本文選題：二腹肌后腹及莖突舌骨肌復合體 + 舌下神經　； 參考：《桂林醫(yī)學院》2014年碩士論文

【摘要】：目的：通過尸體標本解剖獲得上頸椎前外側手術入路中所涉及的重要血管、神經等相關組織結構的詳細解剖學資料,明確其之間的毗鄰關系,為上頸椎前外側手術入路提供臨床參考。方法：選擇經10%福爾馬林固定的顱頸完整的成人濕標本20具(40側),模擬上頸椎前外側手術入路逐層解剖,詳細觀察上頸椎前外側手術入路中所涉及的重要血管、神經等相關組織結構,并測量相關血管與神經的長度、管徑及毗鄰之間的距離,所得結果用SPSS13.0軟件進行統(tǒng)計學處理。結果：1、喉上神經內支穿出動脈鞘點與舌骨大角的位置關系有三種：①平舌骨大角：占12.5%(5/40)。②舌骨大角上方5mm以內：占17.5%(7/40)。③舌骨大角下方10mmm以內:占70%(28/40)。喉上神經內支從穿出點到穿入甲狀舌骨膜的距離：左測(22.3±3.2)mm(16.5～23.9mm),右側為(23.2±3.8)mm(16.6-25.9mm),兩側合并后的距離為(22.7±3.5)mm(16.5～25.91mm)。外支的直徑(0.7±0.11)mm(0.4～1.1),與甲狀腺上動脈形成神經血管束,亦經甲狀舌骨膜穿入,分布于喉部組織。2、舌下神經從舌下神經管出顱,向前內走行,在枕動脈處,發(fā)出一降支與C2及C3神經前支的降支結合形成頸袢,支配舌骨下肌群；在下頜角處,呈弓狀走行于二腹肌后腹及莖突舌骨肌深面,并與之有2次交叉,之后向前彎曲到下頜舌骨肌的深面,發(fā)出分支支配除腭舌肌以外的全部舌肌。3、二腹肌后腹及莖突舌骨肌位于頸深筋膜淺層及中層之間,兩者平行相伴而行,容易辨認,其深面組織由外向內依次為頸內靜脈、副神經、舌下神經、枕動脈、頸外動脈、面動脈等。4、舌骨大角周圍的重要結構有甲狀腺上動脈、舌動脈、喉上神經及舌下神經,它們與舌骨大角尖的最短距離分別為(12.5±3.9)mm(6.9～18.7)；(0.4±1.6)mm(0.2～2.5)；(5.2±1.4)mm(1.6～10.8)；(5.0±1.7)mm(1.6-9.7)。5、在解剖過程中發(fā)現(xiàn)將舌下神經向頭側牽開,喉上神經向尾側牽開,頸動脈鞘向外側牽開,內臟鞘(舌骨、食管和氣管)向內側牽開,即可以形成類似楔形的“窗口”,“窗口”直接對應的部位為C2/C3椎間盤及C3椎體,結合頸部過伸體位及用拉鉤牽拉,可暴露最大范圍：向上達寰椎前弓,向下達頸3椎體下緣,兩側可以暴露至橫突。結論：1、在上頸椎前外側手術入路中,二腹肌后腹及莖突舌骨肌復合體、舌骨大角為尋找舌下神經及喉上神經重要的標志,術中尋找到這兩根神經后,對其游離并加以保護,可以減少損傷機率。2、通過以舌下神經、喉上神經、頸動脈鞘及內臟鞘(舌骨、食管和氣管)組成的類似楔形的“窗口”暴露上頸椎,可以獲得較理想的顯露,并且該概念的提出,為進一步應用微創(chuàng)器械進行上頸椎手術提供了一個良好的通道。
[Abstract]:Objective: to obtain the anatomical data of the important blood vessels, nerves and other related tissue structures involved in the anterolateral cervical vertebrae approach by cadaveric dissection, and to clarify the relationship between them.To provide a clinical reference for the upper cervical anterolateral approach.Methods: 20 adult adult wet specimens fixed with 10% formalin were selected to simulate the anterolateral approach of upper cervical vertebrae. The important blood vessels involved in the approach were observed in detail.The length, diameter and distance between the nerve and the nerve were measured. The results were analyzed by SPSS13.0 software.Results: 1. There are three types of relationship between the sheath point of the internal branch of the superior laryngeal nerve and the position of the great angle of the hyoid bone. There are three types of 1: 1, equal to the great angle of hyoid bone: 12.5% or 5 / 40. 2 within 5mm above the large angle of hyoid bone: within 17.5% 40.3% of 10mmm below the great angle of hyoid bone: 70% within 28% 40% of total hyoid angle.The distance between the internal branch of the superior laryngeal nerve from the point of perforation to the periosteum of the thyroid tongue: left 22.3 鹵3.2mm. 16.5 鹵23.9mm, on the right, 23.2 鹵3.8mm, 16.6-25.9 mm, and the distance after bilateral union was 22.7 鹵3.5mm, 16.525.9mm, respectively.The diameter of the external branch was 0.7 鹵0.11mm ~ (0.11) m ~ (-1), which formed a neurovascular bundle with the superior thyroid artery, and was also perforated through the periosteum of the thyroid tongue and distributed in the laryngeal tissue. The hypoglossal nerve came out of the hypoglossal nerve canal from the cranium and went forward inside the occipital artery.The descending branch is combined with the descending branch of the anterior branches of C2 and C3 nerves to form a cervical loop, which innervates the subhyoid muscle group; at the mandibular angle, it is arcuate along the deep surface of the posterior abdomen and stylohyoid muscle of the bicentric muscle and the styloid hyoid muscle, with which it intersects twice.It then bends forward to the deep surface of the mandibular hyoid muscle, emits branches that innervate all the lingual muscles except palatoglossal muscle .3.The posterior abdomen and stylohyoid muscles of the diabs are located between the superficial and middle layers of the deep cervical fascia, and the two are parallel to each other and are easily recognizable.The internal jugular vein, accessory nerve, hypoglossal nerve, occipital artery, external carotid artery, facial artery, etc.The shortest distance between them and the tip of the hyoid was 12.5 鹵3.9mm ~ 6.9m ~ (-6.9m) ~ 18.7m ~ (-1) ~ (0.4 鹵1.6) mm ~ (-1) ~ (2) ~ (2) ~ (2) ~ (2) ~ (2.5) 鹵1.610.8m ~ (-1) ~ (5.0 鹵1.7) mm ~ (-1) ~ 1.6-9.7mm ~ (-1) respectively. In the anatomic process, it was found that the hypoglossal nerve was pulled sideways, the superior laryngeal nerve was opened to the tail, the carotid artery was opened to the lateral side, and the visceral sheath (hyoid, esophagus and trachea) was opened to the medial side.That is to say, a wedge-like "window" can be formed. The "window" directly corresponds to the C2/C3 intervertebral disc and the C3 vertebra. Combined with cervical hyperextension and pull with a pull hook, the largest range of exposure can be obtained: reaching the anterior arch of atlas upward to the lower margin of the cervical 3 vertebra.Both sides can be exposed to transverse processes.Conclusion: in the anterolateral approach of upper cervical vertebrae, the posterior ventral and styloid hyoid muscle complex of the bicentric muscle and the large angle of hyoid bone are important markers for searching for hypoglossal nerve and superior laryngeal nerve.It can reduce the chance of injury by exposing the upper cervical vertebrae with a wedge of hypoglossal nerve, superior laryngeal nerve, carotid sheath and visceral sheath (hyoid, esophagus and trachea).This concept provides a good channel for the further use of minimally invasive instruments for upper cervical surgery.
【學位授予單位】：桂林醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R322

【參考文獻】

相關期刊論文 前3條

1 彭田紅;徐達傳;李嚴斌;李學雷;石小田;彭珍山;;舌骨大角尖端周圍血管神經的解剖學研究[J];解剖科學進展;2006年01期

2 傅志良;;甲狀腺上動脈及甲狀腺奇動脈[J];解剖學通報;1965年01期

3 吳軻,張建湘,楊慶國,申才良;頸前路椎體次全切手術減壓范圍及安全界限探討[J];臨床骨科雜志;2004年02期

，

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