【摘要】： 目的探討遠(yuǎn)外側(cè)經(jīng)髁入路手術(shù)區(qū)域主要結(jié)構(gòu)的特點(diǎn)和毗鄰關(guān)系,探索獲得枕骨大孔區(qū)腹側(cè)良好顯露時(shí)枕髁磨除的最適范圍。 方法對(duì)36具成人干顱底骨標(biāo)本的乳突尖、枕骨大孔、枕髁、舌下神經(jīng)管、頸靜脈結(jié)節(jié)等骨性標(biāo)志進(jìn)行觀察和測(cè)量;在10例(20側(cè))正常成人帶頸尸頭濕標(biāo)本上模擬遠(yuǎn)外側(cè)經(jīng)髁手術(shù)入路,按肌肉層、硬膜外、硬膜內(nèi)進(jìn)行解剖,測(cè)量磨除枕髁前、磨除枕髁至枕髁后緣與舌下神經(jīng)管內(nèi)口后緣長(zhǎng)度1/2時(shí)、至舌下神經(jīng)管內(nèi)口后緣時(shí)、至相當(dāng)于舌下神經(jīng)管外口后緣時(shí)的手術(shù)暴露野最遠(yuǎn)點(diǎn)至中線的距離。 結(jié)果1.枕髁位于枕骨大孔兩側(cè),枕髁后緣至舌下神經(jīng)管內(nèi)口后緣的距離左側(cè)為(9.64±1.44)mm、右側(cè)為(9.14±1.55)mm。 2.舌下神經(jīng)管位于枕髁的上半部,由一薄層骨皮質(zhì)圍成,后壁與矢狀面的夾角左側(cè)為(31.3±6.0)°、右側(cè)為(31.8±5.8)°。 3.磨除枕髁前手術(shù)暴露野均未至中線,至中線的距離左側(cè)為(2.35±0.40)mm、右側(cè)為(2.26±0.33)mm;磨除枕髁至枕髁后緣與舌下神經(jīng)管內(nèi)口后緣長(zhǎng)度1/2時(shí),手術(shù)野最遠(yuǎn)點(diǎn)即能達(dá)到或越過(guò)中線,至中線的距離左側(cè)為(0.37±0.37)mm、右側(cè)為(0.42±0.51)mm;磨除枕髁至舌下神經(jīng)管內(nèi)口后緣時(shí),手術(shù)野最遠(yuǎn)點(diǎn)越過(guò)中線,至中線的距離為左側(cè)為(3.99±0.27)mm、右側(cè)為(4.19±0.27)mm;磨除枕髁至相當(dāng)于舌下神經(jīng)管外口后緣時(shí)手術(shù)野又有所增加,至中線距離左側(cè)為(5.29±0.54)mm、右側(cè)為(5.61±0.40)mm,任意兩者之間有統(tǒng)計(jì)學(xué)差異。 結(jié)論1.舌下神經(jīng)管周圍的皮質(zhì)骨可作為抵達(dá)舌下神經(jīng)管的標(biāo)志,并可估計(jì)枕髁切除的范圍。 2.寰椎橫突是辨認(rèn)椎動(dòng)脈的重要標(biāo)志。 3.遠(yuǎn)外側(cè)經(jīng)髁入路手術(shù)中,隨著枕髁磨除的增多,手術(shù)暴露野逐漸增大,磨除枕髁至舌下神經(jīng)管內(nèi)口后緣時(shí)手術(shù)暴露野最遠(yuǎn)點(diǎn)已能達(dá)到中線對(duì)側(cè),可獲得枕骨大孔腹側(cè)區(qū)的良好顯露。 4.研究枕下遠(yuǎn)外側(cè)經(jīng)髁入路的顯微解剖,對(duì)提高遠(yuǎn)外側(cè)經(jīng)髁入路手術(shù)的安全性和治療效果有重要實(shí)用價(jià)值。
[Abstract]:Objective to investigate the characteristics of the main structures and the relationship between the main structures and the adjacent areas in the far lateral transcondylar approach, and to explore the optimal range of occipital condyle removal when the occipital foramen area is well exposed. Methods the mastoid apex, foramen magnum, occipital condyle, hypoglossal canal and jugular vein were observed and measured in 36 adult cadaveric skull base specimens. In 10 cases (20 sides) of normal adults with necked cadaveric head wet specimen, simulated far lateral transcondylar approach, according to muscle layer, epidural, intradural anatomy, measurement before grinding occipital condyle. When the length of the posterior edge of the occipital condyle to the posterior margin of the occipital condyle and the posterior edge of the internal orifice of the hypoglossal nerve duct is 1 / 2, the distance from the farthest point to the central line of the surgical exposure field is from the posterior edge of the internal orifice of the hypoglossal nerve canal to the posterior edge of the external orifice of the hypoglossal nerve canal. Result 1. The distance between the occipital condyle and the posterior edge of the occipital condyle is (9.64 鹵1.44) mm, and the distance between the occipital condyle and the posterior edge of the hypoglossal canal is (9.14 鹵1.55) mm.. 2. The hypoglossal canal is located in the upper half of the occipital condyle and is surrounded by a thin layer of bone cortex. The angle between the posterior wall and the sagittal plane is (31.3 鹵6.0) 擄on the left and (31.8 鹵5.8) 擄on the right. 3. The distance between the exposed field and the middle line was (2.35 鹵0.40) mm, and (2.26 鹵0.33) mm;, respectively. When the length of the posterior edge of the occipital condyle to the posterior margin of the occipital condyle and the posterior edge of the hypoglossal nerve canal is 1 / 2, the farthest point of the surgical field can reach or cross the midline, and the distance to the midline is (0.37 鹵0.37) mm, to the left, and (0.42 鹵0.51) mm; to the right. When the occipital condyle was removed to the posterior margin of the internal orifice of the hypoglossal canal, the farthest point of the surgical field crossed the midline and the distance to the midline was (3.99 鹵0.27) mm, on the left side and (4.19 鹵0.27) mm; on the right side. When the occipital condyle was removed to the posterior edge of the external orifice of the hypoglossal canal, the operative field was increased, and the distance from the midline to the left side was (5.29 鹵0.54) mm, to the right (5.61 鹵0.40) mm,. Conclusion 1. The cortical bone around the hypoglossal canal can be used as a marker to reach the hypoglossal canal and to estimate the extent of occipital condylar resection. 2. The transverse process of atlas is an important marker for identifying vertebral artery. 3. In the far lateral transcondylar approach, with the increase of occipital condylar wear, the surgical exposure field gradually increased. The farthest point of the surgical exposure field reached the opposite side of the midline when the occipital condyle was removed from the occipital condyle to the posterior edge of the internal orifice of the hypoglossal canal. Good exposure of the ventral region of foramen magnum can be obtained. 4. To study the microanatomy of the suboccipital far lateral transcondylar approach is of great practical value in improving the safety and therapeutic effect of the far lateral transcondylar approach.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R322

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