本文選題：枕下遠外側(cè)入路 + 枕下三角　； 參考：《山西醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:對枕下遠外側(cè)手術(shù)入路中顱外軟組織結(jié)構(gòu)進行手術(shù)解剖,為臨床工作提供更多的應(yīng)用解剖學(xué)資料,以減少手術(shù)并發(fā)癥。 方法:先將10具(20側(cè))濕性成人頭頸標本用彩色乳膠分別灌注動、靜脈血管,然后在灌注好的頭頸標本上模擬枕下遠外側(cè)手術(shù)入路,逐層解剖枕下區(qū)顱外軟組織結(jié)構(gòu),觀察肌肉、鄰近血管和神經(jīng)的形態(tài)、走行及相互結(jié)構(gòu)關(guān)系。測量寰、樞椎橫突孔之間的距離、枕下區(qū)椎動脈的直徑、寰椎橫突孔上緣至椎動脈穿寰枕筋膜處的距離和椎動脈穿寰枕筋膜處內(nèi)側(cè)緣至枕骨大孔后緣中點的距離。 結(jié)果: 1.頭上斜肌、頭下斜肌和頭后大直肌構(gòu)成了枕下三角,椎動脈從此三角深面通過。 2.頸2神經(jīng)的腹側(cè)支恒定地跨過寰、樞椎段椎動脈的后方。 3.枕下區(qū)椎動脈旁靜脈叢豐富且不規(guī)則,在寰椎橫突孔至椎動脈穿寰枕筋膜處,越接近中線部位靜脈叢越小,在寰、樞椎橫突孔之間的椎動脈被靜脈叢包繞,靜脈叢由下向上越來越密集。 4.寰椎橫突孔位于樞椎橫突孔的上外方,二者之間的距離為(17.82±3.65)mm。 5.寰椎橫突孔上緣至椎動脈穿硬膜處的距離為(33.29±7.79)mm。 6.枕下區(qū)椎動脈走行迂曲多變,椎動脈穿硬膜處內(nèi)側(cè)緣距枕骨大孔后緣中點的距離為(24.85±2.96)mm。 7.枕動脈絕大多數(shù)情況下走行于頭最長肌的下方,當枕動脈溝缺如時,其走行于頭最長肌的淺層頭夾肌的下方。 結(jié)論: 1.在枕下遠外側(cè)手術(shù)入路中,枕下三角、頸2神經(jīng)腹側(cè)支和椎動脈旁靜脈叢是術(shù)中尋找椎動脈的重要標志。 2.在枕下遠外側(cè)手術(shù)入路中,可磨開寰椎橫突孔及磨除至少半個寰椎后弓,分離并向內(nèi)下方移動椎動脈,增加病變的顯露范圍,必要時可從后內(nèi)方磨除部分枕骨髁和寰椎側(cè)塊。 3.對枕下遠外側(cè)手術(shù)入路中顱外軟組織結(jié)構(gòu)的手術(shù)解剖研究,可提高該手術(shù)入路的安全性和手術(shù)療效,減少術(shù)后并發(fā)癥的發(fā)生。
[Abstract]:Objective: to provide more applied anatomical data for the clinical work by dissecting the soft tissue structure of the middle cranial soft tissue via the suboccipital far-lateral approach in order to reduce the complications of the operation. Methods: 10 adult head and neck specimens were perfused with color latex respectively. Then the extracranial soft tissue structure of the suboccipital region was dissected layer by simulating the suboccipital distal approach on the perfused head and neck specimens. Observe the morphology of muscle, adjacent blood vessels and nerves, and the relationship between them. The distance between the transverse foramen of atlas and axis, the diameter of the vertebral artery in the suboccipital area, the distance between the superior margin of the transverse foramen of atlas and the transversed-vertebral artery through the atlantooccipital fascia and the distance between the medial margin of the vertebral artery and the posterior margin of the occipital foramen magnum were measured. Results: 1. Superior oblique, inferior oblique and posterior rectus constitute the inferior occipital triangle from which the vertebral artery passes. 2. The ventral branch of the cervical 2 nerve steadily crosses the posterior part of the atlas and axial vertebral artery. 3. The venous plexus near the inferior occipital artery is abundant and irregular. The venous plexus is smaller from the transverse foramen of the atlas to the place of the vertebral artery penetrating the atlantooccipital fascia, and the vertebral artery between the transverse foramen of the atlas and the foramen of the transverse process of the axis is surrounded by the venous plexus. The venous plexus is thicker and denser from the bottom up. 4. The transverse process foramen of atlas is located in the upper and outer side of transverse foramen of axis, and the distance between them is 17.82 鹵3.65 mm. 5. The distance from the superior margin of transverse foramen of atlas to the point where the vertebral artery penetrates the dura is 33.29 鹵7.79 mm. 6. The distance between the medial margin of vertebral artery through the dura and the middle point of posterior margin of foramen magnum is 24.85 鹵2.96 mm.. 7. Most of the occipital arteries walk below the longissimus capitis muscle, and when the sulcus of the occipital artery is absent, the occipital artery runs below the superficial caput muscle of the longissimus capitalis muscle. Conclusion: 1. In the suboccipital far-lateral approach, the suboccipital triangle, the ventral branch of the cervical 2 nerves and the venous plexus adjacent to the vertebral artery are important signs for searching for the vertebral artery during the operation. 2. In the suboccipital far lateral approach, the transverse foramen of atlas and at least half of the posterior arch of atlas can be ground, and the vertebral artery can be separated and moved down to the medial and lower part of the vertebral artery to increase the exposure of the lesion, and if necessary, part of the condyle of occipital bone and the lateral mass of atlas can be removed from the posterior medial side. 3. The anatomical study of the soft tissue structure of the middle cranial soft tissue via the far lateral suboccipital approach can improve the safety and curative effect of the approach and reduce the incidence of postoperative complications.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R322

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