经皮颈前咽后间隙寰枢椎手术入路的解剖学研究

An anatomic study on anterior transarticular atlantoaxial fixation via percutaneous retropharyngeal approach

目的:通过在成人尸体标本上进行有关颈部血管、神经的解剖学测量,探讨最佳、最安全的经皮颈前咽后间隙手术入路治疗上颈椎不稳的形态学相关参数。方法:在10具20侧经10%福尔马林溶液固定的成人尸体标本上,用游标卡尺对颈椎前方重要血管、神经进行解剖观察和测量,比较经甲状腺上动脉上方与经甲状腺上动脉下方两种入路的数据。结果:C4～C5椎体水平与邻近血管神经的最短距离为(4.59±1.32)mm。经甲状腺上动脉下方入路可以明显减少对周围血管神经的副损伤。从C6至C3颈交感干逐渐偏离前正中线。结论:胸锁乳突肌前缘由C4～C5椎体水平于甲状腺上动脉下方经颈动脉鞘和颈内脏鞘之间联合筋膜至咽后间隙,为最佳经皮上颈椎内固定手术入路的途径。对手术入路邻近的血管神经的解剖学测量,为临床应用中预防邻近重要血管神经等组织副损伤提供参考数据。

Objective To explore the optimal and safest percutaneous retropharyngeal approach for upper cervical spine instability by anatomic measurement of cervical blood vessels and nerves on adult cadavers.Methods The important blood vessels and nerves located bilaterally in front of the cervical spine were observed anatomically and measured with a vernier caliper in 10 cadavers preserved by formalin.The data on two procedures via the upper or the lower side of superior thyroid artery were compared.Results The shortest distance between C4-C5 vertebral body and the adjacent vessel and nerve was（4.59 ± 1.32） mm.The approach via the lower side of superior thyroid artery markedly reduced iatrogenic injury to the adjacent vessel and nerve.The cervical sympathetic trunks of C6 to C3 deviated gradually from anterior median line.Conclusions The surgical route via the fascia between carotid sheath and lamina media fasciae colli to retropharyngeal space of anterior sternocleidomastoid of C4-C5 level below superior thyroid artery was the optimal approach for transarticular atlantoaxial fixation.Anatomic measurement of the blood vessel and nerve adjacent to the approach provides reference data for preventing iatrogenic injury to the adjacent blood vessel and nerve during surgery.