枕下极外侧入路的解剖学量化研究

The quantitative anatomical study of the suboccipital extreme lateral approach

目的从临床术者视角出发,定量测量枕下极外侧入路中颈静脉结节、枕髁、寰椎侧块三个骨性障碍部分磨除对颅颈交界腹侧区暴露的影响,为临床切除颅颈交界腹侧区病变提供解剖学依据。方法成年国人头颅干颅骨标本及颅颈交界区CT骨窗片上测量枕髁、寰椎侧块模拟磨除1/3,颈静脉结节全部磨除后颅颈交界腹侧区暴露的改变。应用所测得数据在成人尸头上模拟枕下极外侧入路。术前术后CT薄扫对比。结果骨性标本及寰枕交界CT测量显示枕髁、寰椎侧块、颈静脉结节磨除后颅颈交界腹侧区手术视角及术野宽度明显增加。模拟手术证实枕髁、寰椎侧块及颈静脉结节部分磨除后使颅颈交界腹侧区暴露致水平视角。结论极外侧入路中枕髁、寰椎侧块及颈静脉结节的部分磨除对颅颈交界腹侧区暴露及病变的切除有显著的作用。术前颅颈交界区三维CT检查对极外侧入路有重要的指导意义。

Objective To quantitative analysis of important bone structure in the extreme lateral approach from clinical need and provide guide of data for surgeon. Method Data was obtained from cranial bones and CT of craniovertebral junction. The change of exposure obtained by stripping part of the bone structure was showed. The data was utilized in surgery by extreme lateral transcondylar approach on two skull specimens. Results The operative angel and operative distance were added greatly after stripping part of occipital condyle and massa lateralis atlantis and jugular tubercle in the extreme lateral approach. The process of surgery by extreme lateral transcondylar approach on two skull specimens verificated the influence of stripping bone structure to operation. Conclusion The stripping of occipital condyle and massa lateralis atlantis and jugular tubercle have a great effect on surgical managing lesion situated in the anterior aspect of the craniovertebral junction by the extreme lateral approach . CT examination of craniovertebral junction can provide reliable guidance of data for surgeon.