摘要
目的 为经口咽前入路处理寰枢椎腹侧病变提供解剖学依据。方法 对 10例新鲜的成人头颈部标本经口咽前入路进行逐层的显微外科解剖 ,观察咽后壁的层次、椎动脉的走行、寰枢椎的解剖毗邻关系和寰枢椎前路钢板内固定的相关解剖参数等。结果 咽后壁分两层(黏膜层、椎前筋膜层)和两个间隙 (咽后间隙、椎前间隙 ) ;经口咽前入路可显露从枕骨大孔前缘至C3 椎体的范围 ;椎动脉距寰椎和枢椎中线的距离分别为 2 5 2± 2 3mm(2 0 4～ 2 9 7mm)和 18 4± 2 6mm(13 1～ 2 3 0mm) ;寰椎和枢椎可显露宽度分别为 39 4±2 2mm(36 2～ 4 2 7mm)和 39 0± 2 1mm(35 8～ 4 2 3mm) ,寰椎进钉点 (侧块中点 )间距 (a)为 31 4± 3 3mm(2 5 4～ 36 6mm) ,寰椎进钉点连线与枢椎进钉点 (椎体中线旁开 3～4mm)连线的垂直间距 (b)为 18 7± 2 7mm(14 9～ 2 3 2mm) ,a/b比值为 1 5～ 1 7。结论 经口咽前入路寰枢椎手术是安全可行的 ,适合做寰枢椎前路钢板内固定 。
Objective To provide anatomical profile of the cranio-cervical region for the surgical treatment of ventral atlantoaxial lesions through transoropharyngeal approach.Methods Ten fresh specimens of craniocervical region were dissected layer by layer with microsurgical technic in accordance with the transoropharyngeal approach for the surgical treatment of atlantoaxial lesion, with special attention to anatomical stratification of pharyngeal posterior wall, the course of the vertebral artery, anatomical relation between the atlas and the axis, and anatomical parameters pertaining to internal fixation for the atlantoaxial joint. Results Pharyngeal posterior wall consisted of two layers (mucosa and prevertebral fascia) and two spaces (posterior interspace of pharynx and anterior interspace of vertebrae). Through anterior transoropharyngeal approach, the region between the anterior rim of the foramen magnum down to C 3 could be exposed. The distance between the vertebral artery and midline of the atlar and axis was 25.2±2.3mm(20.4-29.7mm) and 18.4±2.6mm(13.1-23.0mm) respectively. The exposed areas of the atlas and axis were 39.4±2.2mm(36.2-42.7mm) and midline was 39.0±2.1mm(35.8-42.3mm), respectively. The distance(a) between the two screw inserting points on the atlas (middle point of C 1 lateral mass) was 31.4±3.3mm(25.4-36.6mm). The vertical distance(b) between the connecting line of two screw inserting points on the atlas and that of two screw inserting points on the axis (3-4mm lateral to the midline of C 2 vertebra) was 18.7±2.7mm(14.9-23.2mm). The odds of a/b ranged from 1.5 to 1.7. Conclusion Atlantoaxial surgery through transoropharygeal approach is safe and feasible. The approach is suitable for internal fixation of anterior atlantoaxial joint, and the design of the plate should be based on the above data.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2004年第3期220-222,共3页
Medical Journal of Chinese People's Liberation Army
基金
广东省自然科学基金 (编号 2 0 0 2 30 0 1 )
广东省重点攻关项目 (编号99B0 670 3G)
广东省医学科研基金 (编号A2 0 0 2 51 3)资助课题
关键词
经口咽入路
寰椎
枢椎
解剖学
局部
transoropharyngeal approach
atlas
axis
anatomy, regional
