本文選題：椎動(dòng)脈 + 甲狀腺上動(dòng)脈　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的1、通過對(duì)椎動(dòng)脈V2段及其毗鄰結(jié)構(gòu)的解剖學(xué)研究,探究其解剖結(jié)構(gòu)與毗鄰關(guān)系在椎動(dòng)脈疾病病因?qū)W中的意義,并為臨床上行頸前外側(cè)入路、頸總動(dòng)脈-椎動(dòng)脈搭橋及頸外動(dòng)脈-椎動(dòng)脈搭橋手術(shù)提供解剖學(xué)依據(jù),探討如何安全有效的在頸前區(qū)暴露椎動(dòng)脈V2段;2、通過研究頸外動(dòng)脈分支--甲狀腺上動(dòng)脈與椎動(dòng)脈V2段的解剖關(guān)系,探討頸外動(dòng)脈分支與頸總動(dòng)脈作為供血?jiǎng)用}在后循環(huán)血流重建手術(shù)中的優(yōu)劣,以及甲狀腺上動(dòng)脈-椎動(dòng)脈V2段搭橋在后循環(huán)血流重建中的應(yīng)用前景。對(duì)象和方法1、選擇灌注有彩色硅膠的帶頸部成人尸頭濕標(biāo)本10例(共20側(cè)),模擬頸前外側(cè)入路顯露椎動(dòng)脈V2段,記錄解剖時(shí)經(jīng)過的具體步驟及途徑的層次結(jié)構(gòu);2、選擇頭頸部CTA帶頸椎三維重建影像資料20例(40側(cè)),觀察并記錄椎動(dòng)脈V2段走行、長(zhǎng)度、管徑、分支、變異;3、根據(jù)尸頭標(biāo)本以及三維重建影像資料總結(jié)椎動(dòng)脈V2段與周圍組織的毗鄰關(guān)系;4、測(cè)量尸頭標(biāo)本椎動(dòng)脈優(yōu)勢(shì)側(cè)(均勢(shì)者為左側(cè))頸外動(dòng)脈分支甲狀腺上動(dòng)脈起始部位置、對(duì)應(yīng)椎體水平,以及至甲狀腺上極的長(zhǎng)度、管徑,測(cè)量頭頸部CTA帶頸椎三維重建影像資料中椎動(dòng)脈優(yōu)勢(shì)側(cè)甲狀腺上動(dòng)脈起始部與椎動(dòng)脈V2段的距離。結(jié)果1、頸前外側(cè)入路顯露椎動(dòng)脈V2段的結(jié)構(gòu)依次為:皮膚、皮下脂肪、頸闊肌、胸鎖乳突肌、椎前筋膜、頸長(zhǎng)肌、橫突、椎動(dòng)脈。2、椎動(dòng)脈V2段多數(shù)起自C6橫突孔(39側(cè)),少數(shù)起自其他橫突孔,走行在C6-C3橫突孔所形成的骨性管道內(nèi),在樞椎椎體下緣沿樞椎椎體向上外側(cè)走行,至進(jìn)入樞椎橫突孔為止。左側(cè)優(yōu)勢(shì)者14例,右側(cè)優(yōu)勢(shì)者2例,均勢(shì)者4例。椎動(dòng)脈V2段起點(diǎn)直徑為(3.8±1.3)mm,終點(diǎn)直徑為(3.4±1.2)mm,長(zhǎng)度為(70.0±2.1)mm。3、椎動(dòng)脈V2段與其周圍的靜脈叢一同被橫突骨膜延續(xù)的骨膜鞘所包繞;在兩個(gè)橫突之間,V2段前方為橫突間肌與頸長(zhǎng)肌,C5-C2前外側(cè)還有頭長(zhǎng)肌,內(nèi)側(cè)與Luschka關(guān)節(jié)相鄰,后方為頸椎關(guān)節(jié)突,后內(nèi)側(cè)為椎間孔,頸段脊神經(jīng)根自椎間孔發(fā)出后自V2段后內(nèi)側(cè)向后外側(cè)走行。椎動(dòng)脈V2段主要分支為各個(gè)頸椎節(jié)段發(fā)出的脊神經(jīng)根動(dòng)脈。4、甲狀腺上動(dòng)脈自頸總動(dòng)脈發(fā)出者4例,自頸外動(dòng)脈發(fā)出者3例,于頸總動(dòng)脈分叉部水平發(fā)出者3例;起點(diǎn)在C4椎體上緣水平6例,C3橫突水平3例,C3椎體上緣水平1例;起點(diǎn)直徑為(2.0±0.3)mm,至甲狀腺上極長(zhǎng)度為(45.9±6.4)mm,甲狀腺上極處管徑為(1.7±0.2)mm,與椎動(dòng)脈V2段間的距離為(20.8±1.9)mm。結(jié)論1、通過對(duì)椎動(dòng)脈V2段的顯微解剖學(xué)研究,為臨床上椎動(dòng)脈相關(guān)疾病發(fā)病機(jī)制提供了解剖學(xué)依據(jù),并提供新的思路;2、術(shù)前對(duì)椎動(dòng)脈連帶頸椎進(jìn)行CT三維重建可明確椎動(dòng)脈病變的位置、形態(tài)及與頸椎骨性結(jié)構(gòu)的關(guān)系,對(duì)制定手術(shù)方案以及防止術(shù)后并發(fā)癥的發(fā)生很有幫助;3、在實(shí)際操作中,通過頸前外側(cè)入路,在頸外靜脈與胸鎖乳突肌之間,切開椎前筋膜及頸長(zhǎng)肌,咬除橫突骨質(zhì),可以安全有效的顯露椎動(dòng)脈V2段;4、椎動(dòng)脈V2段與周圍的肌肉、骨骼、血管、神經(jīng)關(guān)系密切,熟悉此區(qū)域的解剖關(guān)系可避免臨床操作時(shí)損傷這些結(jié)構(gòu);5、甲狀腺上動(dòng)脈管徑在2mm左右,可游離段較長(zhǎng),且與椎動(dòng)脈V2段距離較近,可作為椎動(dòng)脈血流重建的良好供體血管。
[Abstract]:Objective 1, through the anatomical study of the V2 segment of the vertebral artery and its adjacent structure, the significance of the anatomical structure and adjacent relationship in the etiology of vertebral artery disease was explored, and the anatomical basis was provided for the clinical ascending cervical anterolateral approach, the common carotid artery bypass grafting and the external carotid artery bypass grafting. The V2 segment of the vertebral artery was exposed in the anterior cervical region. 2, through the study of the anatomical relationship between the external carotid artery branch, the superior thyroid artery and the V2 segment of the vertebral artery, the advantages and disadvantages of the external carotid artery branch and the common carotid artery as the blood supply artery in the reconstruction of the posterior circulation blood flow, and the application of the V2 segment of the superior thyroid artery to the vertebral artery of the vertebral artery in the reconstruction of the posterior circulation blood flow were discussed. Object and method 1, 10 cases (total 20 sides) of the adult cadaver head with color silica gel were selected. The V2 segment of the vertebral artery was exposed in the anterolateral approach of the neck, and the concrete steps and the hierarchical structure of the path were recorded. 2, 20 cases (40 sides) of the cervical spine of the head and neck were selected to observe and record the V2 segment of the vertebral artery. Walk, length, diameter, branch, variation; 3, the adjacent relationship between the V2 segment of the vertebral artery and the surrounding tissue was summed up according to the cadaver head specimens and the 3D reconstruction image data. 4, the position of the upper thyroid artery in the superior lateral cervical artery of the cadaver head specimens (the left) was measured, corresponding to the vertebral level, and the length of the thyroid gland. Diameter, measurement of the distance between the initial part of the upper thyroid artery and the V2 segment of the vertebral artery in the superior lateral thyroid artery of the vertebral artery in the CTA band of the head and neck. Results 1, the structure of the V2 segment of the vertebral artery in the anterolateral approach was the skin, the subcutaneous fat, the latissimus cervix, the sternocleidomastoid muscle, the anterior vertebral fascia, the long neck muscle, the transverse process, the vertebral artery.2, and the vertebral artery V2. Most of the segment from the C6 transverse process (39 sides), a few from the other transverse process holes, walking in the bone pipe formed by the C6-C3 transverse process, the lower edge of the axis along the axis of the axis to the upper lateral, to the axis of the transverse process. The left advantage is 14 cases, the right dominant 2 cases, the equal potential 4 cases. The V2 segment diameter of the vertebral artery is (3.8 + 1.3) mm, the end of the vertebral artery is (3.8 + 1.3) mm. The point diameter is (3.4 + 1.2) mm and the length is (70 + 2.1) mm.3. The V2 segment of the vertebral artery is wrapped around the periosteal sheath along the periosteum of the transverse process with the surrounding vein plexus. Between the two transverse processes, the anterior lateral transverse and cervical long muscles are in the front of the V2 segment, the anterolateral C5-C2 is also the long muscle, the medial is adjacent to the Luschka joint, the rear is the cervical joint process and the posterior medial is the vertebra. The intervertebral foramen, the cervical spinal nerve root after the intervertebral foramen sent out from the V2 segment to the posteriorlateral lateral. The main branch of the V2 segment of the vertebral artery was the.4 of the spinal nerve root arteries from each segment of the cervical vertebra, 4 cases of the superior thyroid artery from the common carotid artery, 3 from the external carotid artery and 3 in the common carotid artery bifurcation, and the starting point on the C4 vertebral body. Margin level 6 cases, C3 transverse process level 3 cases, C3 vertebral upper margin level 1 cases, the starting diameter is (2 + 0.3) mm, to the thyroid pole length is (45.9 + 6.4) mm, the thyroid pole diameter is (1.7 + 0.2) mm, and the distance between the V2 segment of the vertebral artery is (20.8 + 1.9) mm. conclusion 1, through the microanatomical study of the vertebral artery V2 segment, for clinical vertebral artery related disease. The pathogenesis provides anatomical basis and provides new ideas. 2, CT three-dimensional reconstruction of vertebral artery continuous cervical vertebra before operation can identify the position of vertebral artery disease, shape and the relationship with the bone structure of the cervical vertebra, and help to make the operation plan and prevent the postoperative complications; 3, in the actual operation, through the anterolateral neck of the neck. Approach, between the external jugular vein and the sternocleidomastoid muscle, incision of the anterior fascia of the vertebra and the long neck muscle, the V2 segment of the vertebral artery can be exposed safely and effectively, and 4, the V2 segment of the vertebral artery is closely related to the surrounding muscles, bones, blood vessels and nerves, and the familiarity with this area can avoid the damage of these structures in clinical operation; 5, thyroid motion. The vascular diameter is about 2mm, and the free segment is longer, and it is closer to the V2 segment of vertebral artery. It can serve as a good donor blood vessel for reconstruction of vertebral artery blood flow.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651;R322

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