测量尸头标本椎动脉优势侧(均势者为左侧)颈外动脉分支甲状腺上动脉起始部位置、对应椎体水平,以及至甲状腺上极的长度、管径,测量头颈部CTA带颈椎三维重建影像资料中椎动脉优势侧甲状腺上动脉起始部与椎动脉V2段的距离。结果1、颈前外侧入路显露椎动脉V2段的结构依次为:皮肤、皮下脂肪、颈阔肌、胸锁乳突肌、椎前筋膜、颈长肌、横突、椎动脉。2、椎动脉V2段多数起自C6横突孔(39侧),少数起自其他横突孔,走行在C6-C3横突孔所形成的骨性管道内,在枢椎椎体下缘沿枢椎椎体向上外侧走行,至进入枢椎横突孔为止。左侧优势者14例,右侧优势者2例,均势者4例。椎动脉V2段起点直径为(3.8±1.3)mm,终点直径为(3.4±1.2)mm,长度为(70.0±2.1)mm。3、椎动脉V2段与其周围的静脉丛一同被横突骨膜延续的骨膜鞘所包绕;在两个横突之间,V2段前方为横突间肌与颈长肌,C5-C2前外侧还有头长肌,内侧与Luschka关节相邻,后方为颈椎关节突,后内侧为椎间孔,颈段脊神经根自椎间孔发出后自V2段后内侧向后外侧走行。椎动脉V2段主要分支为各个颈椎节段发出的脊神经根动脉。4、甲状腺上动脉自颈总动脉发出者4例,自颈外动脉发出者3例,于颈总动脉分叉部水平发出者3例;起点在C4椎体上缘水平6例,C3横突水平3例,C3椎体上缘水平1例;起点直径为(2.0±0.3)mm,至甲状腺上极长度为(45.9±6.4)mm,甲状腺上极处管径为(1.7±0.2)mm,与椎动脉V2段间的距离为(20.8±1.9)mm。结论1、通过对椎动脉V2段的显微解剖学研究,为临床上椎动脉相关疾病发病机制提供了解剖学依据,并提供新的思路;2、术前对椎动脉连带颈椎进行CT三维重建可明确椎动脉病变的位置、形态及与颈椎骨性结构的关系,对制定手术方案以及防止术后并发症的发生很有帮助;3、在实际操作中,通过颈前外侧入路,在颈外静脉与胸锁乳突肌之间,切开椎前筋膜及颈长肌,咬除横突骨质,可以安全有效的显露椎动脉V2段;4、椎动脉V2段与周围的肌肉、骨骼、血管、神经关系密切,熟悉此区域的解剖关系可避免临床操作时损伤这些结构;5、甲状腺上动脉管径在2mm左右,可游离段较长,且与椎动脉V2段距离较近,可作为椎动脉血流重建的良好供体血管。
[Abstract]:Objective 1, through the anatomical study of the V2 segment of the vertebral artery and its adjacent structure, the significance of the anatomical structure and adjacent relationship in the etiology of vertebral artery disease was explored, and the anatomical basis was provided for the clinical ascending cervical anterolateral approach, the common carotid artery bypass grafting and the external carotid artery bypass grafting. The V2 segment of the vertebral artery was exposed in the anterior cervical region. 2, through the study of the anatomical relationship between the external carotid artery branch, the superior thyroid artery and the V2 segment of the vertebral artery, the advantages and disadvantages of the external carotid artery branch and the common carotid artery as the blood supply artery in the reconstruction of the posterior circulation blood flow, and the application of the V2 segment of the superior thyroid artery to the vertebral artery of the vertebral artery in the reconstruction of the posterior circulation blood flow were discussed. Object and method 1, 10 cases (total 20 sides) of the adult cadaver head with color silica gel were selected. The V2 segment of the vertebral artery was exposed in the anterolateral approach of the neck, and the concrete steps and the hierarchical structure of the path were recorded. 2, 20 cases (40 sides) of the cervical spine of the head and neck were selected to observe and record the V2 segment of the vertebral artery. Walk, length, diameter, branch, variation; 3, the adjacent relationship between the V2 segment of the vertebral artery and the surrounding tissue was summed up according to the cadaver head specimens and the 3D reconstruction image data. 4, the position of the upper thyroid artery in the superior lateral cervical artery of the cadaver head specimens (the left) was measured, corresponding to the vertebral level, and the length of the thyroid gland. Diameter, measurement of the distance between the initial part of the upper thyroid artery and the V2 segment of the vertebral artery in the superior lateral thyroid artery of the vertebral artery in the CTA band of the head and neck. Results 1, the structure of the V2 segment of the vertebral artery in the anterolateral approach was the skin, the subcutaneous fat, the latissimus cervix, the sternocleidomastoid muscle, the anterior vertebral fascia, the long neck muscle, the transverse process, the vertebral artery.2, and the vertebral artery V2. Most of the segment from the C6 transverse process (39 sides), a few from the other transverse process holes, walking in the bone pipe formed by the C6-C3 transverse process, the lower edge of the axis along the axis of the axis to the upper lateral, to the axis of the transverse process. The left advantage is 14 cases, the right dominant 2 cases, the equal potential 4 cases. The V2 segment diameter of the vertebral artery is (3.8 + 1.3) mm, the end of the vertebral artery is (3.8 + 1.3) mm. The point diameter is (3.4 + 1.2) mm and the length is (70 + 2.1) mm.3. The V2 segment of the vertebral artery is wrapped around the periosteal sheath along the periosteum of the transverse process with the surrounding vein plexus. Between the two transverse processes, the anterior lateral transverse and cervical long muscles are in the front of the V2 segment, the anterolateral C5-C2 is also the long muscle, the medial is adjacent to the Luschka joint, the rear is the cervical joint process and the posterior medial is the vertebra. The intervertebral foramen, the cervical spinal nerve root after the intervertebral foramen sent out from the V2 segment to the posteriorlateral lateral. The main branch of the V2 segment of the vertebral artery was the.4 of the spinal nerve root arteries from each segment of the cervical vertebra, 4 cases of the superior thyroid artery from the common carotid artery, 3 from the external carotid artery and 3 in the common carotid artery bifurcation, and the starting point on the C4 vertebral body. Margin level 6 cases, C3 transverse process level 3 cases, C3 vertebral upper margin level 1 cases, the starting diameter is (2 + 0.3) mm, to the thyroid pole length is (45.9 + 6.4) mm, the thyroid pole diameter is (1.7 + 0.2) mm, and the distance between the V2 segment of the vertebral artery is (20.8 + 1.9) mm. conclusion 1, through the microanatomical study of the vertebral artery V2 segment, for clinical vertebral artery related disease. The pathogenesis provides anatomical basis and provides new ideas. 2, CT three-dimensional reconstruction of vertebral artery continuous cervical vertebra before operation can identify the position of vertebral artery disease, shape and the relationship with the bone structure of the cervical vertebra, and help to make the operation plan and prevent the postoperative complications; 3, in the actual operation, through the anterolateral neck of the neck. Approach, between the external jugular vein and the sternocleidomastoid muscle, incision of the anterior fascia of the vertebra and the long neck muscle, the V2 segment of the vertebral artery can be exposed safely and effectively, and 4, the V2 segment of the vertebral artery is closely related to the surrounding muscles, bones, blood vessels and nerves, and the familiarity with this area can avoid the damage of these structures in clinical operation; 5, thyroid motion. The vascular diameter is about 2mm, and the free segment is longer, and it is closer to the V2 segment of vertebral artery. It can serve as a good donor blood vessel for reconstruction of vertebral artery blood flow.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651;R322

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