乳突下侧方入路暴露寰椎侧块临床解剖学研究

发布时间：2018-03-08 09:42

本文选题：乳突下侧方入路　切入点：寰椎侧块　出处：《广西医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的获得乳突下侧方手术入路所涉及的重要血管、神经的解剖学资料,明确其与周围结构的空间定位关系,为临床手术提供参考。方法选取10具(20侧)经10%福尔马林固定完整的国人成人头颈部标本,经双侧颈总动脉灌注红色乳胶,对乳突下侧方手术入路所涉及的结构进行解剖观察和测量,所得结果用SPSS13.0软件进行统计分析。结果 1寰椎横突尖或乳突与副神经、舌下神经、枕动脉、颈交感干、颈动脉鞘内结构的解剖关系: 1.1寰椎横突尖距副神经的最短距离:左(9.5±0.16)mm,右(9.4±0.19)mm;乳突距副神经入胸锁乳突肌前缘处距离:左(28.5±1.63) mm,右(28.7±1.35)mm。 1.2寰椎横突尖距舌下神经的最短距离:左(8.4±0.16)mm,右(8.4±0.14)mm。 1.3寰椎横突尖距枕动脉的最短距离:左(7.3±0.29)mm,右(7.3±0.29)mm。 1.4寰椎横突尖距颈交感干的最短距离:左(10.5±0.40)mm,右(10.4±0.27) mm。 1.5寰椎横突尖距迷走神经的最短距离:左(7.0±0.22) mm,右(7.0±0.30)mm;与颈内静脉最短距离:左(4.0±0.14) mm ,右(4.1±0.23)mm;与颈外动脉最短距离:左(10.1±0.25) mm,右(10.2±0.31)mm;与颈内动脉最短距离:左(10.4±0.36) mm,右(10.3±0.28) mm。 2枕动脉由颈外动脉分出,在面动脉起点上方占55%(11/20),于面动脉平齐的占15%(3/20),在面动脉起点下方的占30%(6/20),沿二腹肌后腹下方行向后上,然后转向二腹肌后腹深面,行于寰椎横突前上方至乳突内侧及后方的枕动脉沟内。枕动脉起点处管径:左(2.0±0.21)mm,右(1.9±0.28)mm;中点处管径:左(1.9±2.0)mm,右(1.9±0.18)mm;穿深筋膜处管径:左(1.9±0.22)mm,右(1.9±0.18) mm。 3椎动脉均由锁骨下动脉后上方发出,穿越颈长肌与前斜角肌之间的裂隙达第六颈椎横突孔,继而上行于第六颈椎横突孔至第一颈椎横突孔相连所形成的骨管内,自寰椎横突孔穿出后,绕过寰椎侧块后方,走行在寰椎后弓的椎动脉沟内,其前方与头侧直肌和寰椎侧块相连,其后方被头上斜肌、头后大直肌和头半脊肌覆盖,向上方穿寰枕后膜及硬脑膜经枕骨大孔进入颅腔。椎动脉寰枢段行程迂曲,有较为恒定的弯曲4~6个,其中弯曲处即形成血管膨大,其血管内外径为(4.7±0.90)mm,非弯曲部血管外径为(3.9±0.31)mm。 4寰椎横突尖与寰椎侧块内缘中点距离:左(28.5±0.47) mm,右(28.5±0.33) mm;寰椎侧块的宽度:左(16.2±1.93) mm,右(15.3±1.10) mm。结论 1寰椎横突尖或乳突与副神经、舌下神经、枕动脉、颈交感干、颈动脉鞘内结构有恒定的解剖关系,可作为术中保护上述神经、血管的解剖标志。 2椎动脉寰枢段行程迂曲,有较为恒定的弯曲4~6个,其中弯曲处形成血管膨大,其血管内外径为(4.7±0.90)mm,非弯曲部血管外径为(3.9±0.31)mm。用较细的神经剥离子将其上、下口游离,用薄型手枪式咬骨钳咬除横突孔前外壁,使其呈敞开状,并沿椎动脉走行向上、下稍许分离,此时包绕椎动脉的薄层纤维鞘膜样结构连同椎动脉可移动2~3cm,可为寰椎侧块病变手术提供操作空间。 3本组实验观测的结果表明:寰椎横突尖与侧块内缘中点距离为(27.5~29.9)mm;寰椎侧块的宽度为(13.1~19.7)mm。因此在行寰椎侧块手术过程中为了避免脊髓损伤,我们确定寰椎横突尖后,向内切除侧块深度一般不超过2.8cm;或者确定侧块外缘后,向内切除侧块深度一般不超过1.5cm。
[Abstract]:objective
The anatomical data of important vessels and nerves involved in the lateral mastoid approach were obtained, and the spatial location relationship with the surrounding structures was identified, so as to provide references for clinical operation.
Method
A total of 10 adult (20 sides) Adult neck and neck specimens fixed by 10% formalin were perfused with red latex through bilateral common carotid arteries. The structures involved in the lateral mastoid approach were observed and measured. The results were statistically analyzed by SPSS13.0 software.
Result
1 the anatomical relationship between the apex of the transverse process of the atlas or the mastoid with the accessory nerve, the hypoglossal nerve, the occipital artery, the sympathetic trunk of the neck and the intrathecal structure of the carotid artery.
1.1, the shortest distance from the apex of the atlas to the accessory nerve: left (9.5 + 0.16) mm, right (9.4 + 0.19) mm, the distance from mastoid to the anterior border of the accessory nerve into the sternocleidomastoid muscle: left (28.5 + 1.63) mm, right (28.7 + 1.35) mm..
1.2 the shortest distance between the apex of the transverse process of the atlas and the hypoglossal nerve: left (8.4 + 0.16) mm, right (8.4 + 0.14) mm.
1.3 the shortest distance between the apex of the transverse process of the atlas and the occipital artery: left (7.3 + 0.29) mm, right (7.3 + 0.29) mm.
1.4 the shortest distance between the apex of the transverse process of the atlas and the cervical sympathetic trunk: left (10.5 + 0.40) mm, right (10.4 + 0.27) mm.
The shortest distance between the 1.5 transverse process of atlas tip distance: the left vagus nerve (7 + 0.22) mm, right (7 + 0.30) mm; and the internal jugular vein in the shortest distance: left (4 + 0.14) mm, right (4.1 + 0.23) mm; external carotid artery and the shortest distance: left (10.1 + 0.25 mm), right (10.2 + 0.31) mm; and the shortest distance of internal carotid artery: the left (10.4 + 0.36) mm, right (10.3 + 0.28) mm.
2 occipital artery from the external carotid artery into the facial artery, accounting for 55% of the starting point above (11/20), to flush the facial artery accounted for 15% (3/20), below the starting point of facial artery accounted for 30% (6/20), the two pbdm below the line back, then turned to the two pbdm deep surface, pillow in the transverse process of the atlas artery in front and rear. The medial to the mastoid and occipital artery diameter at the starting point: left (2 + 0.21) mm, right (1.9 + 0.28) mm; midpoint diameter: left (1.9 + 2) mm, right (1.9 + 0.18) mm in diameter: the deep fascia; left (1.9 + 0.22) mm, right (1.9 + 0.18) mm.
3 of vertebral artery by subclavian artery after the above issue, crossing between collilongus and scalenus anterior fracture of sixth cervical transverse foramen, then ascending in sixth cervical transverse foramen to the first cervical transverse foramen is formed by bone tube from the transverse foramen of atlas piercing, bypassing the lateral mass of atlas go behind the vertebral groove in the posterior arch, the front and the head of the lateral rectus and lateral mass of atlas is the rear of the head oblique, rectus capitis posteriormajor muscle and head semi spinal muscular membrane to the top cover, and the dura wear after atlanto occipital foramen magnum into the cranial cavity. The atlantoaxial vertebral artery stroke there is a tortuous, bending 4~6 is constant, the bend forming vascular enlargement, the vascular diameter is (4.7 + 0.90) mm, non bending of vascular diameter (3.9 + 0.31) mm.
The 4 transverse process of atlas tip and lateral mass of atlas edge midpoint: left (28.5 + 0.47) mm, right (28.5 + 0.33) mm; the width of the lateral mass of atlas: left (16.2 + 1.93) mm, right (15.3 + 1.10) mm.
conclusion
1, there is a constant anatomic relationship between the apex of transverse process of the atlas, or the mastoid and the accessory nerve, hypoglossal nerve, occipital artery, cervical sympathetic trunk, and the sheath of carotid artery. It can be used as an anatomical landmark for protecting the above nerves and vessels during operation.
2 atlantoaxial vertebral artery segments have a tortuous, bending 4~6 is constant, the bend forming vascular enlargement, the vascular diameter is (4.7 + 0.90) mm, non bending of vascular diameter (3.9 + 0.31) mm. with fine nerve ion stripping the mouth, free, with thin hand gun type rongeur transverse wall front hole, which was opened, and along the vertebral artery to go up, down slightly separated, then wrapped around the vertebral artery thin fibrous sheath like structures with vertebral artery mobile 2~3cm, can provide the space for the lateral mass of atlas lesions.
3 the experimental observation results show that the transverse process of atlas lateral mass inner tip and the midpoint for (27.5~29.9) mm; the width of the lateral mass of atlas (13.1~19.7) mm. so at the lateral mass of atlas operation process in order to avoid spinal cord injury, we determine the transverse process of atlas tip after resection of lateral inward block depth of not more than 2.8cm; or the side edge block after block resection of lateral inward depth of not more than 1.5cm.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

【参考文献】