本文選題：乳突下側(cè)方入路　切入點(diǎn)：寰椎側(cè)塊　出處：《廣西醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的 獲得乳突下側(cè)方手術(shù)入路所涉及的重要血管、神經(jīng)的解剖學(xué)資料,明確其與周圍結(jié)構(gòu)的空間定位關(guān)系,為臨床手術(shù)提供參考。 方法 選取10具(20側(cè))經(jīng)10%福爾馬林固定完整的國人成人頭頸部標(biāo)本,經(jīng)雙側(cè)頸總動脈灌注紅色乳膠,對乳突下側(cè)方手術(shù)入路所涉及的結(jié)構(gòu)進(jìn)行解剖觀察和測量,所得結(jié)果用SPSS13.0軟件進(jìn)行統(tǒng)計分析。 結(jié)果 1寰椎橫突尖或乳突與副神經(jīng)、舌下神經(jīng)、枕動脈、頸交感干、頸動脈鞘內(nèi)結(jié)構(gòu)的解剖關(guān)系: 1.1寰椎橫突尖距副神經(jīng)的最短距離:左(9.5±0.16)mm,右(9.4±0.19)mm;乳突距副神經(jīng)入胸鎖乳突肌前緣處距離:左(28.5±1.63) mm,右(28.7±1.35)mm。 1.2寰椎橫突尖距舌下神經(jīng)的最短距離:左(8.4±0.16)mm,右(8.4±0.14)mm。 1.3寰椎橫突尖距枕動脈的最短距離:左(7.3±0.29)mm,右(7.3±0.29)mm。 1.4寰椎橫突尖距頸交感干的最短距離:左(10.5±0.40)mm,右(10.4±0.27) mm。 1.5寰椎橫突尖距迷走神經(jīng)的最短距離:左(7.0±0.22) mm,右(7.0±0.30)mm;與頸內(nèi)靜脈最短距離:左(4.0±0.14) mm ,右(4.1±0.23)mm;與頸外動脈最短距離:左(10.1±0.25) mm,右(10.2±0.31)mm;與頸內(nèi)動脈最短距離:左(10.4±0.36) mm,右(10.3±0.28) mm。 2枕動脈由頸外動脈分出,在面動脈起點(diǎn)上方占55%(11/20),于面動脈平齊的占15%(3/20),在面動脈起點(diǎn)下方的占30%(6/20),沿二腹肌后腹下方行向后上,然后轉(zhuǎn)向二腹肌后腹深面,行于寰椎橫突前上方至乳突內(nèi)側(cè)及后方的枕動脈溝內(nèi)。枕動脈起點(diǎn)處管徑:左(2.0±0.21)mm,右(1.9±0.28)mm;中點(diǎn)處管徑:左(1.9±2.0)mm,右(1.9±0.18)mm;穿深筋膜處管徑:左(1.9±0.22)mm,右(1.9±0.18) mm。 3椎動脈均由鎖骨下動脈后上方發(fā)出,穿越頸長肌與前斜角肌之間的裂隙達(dá)第六頸椎橫突孔,繼而上行于第六頸椎橫突孔至第一頸椎橫突孔相連所形成的骨管內(nèi),自寰椎橫突孔穿出后,繞過寰椎側(cè)塊后方,走行在寰椎后弓的椎動脈溝內(nèi),其前方與頭側(cè)直肌和寰椎側(cè)塊相連,其后方被頭上斜肌、頭后大直肌和頭半脊肌覆蓋,向上方穿寰枕后膜及硬腦膜經(jīng)枕骨大孔進(jìn)入顱腔。椎動脈寰樞段行程迂曲,有較為恒定的彎曲4~6個,其中彎曲處即形成血管膨大,其血管內(nèi)外徑為(4.7±0.90)mm,非彎曲部血管外徑為(3.9±0.31)mm。 4寰椎橫突尖與寰椎側(cè)塊內(nèi)緣中點(diǎn)距離:左(28.5±0.47) mm,右(28.5±0.33) mm;寰椎側(cè)塊的寬度:左(16.2±1.93) mm,右(15.3±1.10) mm。 結(jié)論 1寰椎橫突尖或乳突與副神經(jīng)、舌下神經(jīng)、枕動脈、頸交感干、頸動脈鞘內(nèi)結(jié)構(gòu)有恒定的解剖關(guān)系,可作為術(shù)中保護(hù)上述神經(jīng)、血管的解剖標(biāo)志。 2椎動脈寰樞段行程迂曲,有較為恒定的彎曲4~6個,其中彎曲處形成血管膨大,其血管內(nèi)外徑為(4.7±0.90)mm,非彎曲部血管外徑為(3.9±0.31)mm。用較細(xì)的神經(jīng)剝離子將其上、下口游離,用薄型手槍式咬骨鉗咬除橫突孔前外壁,使其呈敞開狀,并沿椎動脈走行向上、下稍許分離,此時包繞椎動脈的薄層纖維鞘膜樣結(jié)構(gòu)連同椎動脈可移動2~3cm,可為寰椎側(cè)塊病變手術(shù)提供操作空間。 3本組實(shí)驗(yàn)觀測的結(jié)果表明:寰椎橫突尖與側(cè)塊內(nèi)緣中點(diǎn)距離為(27.5~29.9)mm;寰椎側(cè)塊的寬度為(13.1~19.7)mm。因此在行寰椎側(cè)塊手術(shù)過程中為了避免脊髓損傷,我們確定寰椎橫突尖后,向內(nèi)切除側(cè)塊深度一般不超過2.8cm;或者確定側(cè)塊外緣后,向內(nèi)切除側(cè)塊深度一般不超過1.5cm。
[Abstract]:objective
The anatomical data of important vessels and nerves involved in the lateral mastoid approach were obtained, and the spatial location relationship with the surrounding structures was identified, so as to provide references for clinical operation.
Method
A total of 10 adult (20 sides) Adult neck and neck specimens fixed by 10% formalin were perfused with red latex through bilateral common carotid arteries. The structures involved in the lateral mastoid approach were observed and measured. The results were statistically analyzed by SPSS13.0 software.
Result
1 the anatomical relationship between the apex of the transverse process of the atlas or the mastoid with the accessory nerve, the hypoglossal nerve, the occipital artery, the sympathetic trunk of the neck and the intrathecal structure of the carotid artery.
1.1, the shortest distance from the apex of the atlas to the accessory nerve: left (9.5 + 0.16) mm, right (9.4 + 0.19) mm, the distance from mastoid to the anterior border of the accessory nerve into the sternocleidomastoid muscle: left (28.5 + 1.63) mm, right (28.7 + 1.35) mm..
1.2 the shortest distance between the apex of the transverse process of the atlas and the hypoglossal nerve: left (8.4 + 0.16) mm, right (8.4 + 0.14) mm.
1.3 the shortest distance between the apex of the transverse process of the atlas and the occipital artery: left (7.3 + 0.29) mm, right (7.3 + 0.29) mm.
1.4 the shortest distance between the apex of the transverse process of the atlas and the cervical sympathetic trunk: left (10.5 + 0.40) mm, right (10.4 + 0.27) mm.
The shortest distance between the 1.5 transverse process of atlas tip distance: the left vagus nerve (7 + 0.22) mm, right (7 + 0.30) mm; and the internal jugular vein in the shortest distance: left (4 + 0.14) mm, right (4.1 + 0.23) mm; external carotid artery and the shortest distance: left (10.1 + 0.25 mm), right (10.2 + 0.31) mm; and the shortest distance of internal carotid artery: the left (10.4 + 0.36) mm, right (10.3 + 0.28) mm.
2 occipital artery from the external carotid artery into the facial artery, accounting for 55% of the starting point above (11/20), to flush the facial artery accounted for 15% (3/20), below the starting point of facial artery accounted for 30% (6/20), the two pbdm below the line back, then turned to the two pbdm deep surface, pillow in the transverse process of the atlas artery in front and rear. The medial to the mastoid and occipital artery diameter at the starting point: left (2 + 0.21) mm, right (1.9 + 0.28) mm; midpoint diameter: left (1.9 + 2) mm, right (1.9 + 0.18) mm in diameter: the deep fascia; left (1.9 + 0.22) mm, right (1.9 + 0.18) mm.
3 of vertebral artery by subclavian artery after the above issue, crossing between collilongus and scalenus anterior fracture of sixth cervical transverse foramen, then ascending in sixth cervical transverse foramen to the first cervical transverse foramen is formed by bone tube from the transverse foramen of atlas piercing, bypassing the lateral mass of atlas go behind the vertebral groove in the posterior arch, the front and the head of the lateral rectus and lateral mass of atlas is the rear of the head oblique, rectus capitis posteriormajor muscle and head semi spinal muscular membrane to the top cover, and the dura wear after atlanto occipital foramen magnum into the cranial cavity. The atlantoaxial vertebral artery stroke there is a tortuous, bending 4~6 is constant, the bend forming vascular enlargement, the vascular diameter is (4.7 + 0.90) mm, non bending of vascular diameter (3.9 + 0.31) mm.
The 4 transverse process of atlas tip and lateral mass of atlas edge midpoint: left (28.5 + 0.47) mm, right (28.5 + 0.33) mm; the width of the lateral mass of atlas: left (16.2 + 1.93) mm, right (15.3 + 1.10) mm.
conclusion
1, there is a constant anatomic relationship between the apex of transverse process of the atlas, or the mastoid and the accessory nerve, hypoglossal nerve, occipital artery, cervical sympathetic trunk, and the sheath of carotid artery. It can be used as an anatomical landmark for protecting the above nerves and vessels during operation.
2 atlantoaxial vertebral artery segments have a tortuous, bending 4~6 is constant, the bend forming vascular enlargement, the vascular diameter is (4.7 + 0.90) mm, non bending of vascular diameter (3.9 + 0.31) mm. with fine nerve ion stripping the mouth, free, with thin hand gun type rongeur transverse wall front hole, which was opened, and along the vertebral artery to go up, down slightly separated, then wrapped around the vertebral artery thin fibrous sheath like structures with vertebral artery mobile 2~3cm, can provide the space for the lateral mass of atlas lesions.
3 the experimental observation results show that the transverse process of atlas lateral mass inner tip and the midpoint for (27.5~29.9) mm; the width of the lateral mass of atlas (13.1~19.7) mm. so at the lateral mass of atlas operation process in order to avoid spinal cord injury, we determine the transverse process of atlas tip after resection of lateral inward block depth of not more than 2.8cm; or the side edge block after block resection of lateral inward depth of not more than 1.5cm.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322

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