经口咽入路行枕骨大孔扩大术的解剖学基础研究

Anatomy of Transoral-transpharyngeal Foramen Magnum Augmentation

目的:对枕骨斜坡骨性结构及周围毗邻关系的解剖学测量,为经口咽入路行枕骨大孔扩大术提供详尽的解剖学数据及理论依据。方法:①选取成人干燥颅骨标本40例,分别测量斜坡颅底内面、颅底外面的长度;斜坡咽结节处宽度、斜坡最小厚度、中部厚度和最大厚度;斜坡与水平面的夹角;颈动脉管外口内缘、颈静脉孔内外口内缘、破裂孔内外口内缘、舌下神经内外口内缘、寰枕关节内缘与斜坡中线的距离。②选取完整头颈部标本20例,观察斜坡与周围血管神经的毗邻关系。结果:①斜坡颅底内面长(40.1±2.5)mm,外面长(28.2±3.1)mm;斜坡中部宽度(18.8±2.5)mm,;最小厚度(6.8±2.3)mm,;中部厚度(9.8±2.2)mm,最大厚度(11.5±1.7)mm;咽结节至枕骨大孔前缘距离(12.8±1.5)mm。②斜坡与水平面的夹角(46.8±4.5)°。③颈动脉管外口内缘距离斜坡中线(26.1±3.1)mm,颈静脉孔内口内缘距离斜坡中线(21.8±2.5)mm,颈静脉孔外口内缘距离斜坡中线(25.1±2.7)mm,破裂孔内口内缘距离斜坡中线(10.5±2.9)mm,破裂孔外口内缘距离斜坡中线(11.8±2.5)mm,舌下神经管内口内缘距离斜坡中线(13.8±2.3)mm,舌下神经管外口内缘距离斜坡中线(21.1±2.3)mm,寰枕关节内缘距离斜坡中线(10.5±2.3)mm。④斜坡上部距离后方基底动脉(7.6±1.0)mm,距离后方脑桥(8.3±1.2)mm,斜坡中部距离后方延髓脑桥沟(13.5±1.7)mm,斜坡下部距离后方延髓(6.5±0.8)mm。⑤斜坡上部与后方硬脑膜之间间隙为(1.8±0.2)mm,斜坡中部与后方硬脑膜之间间隙为(1.3±0.1)mm,斜坡下部与后方硬脑、脊膜之间间隙为(1.3±0.1)mm。⑥在斜坡开骨窗的宽度为20mm,高度为15mm,深度为6mm,可以满足经口咽入路枕骨大孔扩大术的要求,并有可靠的安全性。结论:本研究通过对斜坡骨性结构及周围毗邻关系的测量与观察,为临床斜坡区手术提供解剖学数据。

Objective： To provide detailed anatomical data and theory for Transoral-line of the foramen magnum augmentation through the anatomy measure of the relationship between the bone structures of the occipital slopes and the surrounding adjacent slopes.Methods： ①40 cases were selected and the following were measured： the slope inside base of the skull,the length of the outside base of the skull;Pharyngeal tubercle width of slope,slope minimum thickness,the central thickness and maximum thickness;the angle between the slope and horizontal plane;outer edge of the hole in carotid canal,outer edge of the hole in the jugular foramen,inner and outer edge of the mouth of the rupture hole,inner and outer edge of the hole of the hypoglossal nerve,the distance between the inner margin of Atlanto-occipital joint and central line of slopes.②20 cases were selected and respectively dissected,and the adjacent structures of slopes and the surrounding blood vessels and nerves were observed.Results：① The length of slope inside base of the skull is 40.1 ± 2.5mm.The length of slope outside the base of the skull is 28.2 ± 3.1mm.The width of the central slope is 18.8 ± 2.5mm.The mini-mum thickness of slope is 6.8 ± 2.3mm,and the thickness of the central slope is 9.8 ± 2.2mm,and the maximum slope thickness is 11.5 ± 1.7 mm.The length from the pharyngeal tubercle to the anterior foramen magnum is 12.8 ± 1.5mm.② The angle between slope and the horizontal is 46.8±4.5 °.③ Distance from outer edge of the mouth of carotid artery to the central line of the slope is 26.1 ± 3.1mm,while the distance from inner edge of the mouth of jugular vein to the center line of the slope is 21.8 ± 2.5mm,and that from the outer edge of the mouth of the jugular foramen to the central line of the slope is 25.1 ± 2.7mm,that from the inner edge of mouth of rup-ture hole to the central line of the slope is 10.5 ± 2.9mm,that from the outer edge of the mouth of rupture hole to the central line of the slope is 11.8 ± 2.5mm.The distance from the inner edge of the mouth of hypoglossal canal to the central line of the slope is 13.8 ± 2.3mm,and that from the outer edge of the mouth of hypoglossal canal to the central line of the slope is 21.1 ± 2.3mm,and that from the inner edge of atlanto-occipital joint to the central line of the slope is 10.5 ± 2.3mm.④The distance from the upper part of the slope to the rear of basilar artery is 7.6 ± 1.0mm,that to the rear of the pons is 8.3 ± 1.2mm.The distance from the middle of the slope to the ditch behind the medulla oblongata Pons is 13.5 ± 1.7mm,while that from the lower part of the slope to the rear of the medulla oblonga-ta is 6.5 ± 0.8mm.⑤Space between the upper slope and rear epidural is 1.8 ± 0.2mm,and that between the central slope and posterior epidural is 1.3 ± 0.1mm.Gap from the bottom slope to the rear hard brain and meninges is 1.3 ± 0.1mm.⑥The opening bone window in the slope has the width of 20mm,height of 15mm and depth of 6mm,meet the requirements of Transoral foramen magnum augmenta-tion,and has a reliable security.Conclusions： This study provided anatomical data for the clinical surgeries on the slope area through the measurement and observation of the slope bony structures and the adjacent relationship of neighborhood.