摘要
目的探讨枕动脉枕下段的解剖定位标志及其在手术中的意义。方法应用10具(20侧)10%甲醛固定的成人尸头标本,由浅入深逐层解剖枕项部肌肉,观察枕动脉的穿行层次及其与肌肉、骨缝的解剖关系,测量枕动脉枕下段的长度及其起点和终点处的血管直径。回顾性分析2021年1月至2023年12月于郑州大学第一附属医院神经外科就诊且行头颅MRI增强扫描的60例(120侧)患者的影像学资料:测量头颅MRI上枕动脉枕下段起点和终点处的血管直径。结果10具尸头标本的枕动脉枕下段由深入浅穿行于枕下3层肌群内。深层:以二腹肌后腹、头外侧直肌和上斜肌为标志。20侧标本的枕动脉枕下段均走行于二腹肌后腹内侧、上斜肌外侧、头外侧直肌外侧和二腹肌沟内侧;9侧标本的枕动脉枕下段走行于枕乳缝内侧,11侧走行于外侧。中层:以头最长肌为标志,枕动脉多位于头最长肌深面(19/20),此处的枕动脉包绕在茎突隔膜内,常与乳突导静脉邻近。浅层:以胸锁乳突肌腱膜为标志。10具(20侧)尸头标本枕动脉枕下段的长度为(66.88±5.46)mm,起点处直径为(2.99±0.63)mm,终点处直径为(1.94±0.48)mm。影像学解剖测量结果显示,60例(120侧)患者枕动脉枕下段起点处直径为(2.61±0.37)mm,终点处直径为(1.96±0.37)mm结论熟悉枕动脉枕下段的局部解剖,以头最长肌、上斜肌、枕乳缝等肌肉和骨性解剖标志构建枕动脉空间分层解剖定位方法,可在枕下外侧入路中快速、有效地分离和获取枕动脉。
Objective To investigate the anatomical landmarks of the positional sign of the suboccipital segment of the occipital artery and its significance in surgery.Methods The suboccipital muscles were dissected layer by layer from superficial to deep on 10 cadaveric heads(20 sides)fixed with 10%formalin to observe the levels of the occipital artery and its anatomical relationship with the muscles and sutures.The imaging of patients(60 cases,120 sides)who visited the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023 and underwent enhanced MRI scans were retrospectively analyzed.The length of the suboccipital segment of the occipital artery was measured on the cadaveric heads,and the diameter of artery at the starting and ending points of this segment was measured on the specimens and on the MRI of the skull.Results The dissection of 10 cadaveric showed that the suboccipital segment of the occipital artery ran through the three layers of muscles in the suboccipital region from deep to shallow.Deep layer:the posterior belly of the digastric muscle,the lateral rectus muscle of the head and the superior oblique muscle were used as landmarks.The suboccipital segment of the occipital artery on the 20 sides of the specimens ran medially to medial side of the posterior belly of the digastric muscle,laterally to the lateral side of the superior oblique muscle,laterally to the lateral side of the lateralus muscle of the head,and medially to the medial side of the digastric groove;9 specimens of the suboccipital segment of the occipital ran medially to the medial side of the occipitomastoid suture,and 11 ran laterally.Middle layer:the longest muscle of the head was used as an anical landmark,and the occipital artery was mostly located deep to the longest muscle of the head(19/20),where the occipital artery was surrounded the petrosal partition and was often adjacent to the sigmoid sinus.Superficial layer:the tendon sheath of the sternocleidomastoid muscle was used as a landmark.The length of the suboccipital segment the occipital artery was 66.88±5.46 mm,the diameter at the starting point was 2.99±0.63 mm,and the diameter at the ending point was 1.94±0.48 mm.The results of the imaging anatomy measurement showed that the diameter at the point of the suboccipital segment of the occipital artery was 2.61±0.37 mm and the diameter at the ending point was 1.96±0.37 mm in 60 cases(120 sides)of the subjects.Conclusion Familiarizing the local anatomy of the occipital segment of the occipital artery and establishing a method of spatial stratified anatomical positioning of the occipital artery with muscles and bony anatomical such as the longest muscle of the head,the superior oblique muscle,and the occipitomastoid suture could facilitate quick and effective separation and obtaining of the occipital artery in the suboccipital lateral approach.
作者
杨爱民
王树凯
孙剑瑞
陶晓刚
Yang Aimin;Wang Shukai;Sun Jianrui;Tao Xiaogang(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 45O003,China;Department of Neurosurgery,the People's Hospital of Mianchi,Sanmenxia 472400,China)
出处
《中华神经外科杂志》
北大核心
2025年第11期1147-1151,共5页
Chinese Journal of Neurosurgery
基金
河南省医学科技攻关计划——省部共建项目(SBGJ202002108)。
关键词
解剖学
局部
解剖标志
枕动脉
枕下段
Anatomy,regional
Anatomic landmarks
Occipital artery
Suboccipital segment
