远外侧经枕髁经颈静脉结节手术入路的量化分析

Quantitative analyse of the far -lateral surgical approach via occipital condyle and jugular tuberculum

目的建立远外侧经枕髁经颈静脉结市手术入路的相关解剖数据,并将其与枕下开颅术相比较。方法应用30具成人带颈尸头湿标本及30具成人干颅骨标本按远外侧经枕髁经颈静脉结节手术入路进行显微解削并测量。从枕骨大孔后缘中点至枕髁后缘画一参考线,以这条参考线测量手术入路角度,确定暴露对侧颈静脉结节内缘必须磨除枕髁的程度。结果自枕骨大孔后缘中点至枕髁内缘的距离左(27．46±2．75)mm,有(27．28±2．11)mm;至枕髁后缘的距离左(25．42±2．48)mm,右 (25．84±2．40)mm。枕髁后缘至斜坡中点(两侧颈静脉结节连线中点)距离左(28．67±1．73)mm,右(29．43± 1．66)mm。舌下神经管内口至斜坡中点距离左(13．48±1．63)mm,右(13．63+1．36)mm;至对侧颈静脉结节内缘左(19．68±1．61)mm,右(19．34±1．16)mm。枕下开颅时的手术角度为(88±2)度,去除枕髁至打开舌下神经管内口,无牵拉脑干即可暴露对侧颈静脉结节内缘的手术角度平均为(52±1)度,即每切除1 mm的枕髁即能平均减小陔角度4度。结论去除枕髁至打开舌下神经管内口并去除同侧颈静脉结节能充分暴露区域上颈髓腹侧、枕骨大孔前部、中下斜坡及颈静脉孔区。

Objective To study the data of relative anatomic structure in the far-lateral approach via occipital condyle and jugular tuberculum and compare it with the suboccipital craniectomy. Methods 30 adult cadaveric wet head samples and 30 dry skulls were micro-anatomized with the far-lateral surgical approach via occipital condyle andjugular tuberculum. A reference line was set from the middle point ofposterior margin of the foramen magnum （FM） to the posterior border of the occipital condyle （OC）. From this line, the angle of surgical approach provided was measured to confirm the degree to which the inside tubercular wall of side jugular vain must abrade occipital condylein the condition of exposure. Results The distance between the rear wall of occipital foramen and the left inside wall of occipital condyle was （27.46±2.75）mm, and the right （2728±2.11）mm. The distance between the rear wall of occipital foramen and the left rear wall of occipital condyle was （25.42±2.48）mm,and the right （25.84±2.40）mm. The distance between the rear left wall of occipital condyle to the center of the clivus （the tubercular and connecting center between two sides ofjugular vein ） was （28.67±1.73）mm, andthe right （29.43±1.66）mm The left distance between the inside foramen ofhypoglossal canal and the center ofclivus was （13.48±1.63）mm, and the right （13.63± 1.36）mm; The left distance between the inside foramen ofhypoglossal canal and inside wall ofcontralateraljugular tuberculum was （19.68±1.61 ）mm, and the right （19.34 ±1.16）mm. The angle of the suboccipital craniectom was 88 degree, the angle of the far-lateral transcondylar transtubercular approach was 52 degree, the angle was average decreased to 4 degrees per millimeter of OC removed. Conclusion The removal of condylar to internal open ofhypoglossal canal could sufficiently expose the area of the upper ventral cervical spinal canal, the anterior portion of the FM, the lower and middle clivus and jugular foramen.