枕大神经卡压综合征的应用解剖学和针刀治疗研究

Study of applied anatomic and acupuncture therapy on the greater occipital nerve compressive syndrome

目的为枕大神经卡压综合征临床治疗提供应用解剖学依据和针刀治疗之法。方法在20侧成人尸体头颈标本上,对枕大神经的行径、动静脉穿斜方肌腱膜的部位、深筋膜以及易发生卡压的部位进行了解剖观察和测量。对200例具有枕大神经卡压症状的颈椎病患者应用针刀分离松解术,采用不同方向和大小范围分离松解,进行对比性治疗,观察治疗效果有何差异。结果枕大神经在枕外隆突下方(28±02)cm,旁开(26±01)cm处穿斜方肌腱膜至皮下;动静脉穿斜方肌腱膜和深筋膜的部位约位于枕外隆突至乳突尖连线的中、上1/3交界点;穿出点有大量腱纤维和筋膜束缠绕枕动静脉,是神经血管发生卡压的部位。结论采用枕大神经穿出腱膜和筋膜点的稍内侧进针,从外上向内下方(与后正中线约40°夹角)分离松解,便可解除因神经主干受压引起后半头麻痛。有时往往还需要扩大松解范围,因为枕外隆突至乳突尖连线中1/3外上方枕大神经分支浅出皮下处的分支,易被深筋膜硬化组织粘连和卡压,结合压痛点范围进行扩大松解,才能获得最佳治疗效果。

Objective:To provide the anatomic basis and acupotomologic therapeutic methods for greater occipital nerve compressive syndrome.Methods:The pathway and position of greater occipital nerve,the position of the arteria and vein through trapezius muscle tendon,deep fascia and predilection site of compression were observed and measured on 20 specimens of adult corpse.200 patients of cevial spondylosis accompanied with greater occipital nerve compression syndrome,which were treated relatively with acupuncture therapy according to different direction and range and observing their clinical effect.Results:The position of the greater occipital nerve existed descend (2.8±0.2) cm and leave aside (2.6±0.1) cm from external occipital protuberance;the position of the arteria and vein through trapezius tendon and deep fascia existed the point of intersection of median and superior 1/3 of the line from external occipital protuberance to mastoid apex.There were lots of tendon fibers and fascia bond twisted with the greater occipital nerve and the occipital artery and vein at the positions,which was predilection site of compress syndrome.Conclusion:At the interior site of through aponeurosis and fascia,to loose the greater occipital nerve from exo-superior to inter-inferior by needle,which can treat the greater occipital nerve compression syndrome.The loose area of some patients’ should be enlarged.Because the greater occipital nerve is pressed very easy at this point.We can acquire the best curative effect through enlarging loose area according to painful point.