下颈椎血供的解剖研究及其临床意义

Anatomy and clinical significance on blood supply of the subaxial cervical vertebrae

目的为颈椎前路减压手术中减少出血量,改善显露和减少手术并发症的发生提供解剖学基础。方法在15具成人尸体标本上,解剖观测C3～7椎体前后部血供的起源、走行、分支及吻合。结果椎体前部血供来自颈升动脉脊支、甲状腺下动脉和颈深动脉脊支,C4～7椎前动脉在椎体上的分支相互吻合,在颈长肌的内侧缘处常吻合成一纵行动脉链;椎体后部血供来自椎间动脉发出的椎后动脉,其分支在颈椎体后部吻合形成节段性弧形动脉吻合链。结论阻断术椎的椎前动脉及其与相邻椎前动脉的纵行动脉吻合,并在颈椎后部减压时注意对硬膜囊外侧缘及椎体中部处的椎后动脉及其分支的处理,可减少颈椎前路减压手术的术野出血,改善手术显露。

Objectivo To provide anatomic basis for reducing hemorrhage within operating field, improving operation exposure and reducing complication in cervical anterior decompression procedure through illuminating the feature of blood supply in subaxial cervical vertebrae. Methods The origin, course, distribution and anastomosis of anteroposterior blood supply were observed at C3-7 of 15 adult cadaveric specimens perfused with red latex, Results Anterior cervical vertebral artery originated from spinal branches of ascending cervical artery, inferior thyroid artery and pinal branches of deep cervical artery. Its branches distributed at anterior cervical vertebrae, among which the branches at superior 1/3 segment of vertebrae were grossusest, and anastomosed with the branches in opposite side. The branches of anterior vertebral artery in C,7 anastomosed with each other, and formed a longitudinal arterial chain at the medial margin of longus colli muscle. Posterior cervical vertebral artery originated from vertebral artery or ascending cervical and deep cervical arteries, and its branches sent out ascending and descending branches fairly at lateral border of dura mater, which formed a segmented vaulted arterial chain at posterior cervical vertebrae, which sent out 1-2 relatively grossus branches at central region of vertebrae, and anastomosed with the branches in opposite side. Conclusions Interrupting anterior vertebral arteries of underwent vertebrae and anastomosis of longitudinal arteries with adjoining anterior vertebral arteries, and paying attention to deal with posterior vertebral arteries and its branches at central region of vertebrae and lateral border of dura mater when decompressing at posterior part of cervical vertebrae could reduce hemorrhage within operating field and improve operation exposure in cervical anterior decompression procedure.