摘要
目的为了充分了解中下斜坡和颅颈交界区解剖结构,探明颅骨表面标志与其周围重要结构的对应关系,为安全、合理地运用远外侧入路提供显微外科解剖学依据。方法通过对10例(20侧)经甲醛固定的国人成人带颈尸体头颅(不分性别)和干性颅骨10例(20侧)(不分性别)进行解剖、测量拍摄获取相关资料。结果①枕髁、颈静脉孔、舌下神经管、环椎、枕骨大孔、乳突是枕下远外侧入路的重要骨性标志;②枕下三角和头外侧直肌、二腹肌是保护深部重要血管、神经的重要肌学标志;③舌下神经管后缘至枕髁后极距离(9.91±0.93)mm(左),(9.99±0.85)mm(右);舌下神经管下缘至枕裸下极距离(8.77±1.07)mm(左),(8.80±1.l l)mm(右);舌下神经管上缘至颈静脉孔下缘距离(9.48±0.87)mm(左),(9.28±1.04)mm(右);舌下神经管长度(10.68±1.07)mm(左),(10.40±1.03)mm(右);舌下神经管与正中矢状面角度(48.3±4.7°)(左),(47.9±4.5°)(右)。结论远外侧入路可以以最短的距离到达脑干和颈延髓的腹侧和外侧,直接的显露下斜坡和颈延髓的腹侧和外侧,为颅神经和椎动脉提供了良好的显露,易于利用颅神经的自然间隙;避免对脑干和颅神经的牵拉,提高手术切除率,降低手术损伤及术后并发症。
Objective In order to learn the anatomy of the middle and lower slopes and craniocervical junction; prove up the relationship of the skull surface markers and the important structures around them; provide anatomical basis of microsurgery for using far lateral approach safely and rationally. Methods The relevant information were obtained by dissecting and measuring 10 cases （ 20 sides） adult cadaver heads with connected neck fixed in formalin （regardless of gender） and 10 cases （20 sides） adult dried skulls （re- gardless of gender）. Results （1） Occipital condyle, jugular foramen, hypoglossal canal, atlas, foramen magnum, mastoidectomy were important osseous landmarks of far lateral approach. （2） Suboccipital triangle ,rectus capitis posterior major muscle, digastric muscle were important muscular landmarks in protecting deep vital vessels and nerves. （3） The posterior edge of hypoglossal canal to the posterior pole of occipital condyle： 8.96 ± 0.47mm （left）, 10.30 ±0.62mm （right） ; the lower edge of hypoglossal canal to the lower pole of the occipital eondyle： 8.50 ± 2.02mm （left）, 8.38 ± 1.61 lmm （right） ; the upper edge of hypoglos- sal canal to the lower edge of jugular foramen ： 9.48 ± 0.87mm （left）, 9.28 ± 1.04mm （right） ; length of hypoglossal canal ：11.03± 0.85mm （left）, 10.68 ±0.91ram （right） ; angle of hypoglossal canal and the median sagittal plane 33.48 ± 3.25°（left）, 34.27 ±5.08°（right）. Conclusion Far lateral approach can reach the ventral and lateral sides of brain stem and cervical medulla oblongata with the shortest distance; expose lower slopes and the ventral and lateral sides of cervical medulla oblongata directly; provide a good exposure of brain stem and vertebral artery, use natural gap of cranial nerve easily; avoid the distraction of the brain stem and crani- al nerve, increase the resection rate; decrease injury and postoperative complications of surgery.
出处
《中国煤炭工业医学杂志》
2012年第10期1578-1580,共3页
Chinese Journal of Coal Industry Medicine
