椎动脉、颈交感干和颈长肌的解剖关系及其在颈椎手术中的意义

The importance of the anatomical relationship between the vertebral artery,the sympathetic trunk and the longus colli in the operation on cervical vertebra

目的研究椎动脉、颈交感干和颈长肌的相互关系,为颈椎前入路手术提供参考资料。方法采用12具正常尸体标本,测量椎动脉起始部至第6颈椎(C6)横突孔间距及其与前斜角肌内侧缘的夹角,并测量C6水平椎动脉至颈长肌内侧缘的距离、两颈长肌内侧缘的距离、颈交感干至颈长肌内侧缘的距离、颈交感干至颈正中线的距离。结果椎动脉起始部至第6颈椎横突孔的间距为(47.76±17.28)mm。在C6水平椎动脉至颈长肌内侧缘的距离为(8.25±2.03)mm,与前斜角肌内侧缘的夹角为24.28°±2.13,°两颈长肌内侧缘的距离为(13.78±1.49)mm,颈交感干至颈长肌内侧缘的距离为(14.57±1.62)mm,至颈正中线的距离为(20.64±2.42)mm。结论颈椎前入路手术中对椎动脉及颈交感干的定位应参照颈长肌、前斜角肌等重要标志,并应注意椎动脉可能的变异。在C6水平,颈交感干与颈长肌的距离最近,为手术中容易误伤的结构。

Objective To provide the reference data for performing the anterior approach to the cervical vertebra, the anatomical relationship between the vertebral artery,the sympathetic trunk and the longus colli is studied. Methods Using 12 cadavers in this study, on C6 level, the distance between two medial borders of the longus colli, the distance between the sympathetic trunk and the medial border of the longus colli and the distance between the sympathetic trunk and the midline of the neck were measured. The distance between the originating point of the vertebral artery and the transverse foramen of the sixth cervical vertebra and the distance from the vertebral artery to the medial border of the longus colli were measured. The angle between the vertebral artery and the scalenus anterior was also measured. Results The distance between the originating point of the vertebral artery and the transverse foramen of the sixth cervical vertebra was （47.76±17.28） mm. On C6, the distance from the vertebral artery to the medial border of the longus colli was （8.25±2.03） mm, the angle between the vertebral artery and the scalenus anterior was 24.28°±2.13°.The distance between two medial borders of the longus colli is （13.78±1.49） mm.The distance between the sympathetic trunk and the medial border of the longus colli was （14.57±1.62） mm and the distance between the sympathetic trunk and the midline of the neck was （20.64±2.42） mm. Conclusion The longus colli and the scalenus anterior are used to locate the vertebral artery and the sympathetic trunk when performing the anterior approach to the cervical vertebra. And we should pay attention to the variation of the vertebral artery. On C6 level, the distance between the sympathetic trunk and the longus colli is the shortest, so the sympathetic trunk is easily damaged during the operation.