寰枢椎病变植入物内固定:口咽入路的优势

Atlantoaxial lesions treated with internal fixation: Advantages of transoral approach

背景:经口咽入路是治疗寰枢椎病变的传统方法,一直以来都是脊柱外科研究的热点和难点。目的:为经口咽入路到达颅颈交界区提供直观操作路径,并提供安全操作的解剖学数据。方法:对尸体标本进行经口咽入路逐层外科解剖,观察解剖层次、组织结构以及相互之间的毗邻关系,以门齿为标志点测量各主要解剖结构与其之间的距离,并测量椎动脉与中线之间的距离以及寰枢椎的形态学结构。结果与结论:经口咽前入路能直接显露从斜坡中下段至C3椎体上缘的范围,双侧椎动脉到中线的距离C1水平左侧为20.72-29.70mm、右侧为20.36-28.98mm,C2水平左侧为13.10-23.00mm、右侧为13.85-24.02mm。前结节、齿突前面、齿突后面、硬脊膜、脊髓以及C2椎体前缘和C3椎体前缘与门齿之间的距离分别为69.24-88.16mm、74.95-96.27mm、84.77-107.39mm、87.65-111.45mm、91.38-116.11mm、76.21-92.77mm和78.53-105.13mm。寰椎长度为(19.8±2.3)mm,齿突高度为(15.9±1.9)mm,最大横径为(10.5±0.6)mm,最大矢状径为(11.5±1.9)mm;枢椎最大横径为(15.1±1.6)mm,最大矢状径为(17.7±1.3)mm,上关节面外缘到中线的距离为(26.1±1.7)mm,横突孔入口与上关节面之间的距离为(8.1±1.3)mm。颅颈交界区的解剖结构复杂,经口咽入路在解剖安全范围内处理颅颈交界区病变存在优势。

BACKGROUND： Transoral approach is the traditional method for the treatment of atiantoaxial lesions, and is the hotspot and difficulty of the researches on spine surgery.OBJECTIVE： To provide intuitive operation path for transoral approach reach to the craniocervical junction area, and to provide anatomical data for safe operation. METHODS： Cadaver specimen received layer by layer surgical anatomy through transoral approach, and then the anatomical level, organization structure, and the relationship with the adjacent were observed. The main anatomical structures and the distances between structures were measured with the maker point of incisor; the distance between vertebral artery and center line and the atlantoaxial morphological structure were measured. RESULTS AND CONCLUSION： Transoral anterior approach could directly expose the range from the middle±lower segment of the slope to the upper edge of C3 vertebral body, showed that the distance between bilateral vertebral arteries and center line was as follows： distance between left C1 vertebral artery and the center line was （20.72±29.70） mm, distance between right C1 vertebral artery and the center line was （20.36±28.98） mm, distance between left C2 vertebral artery and the center line was （13.10±23.00） ram, distance between right C2 vertebral artery and the center line was （13.85±24.02） mm. The distances from anterior tubercle, anterior odontoid process, posterior odontoid process, spinal dural, spinal cord, anterior C2 vertebral body and anterior C3 vertebral body to the incisor were （69.24±88.16） mm, （74.95±96.27） mm, （84.77±107.39） mm, （87.65±111.45） mm, （91.38±116.11 ） mm, （76.21 ± 92.77） mm and （78.53±105.13） respectively. The length of atlas was （19.8±2.3） mm, the height of odontoid process was （15.9±1.9） mm, the maximum transverse diameter was （10.5±0.6） mm, and the maximum sagittal diameter was （11.5±1.9） mm; the atlantoaxial maximum transverse diameter was （15.1±1.6） mm, the atlantoaxial maximum sagittal diameter was （17.7±1.3） mm, the distance from the outer edge of upper articular surface to the center line was （26.1±1.7） mm, and the distance between transverse foramen entrance and the upper articular surface was （8.1±1.3） mm. The anatomical structures of craniocervical junction are complex, and transoral approach has advantages in the treatment of craniocervical junction lesions within anatomical security range.