枕下远外侧经髁入路的显微解剖学定量研究
发布时间：2018-12-21 07:48
【摘要】： 目的探讨远外侧经髁入路手术区域主要结构的特点和毗邻关系,探索获得枕骨大孔区腹侧良好显露时枕髁磨除的最适范围。 方法对36具成人干颅底骨标本的乳突尖、枕骨大孔、枕髁、舌下神经管、颈静脉结节等骨性标志进行观察和测量;在10例(20侧)正常成人带颈尸头湿标本上模拟远外侧经髁手术入路,按肌肉层、硬膜外、硬膜内进行解剖,测量磨除枕髁前、磨除枕髁至枕髁后缘与舌下神经管内口后缘长度1/2时、至舌下神经管内口后缘时、至相当于舌下神经管外口后缘时的手术暴露野最远点至中线的距离。 结果1.枕髁位于枕骨大孔两侧,枕髁后缘至舌下神经管内口后缘的距离左侧为(9.64±1.44)mm、右侧为(9.14±1.55)mm。 2.舌下神经管位于枕髁的上半部,由一薄层骨皮质围成,后壁与矢状面的夹角左侧为(31.3±6.0)°、右侧为(31.8±5.8)°。 3.磨除枕髁前手术暴露野均未至中线,至中线的距离左侧为(2.35±0.40)mm、右侧为(2.26±0.33)mm;磨除枕髁至枕髁后缘与舌下神经管内口后缘长度1/2时,手术野最远点即能达到或越过中线,至中线的距离左侧为(0.37±0.37)mm、右侧为(0.42±0.51)mm;磨除枕髁至舌下神经管内口后缘时,手术野最远点越过中线,至中线的距离为左侧为(3.99±0.27)mm、右侧为(4.19±0.27)mm;磨除枕髁至相当于舌下神经管外口后缘时手术野又有所增加,至中线距离左侧为(5.29±0.54)mm、右侧为(5.61±0.40)mm,任意两者之间有统计学差异。 结论1.舌下神经管周围的皮质骨可作为抵达舌下神经管的标志,并可估计枕髁切除的范围。 2.寰椎横突是辨认椎动脉的重要标志。 3.远外侧经髁入路手术中,随着枕髁磨除的增多,手术暴露野逐渐增大,磨除枕髁至舌下神经管内口后缘时手术暴露野最远点已能达到中线对侧,可获得枕骨大孔腹侧区的良好显露。 4.研究枕下远外侧经髁入路的显微解剖,对提高远外侧经髁入路手术的安全性和治疗效果有重要实用价值。
[Abstract]:Objective to investigate the characteristics of the main structures and the relationship between the main structures and the adjacent areas in the far lateral transcondylar approach, and to explore the optimal range of occipital condyle removal when the occipital foramen area is well exposed. Methods the mastoid apex, foramen magnum, occipital condyle, hypoglossal canal and jugular vein were observed and measured in 36 adult cadaveric skull base specimens. In 10 cases (20 sides) of normal adults with necked cadaveric head wet specimen, simulated far lateral transcondylar approach, according to muscle layer, epidural, intradural anatomy, measurement before grinding occipital condyle. When the length of the posterior edge of the occipital condyle to the posterior margin of the occipital condyle and the posterior edge of the internal orifice of the hypoglossal nerve duct is 1 / 2, the distance from the farthest point to the central line of the surgical exposure field is from the posterior edge of the internal orifice of the hypoglossal nerve canal to the posterior edge of the external orifice of the hypoglossal nerve canal. Result 1. The distance between the occipital condyle and the posterior edge of the occipital condyle is (9.64 卤1.44) mm, and the distance between the occipital condyle and the posterior edge of the hypoglossal canal is (9.14 卤1.55) mm.. 2. The hypoglossal canal is located in the upper half of the occipital condyle and is surrounded by a thin layer of bone cortex. The angle between the posterior wall and the sagittal plane is (31.3 卤6.0) 掳on the left and (31.8 卤5.8) 掳on the right. 3. The distance between the exposed field and the middle line was (2.35 卤0.40) mm, and (2.26 卤0.33) mm;, respectively. When the length of the posterior edge of the occipital condyle to the posterior margin of the occipital condyle and the posterior edge of the hypoglossal nerve canal is 1 / 2, the farthest point of the surgical field can reach or cross the midline, and the distance to the midline is (0.37 卤0.37) mm, to the left, and (0.42 卤0.51) mm; to the right. When the occipital condyle was removed to the posterior margin of the internal orifice of the hypoglossal canal, the farthest point of the surgical field crossed the midline and the distance to the midline was (3.99 卤0.27) mm, on the left side and (4.19 卤0.27) mm; on the right side. When the occipital condyle was removed to the posterior edge of the external orifice of the hypoglossal canal, the operative field was increased, and the distance from the midline to the left side was (5.29 卤0.54) mm, to the right (5.61 卤0.40) mm,. Conclusion 1. The cortical bone around the hypoglossal canal can be used as a marker to reach the hypoglossal canal and to estimate the extent of occipital condylar resection. 2. The transverse process of atlas is an important marker for identifying vertebral artery. 3. In the far lateral transcondylar approach, with the increase of occipital condylar wear, the surgical exposure field gradually increased. The farthest point of the surgical exposure field reached the opposite side of the midline when the occipital condyle was removed from the occipital condyle to the posterior edge of the internal orifice of the hypoglossal canal. Good exposure of the ventral region of foramen magnum can be obtained. 4. To study the microanatomy of the suboccipital far lateral transcondylar approach is of great practical value in improving the safety and therapeutic effect of the far lateral transcondylar approach.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322
本文编号：2388609
[Abstract]:Objective to investigate the characteristics of the main structures and the relationship between the main structures and the adjacent areas in the far lateral transcondylar approach, and to explore the optimal range of occipital condyle removal when the occipital foramen area is well exposed. Methods the mastoid apex, foramen magnum, occipital condyle, hypoglossal canal and jugular vein were observed and measured in 36 adult cadaveric skull base specimens. In 10 cases (20 sides) of normal adults with necked cadaveric head wet specimen, simulated far lateral transcondylar approach, according to muscle layer, epidural, intradural anatomy, measurement before grinding occipital condyle. When the length of the posterior edge of the occipital condyle to the posterior margin of the occipital condyle and the posterior edge of the internal orifice of the hypoglossal nerve duct is 1 / 2, the distance from the farthest point to the central line of the surgical exposure field is from the posterior edge of the internal orifice of the hypoglossal nerve canal to the posterior edge of the external orifice of the hypoglossal nerve canal. Result 1. The distance between the occipital condyle and the posterior edge of the occipital condyle is (9.64 卤1.44) mm, and the distance between the occipital condyle and the posterior edge of the hypoglossal canal is (9.14 卤1.55) mm.. 2. The hypoglossal canal is located in the upper half of the occipital condyle and is surrounded by a thin layer of bone cortex. The angle between the posterior wall and the sagittal plane is (31.3 卤6.0) 掳on the left and (31.8 卤5.8) 掳on the right. 3. The distance between the exposed field and the middle line was (2.35 卤0.40) mm, and (2.26 卤0.33) mm;, respectively. When the length of the posterior edge of the occipital condyle to the posterior margin of the occipital condyle and the posterior edge of the hypoglossal nerve canal is 1 / 2, the farthest point of the surgical field can reach or cross the midline, and the distance to the midline is (0.37 卤0.37) mm, to the left, and (0.42 卤0.51) mm; to the right. When the occipital condyle was removed to the posterior margin of the internal orifice of the hypoglossal canal, the farthest point of the surgical field crossed the midline and the distance to the midline was (3.99 卤0.27) mm, on the left side and (4.19 卤0.27) mm; on the right side. When the occipital condyle was removed to the posterior edge of the external orifice of the hypoglossal canal, the operative field was increased, and the distance from the midline to the left side was (5.29 卤0.54) mm, to the right (5.61 卤0.40) mm,. Conclusion 1. The cortical bone around the hypoglossal canal can be used as a marker to reach the hypoglossal canal and to estimate the extent of occipital condylar resection. 2. The transverse process of atlas is an important marker for identifying vertebral artery. 3. In the far lateral transcondylar approach, with the increase of occipital condylar wear, the surgical exposure field gradually increased. The farthest point of the surgical exposure field reached the opposite side of the midline when the occipital condyle was removed from the occipital condyle to the posterior edge of the internal orifice of the hypoglossal canal. Good exposure of the ventral region of foramen magnum can be obtained. 4. To study the microanatomy of the suboccipital far lateral transcondylar approach is of great practical value in improving the safety and therapeutic effect of the far lateral transcondylar approach.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322
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