经口入路颅颈交界区的显微外科解剖

MICROSURGICAL ANATOMY OF TRANSORAL APPROACH TO THE CRANIOCERVICAL JUNCTION

目的：使经口入路手术广泛地用于处理颅颈交界区腹侧的病变。方法：在３０例经动脉灌注红色乳胶的尸颅行拟经口入路术的显微外科解剖。结果：不作切开暴露或仅切开软腭足以达斜坡下部至第二颈推的范围；在斜坡下部、寰椎、枢椎前部可分别开１６．３（１０．０～２３．０）ｍｍ、１５．９（１３．０～２０．０）ｍｍ、１８．１（１４．０～２７．０）ｍｍ宽的骨窗而不会损伤两侧后组脑神经和椎动脉；在齿突基底部以下４ｍｍ～５ｍｍ处斜行切除之可较彻底地前减压。结论：研究证实了经口入路手术在处理时的若干优势，并就如何提高手术疗效、减少术后颅颈部不稳等问题进行了探讨。

Objective:To make transoral approach(TOA)applied in dealing with lesions of the ventral craniocervical junction spreadly Methods:Microsurgical dissecting in 30 cadaveric head with the arteries poured into bed emulsion according to the operative procedure of TOA Results:It was enough to reach from lower clivus to C 2 vertebae without any cutting exposure or only with the soft palate cut open along its midline The window of the lower clivus could be opened 16 3(10 0～23 0)mm in width,that of the atlas,15 9(13 2～20 0)mm,and the axis,18 1(14 0～27 0)mm The dens could be cut off obliquely at the level of 4 mm～5 mm below the basilar part of the dens for the purpose of anterior depression completely Conclusions:The study revealed that the TOA had several advantages in dealing with lesions of the ventral craniocervical junction Also,combining with the relative anatomic structure with the operative procedure,the author discussed how to improve the curative effect and reduce the happeness of instabilites of the craniocervical junction