摘要
目的了解国人寰枢椎侧块关节周围血管、神经的解剖关系。为后路寰枢椎侧块关节融合器准确、安全置入提供解剖学依据。方法选用成人尸体标本20具，冠状面上观察寰枢椎侧块关节后缘周围解剖关系；平枢椎侧块上关节面后缘测量C1、2间椎动脉内缘至颈髓硬脊膜外缘的距离，确定手术冠状位的“安全操作空间”；测量枢椎下关节突后内缘的纵垂线与枢椎椎弓上缘交点（G点）至枢椎椎弓根上缘中线延长线的水平距离，确定手术切入点。结果“安全操作空间”为（19．72±1．84）mm，水平距离为（2．23±0．45）mm。寰枢椎后膜下的静脉丛主要集中在寰枢椎侧块关节的外缘、上方和内缘，其下方尤其枢椎椎弓根上缘的静脉丛稀疏。位于寰椎椎弓根下方、寰枢椎侧块关节内上侧的C2神经根，距颈硬脊膜外缘5～7mm处膨大成颈神经节，并发出前、后支。结论G点恒定在枢椎椎弓根上缘中线延长线的内侧2．5mm处，以此点向外水平旁开2．5mm，向上推开寰枢后膜，内上骨膜下剥离并沿枢椎椎弓根上缘中线一并剥离枢椎椎弓根骨膜和寰枢椎侧块关节囊，即可显露寰枢椎侧块关节并置入融合器。以此人路在“安全操作空间”内置入融合器，可避免切开寰枢后膜而损伤血管和神经。保证了手术的安全。
Objective To oberserve neurovascular anatomy of atlantoaxial lateral mass joint to provide Chinese anatomy data for placement of the posterior atlantoaxial lateral mass intervertebral cage. Methods human cadavers were investigated in our study. The distance of atlantoaxial lateral mass from C1、2 vertebral artery to the inner edge of C1、2 spinal cord by flaring upper edge of axial lateral mass joint were measured for determining the safe space in surgery. The horizontal distance from the crossing point （intersection point relative） of the medial border C2 inferior articular process vertical with the upper edge of C2 pedicle to the extencted midline of upper edge of C2 pedicle was measured for determining the entry point to surgery. Results The safe space was （19.72±1.84）mm, and the horizontal distance was （2.23±0.45）mm. Venous plexus mainly concentrated in the outer side, upper edge and inner edge of atlantoaxial lateral mass joint, but spared at the below of axis lateral mass and especially at the upper edge of C2 pedicle. Conclusion The relative point is relatively constant at the inner edge of the midline extended of upper edge of C2 pedicle, by 2.5 mm from the relative point to cut atlantoaxial membrane, along the midline of upper edge of C2 pedicle to stripe atiantoaxial membrane and atlantoaxial capsule, so we can easily expose atlantoaxial lateral mass joint. The neurovascular anatomy can ensure the safety to insert the posterior atlantoaxlal lateral mass intervertebral cage in the the safe space.
出处
《中国骨与关节损伤杂志》
2012年第5期385-388,共4页
Chinese Journal of Bone and Joint Injury
基金
铜陵市2011年度科技计划项目(2011NS42)
关键词
寰枢椎侧块关节
侧块融合器置入术
应用解剖
定量测量
Atlantoaxial lateral mass joint
Lateral mass fusion cage implantation
Anatomy
Quantitative measuremen
