枕大神经卡压综合征的解剖学研究

Anatomical study of greater occipital nerve entrapment syndrome

目的为枕大神经卡压综合征的诊断、治疗提供解剖学依据。方法用放大10倍的解剖显微镜在30具成人尸体（60侧）上观察枕大神经的行径、分段、分布、易卡压的部位及与枕血管的毗邻关系。用游标卡尺测量枕大神经易卡压部位与枕外隆凸、乳突尖、上项线等相关结构的距离，并标出易卡压部位的体表投影。结果皮下段与浅筋膜连接紧密，较易形成卡压，枕大神经最易卡压部位在其浅出部位，且有枕血管伴行。此部位枕大神经在枕动脉的内侧、枕外隆凸外（27．60±5．20）mm、上项线下方（18．46±5．12）mm处，其体表投影为枕外隆凸与乳突尖连线的中上1／3交点部位。结论闭合性手术治疗枕大神经综合征的最佳进针（刀）部位在枕外隆凸与乳突尖连线的中上1／3交点下方的稍内侧；术中不但要分离、松解枕大神经主干的卡压，同时也要分离、松解其皮下分支的卡压。

Objective To provide anatomical basis for diagnosis and therapeutic methods for treating greater occipital nerve entrapment syndrome. Methods With 10 multiples microscope, the trace, distribution, compression and relationship with occipital vessel of greater occipital nerve were observed and measured on 60 specimens of adult corpse. With a vernier caliper the distance of the easily compressed part of greater occipital nerve with external occipital protuberance, mastoidal and superior nuchal line were measured, and the superficial projection of the easily compressed part was marked. Results The course of the nerve could be divided into two parts： active part and inactive part. The former laid in the nuchal muscles, the latter ran and anchored to superficial fascia of the scalp, and easily compressed, accompanying with occipital vessel. This point lay in medial to occipital vessel and lateral to external occipital protuberance（27.60 ± 5.20） mm, and inferior to superior nuchal line （ 18.46 ± 5.12 ） mm, and the superficial projection lay in median and superior 1/3 of the line from external occipital protuberance to mastoid apex. Conclusion Treating the greater occipital nerve compression syndrome by closed operation, the best position for needling lays in a bit inferior to point of median and superior 1/3 of the line from external occipital protuberance to mastoid apex. During the operation we should loose the main trunk compression of the greater occipital nerve as well as the branches compression on it.