枕颈后外侧入路显露枢椎齿突的应用解剖

The clinical anatomy of the postero l ateral approach to dens axis

目的 研究显露枢椎齿突的枕颈后外侧入路的应用解剖学并图示。方法 解剖并观察了 12具尸体的枕颈区 ;对 9具尸体的头颈部进行了冠状、矢状或水平断面的断层解剖学研究。结果 (1)皮肤、浅筋膜、封套筋膜 (或斜方肌 )、头夹肌和头半棘肌可被认为该入路的浅结构。 (2 )头下斜肌和第二颈神经节为该入路的标志性结构。 (3)经寰枢椎侧关节和第二颈神经节及其相连的硬膜囊间显露枢椎齿突 ,必要时可切除部分寰枕关节 ;寰椎后弓下缘或枢椎椎板上缘至齿突的水平距离约 2cm ;(4)术中易于辨认和保护椎动脉。结论 枕颈后外侧入路容易显露枢椎齿突 ,能在直视下保护脊髓 ,并可同时做枕颈融合或 /和寰枢侧关节融合术以稳定脊柱。

Objective Toinvestigateandfiguretheclinicalanatomyforthepostero lateralapproachto thedensaxis.Methods Thesub occipitalregionof 12cadaverwasdissected ,andtheheadandneckof9ca daverswassectionedinthecoronal,sagittalortransverseplanesandobserved.Results 1)Theskin ,super ficialfascia,investingfascia (ortrapezius) ,spleniusandsemispinaliscapitiscouldbeencounteredassuperficial structureinthisapproach .2 )Theinferiorobliguemuscleandganglionofthe 2ndcervicalnerveweretheland markstructureinthisapproach .3)Densaxiscouldbeexposedeasilybydissectingordividingbetweenthecap suleofatlantoaxialjointandtheganglionofthe 2ndcervicalnerveanditsconnectingstructurenamelythebag ofduramaterspinalis,ifnecessary,partofatlanto occipitaljointcouldalsoberemoved .Thedistancebetween densaxisandtheinferiorbrimofposteriorarchofatlasorthesuperiorbrimoflaminaaxisisabout 2cms.4) Thevertebralarterycanbefoundeasilyandprotected .Conclusion Thepostero lateralapproachtodensaxis canmaketheremovaloperationofthedenssimpleandsafe.Thespinalcordcanbeprotectedundervisionand theinstabilitybetweentheatlasandaxiscanbetreatedatthesamesetting .