本文選題：寰椎　切入點：韌帶　出處：《中南大學》2007年碩士論文

【摘要】： 目的:為內(nèi)窺鏡下經(jīng)口咽入路處理枕頸區(qū)病變中寰椎橫韌帶手術提供解剖學支持,并探討內(nèi)窺鏡下經(jīng)口咽入路處理寰椎橫韌帶手術的可行性和方法學。 方法:①選取50套完整寰椎骨性標本,測量寰椎前弓長度和寰椎橫韌帶結節(jié)間距。②選取20套帶軟組織的寰樞椎復合體標本,測量寰椎橫韌帶及其毗鄰結構的相關解剖學數(shù)據(jù)。③將20具完整頭頸部標本分為兩組(傳統(tǒng)組與內(nèi)窺鏡組),分別按傳統(tǒng)及內(nèi)窺鏡下經(jīng)口咽入路方法處理寰椎橫韌帶,探討內(nèi)窺鏡下經(jīng)口咽入路處理寰椎橫韌帶手術的可行性及處理寰椎橫韌帶的方法。 結果:①寰椎前弓的長度為18.78±2.4mm。②寰椎橫韌帶結節(jié)間距為17.82±1.9mm。③寰椎橫韌帶呈弓形凸向后方,長度為19.67±2.4mm,其厚薄不均勻,中部薄而寬,兩端厚而窄。左右寰椎橫韌帶附著點處的寬度分別為6.39±1.2mm和6.49±1.3mm;左右寰椎橫韌帶附著點處的厚度分別為3.50±0.8mm和3.6±0.8mm。中點處的寬度和厚度分別為10.34±1.8mm和1.96±0.3mm。④覆膜中點處的厚度為0.93±0.2mm,左右兩端的厚度分別為2.48±0.7mm和2.52±0.7mm。⑤寰椎橫韌帶中點及左右兩附著點處后緣與硬膜囊的最小距離分別為1.7±0.2mm、4.5±0.8mm和4.5±0.8mm。⑥寰椎橫韌帶中點及左右兩附著點處后緣與脊髓的最小距離分別為4.0±0.5mm、8.1±1.2mm和8.0±1.2mm。⑦寰椎橫韌帶兩附著點處與兩側椎動脈的最小距離分別為11.8±0.9mm和11.9±1.0mm。⑧寰椎橫韌帶在齒突切除以后,自身可發(fā)生形變,其中點在矢狀位上可發(fā)生的最大位移,大小為5.62±1.3mm;切斷其一側附著點以后,中點在矢狀位上移動的距離最大可達到11.70±1.6mm。 結論:1、本研究認為內(nèi)窺鏡下經(jīng)口咽入路處理寰椎橫韌帶在技術上是可行的,不僅能達到傳統(tǒng)手術入路的術野范圍,而且對寰椎橫韌帶顯露更為清晰,操作更為方便和精確。 2、內(nèi)窺鏡下寰椎橫韌帶的處理可采用緊貼一側寰椎橫韌帶結節(jié),自上而下,垂直切斷其附著點的方法,一般只切斷一側附著點即可達到減壓的目的;切斷寰椎橫韌帶的操作深度不能超過“安全深度”。 3、齒突切除后,寰椎橫韌帶后方存在一個“緩沖空間”。對臨床上判斷病理狀態(tài)下寰椎橫韌帶是否需要處理有一定幫助。
[Abstract]:Objective: to provide anatomical support for the operation of transverse ligament of atlas in occipitocervical region by oropharyngeal approach under endoscope, and to explore the feasibility and methodology of transoropharyngeal approach for the treatment of transverse ligament of atlanto vertebrae. Methods the length of anterior arch of atlas and the distance between tubercle of transverse ligament of atlas were measured in 50 intact atlantoaxial bone specimens. Twenty specimens of atlantoaxial complex with soft tissue were selected. The anatomical data of atlas transverse ligament and its adjacent structures. 3. 20 intact head and neck specimens were divided into two groups (traditional group and endoscope group). The transverse ligaments of atlas were treated by traditional and endoscopic oropharynx approach, respectively. To explore the feasibility of transoropharyngeal approach for the treatment of transverse ligament of atlas under endoscope and the method of management of transverse ligament of atlas. Results the length of anterior arch of atlas was 18.78 鹵2.4mm.2. The distance of transverse ligament nodule of atlas was 17.82 鹵1.9mm.3 and the length was 19.67 鹵2.4 mm. The length of the transverse ligament of atlas was not uniform and the middle part was thin and wide. The width of the insertion point of the transverse ligament of the left and right atlas is 6.39 鹵1.2mm and 6.49 鹵1.3mm, the thickness of the insertion point of the transverse ligament of the left and right atlas is 3.50 鹵0.8mm and 3.6 鹵0.8mm. the width and thickness of the midpoint are 10.34 鹵1.8mm and 1.96 鹵0.3mm.4, respectively. The minimum distance between the posterior edge of the transverse ligament of atlas and the dural sac is 1.7 鹵0.2mm, 4.5 鹵0.8mm and 4.5 鹵0.8mm.6, respectively, and the minimum distance between the posterior edge and the spinal cord of the transverse ligament of atlas and the posterior edge of the left and right attachment points is 2.48 鹵0.7mm and 2.52 鹵0.7mm.5, respectively. The minimum distance between the insertion point of transverse ligament of atlas and bilateral vertebral artery was 11.8 鹵0.9mm and 11.9 鹵1.0mm.8 respectively after odontoidectomy. The maximum displacement of the point in sagittal position is 5.62 鹵1.3mm, and the maximum distance of midpoint moving in sagittal position is 11.70 鹵1.6mm. Conclusion 1. This study suggests that endoscopic transoropharyngeal approach is technically feasible for the treatment of transverse ligaments of atlas, which can not only reach the range of the operative field of the traditional approach, but also reveal the transverse ligament of the atlas more clearly, and the operation is more convenient and accurate. 2. The treatment of transverse ligaments of atlas under endoscope can be done by sticking to one side of transverse ligament nodule of atlas and cutting its attachment point vertically from top to bottom. The purpose of decompression can be achieved only by cutting off the attachment point of one side. The operating depth of transection of transverse ligament of atlas should not exceed "safe depth". 3. After odontoidectomy, there is a "buffer space" behind the transverse ligament of atlas.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R687.3;R322

【引證文獻】

相關碩士學位論文 前1條

1 蔡斌;頸椎前路鉤狀鈦板的研制及初步臨床應用[D];南華大學;2008年

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本文編號：1664907