摘要
目的通过掌握枕下远外侧入路的显微解剖学特点,将其应用于临床,以改善枕骨大孔区显微外科手术疗效。方法采用枕下远外侧入路解剖成人头颅标本15具30侧,在显微镜下对该入路涉及的血管、神经、骨性结构、肌肉进行解剖学观察和测量。另对收治的10例枕骨大孔前方肿瘤患者采用枕下远外侧入路显微手术。结果枕下三角和颈2神经的腹侧支是识别椎动脉的重要标志,头外侧直肌是识别颈静脉孔的重要标记。后颅窝开颅常用的解剖标志为星点、前星点、乳突尖、颧弓根。星点到前星点的距离:左侧(22.64±1.88)mm,右侧(21.96±2.64)mm;前星点至乳突尖的距离:左侧(38.54±3.42)mm,右侧(39.04±2.28)mm;星点至颧弓根的距离:左侧(55.82±3.84)mm,右侧(56.26±2.86)mm。10例患者中,8例显微镜下全切除,2例大部分切除,无死亡病例,除1例需呼吸机辅助呼吸外,余患者无明显术后并发症。结论熟悉并掌握枕下远外侧入路的显微解剖知识,能提高枕骨大孔区手术疗效,减少术后并发症。
Objective To study the microsurgical anatomy features of far lateral suboccipital approach and its clinical application in order to improve the therapeutic effectiveness of microsurgical operation at the region of great foramen. Methods Through the far lateral suboccipital approach, 15 adult cadveric heads （30 sides） were anatomized. Under the microscopy, the involving vessels, nerves, bony structures and muscles were observed and measured anatomically. The admitted 10 cases of anterior great foramen tumors were subjected to the microsurgical operation through the far lateral suboccipital approach. Results The suboccipital triangle and ventral branch of C2 nerve were the important marks, and rectus capitis lateralis was the important symbol to identiify the jugular foramen. The commonly used anatomic landmarks in posterior carnial fossa microsurgical operations included asteria, anterior asteria, mastoidale and root of zygoma. The distance from asteria to anterior asteria was （22.64±1.88） mm （left） and （21.96±2. 64） mm （right）, The distance from anterior asteria to mastoidale was （38.54± 3.42） mm （left） and （39.04±2.28） mm （right） ; The distance from asteria to root of zygoma was （55.82±3.84） mm （left） and （56.26 ± 2.86） mm （right）. In 10 cases of anterior great foramen tumors, 8 were subjected to the microsurgically complete resection and 2 most resection. There were no dead cases. Except one case with assisted respiration by breathing machine, the remaining cases had no postoperative complications. Conclusion The understanding of the microsurgical anatomy through the far lateral suboccipital approach can improve the surgical curative effectiveness of the great foramen diseases and reduce the postoperative comlications.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2008年第3期412-414,共3页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
关键词
枕下远外侧入路
显微解剖
临床应用
far lateral suboccipital approach
microsurgical anatomy
clinical application
