成人椎-基底动脉应用解剖及临床意义

On applied anatomy of vertebral basilar artery in adults and its clinical significance

目的对成人椎-基底动脉行应用性解剖、测量和分析,为头颈椎部外科手术及血管介入提供依据。方法选取16具成人完整头颈部尸体标本,锁骨下动脉灌注,逐层解剖,暴露椎-基底动脉和邻近组织,观测两侧椎动脉起始处及其穿第6颈椎横突孔下缘的外径,两侧小脑下前动脉、小脑下后动脉、大脑后动脉和小脑上动脉的起始处外径;观测并比较两侧小脑下后动脉、锁骨下动脉与椎动脉的夹角,及小脑下前动脉、小脑上动脉、大脑后动脉与基底动脉的夹角。结果 16具标本两侧:左侧椎动脉起始处外径及其穿第6颈椎横突孔下缘外径较右侧的均大(P<0.05);左侧小脑下前动脉起始处外径较右侧的小(P<0.05);左侧锁骨下动脉与椎动脉的夹角及大脑后动脉、小脑上动脉与基底动脉的夹角较右侧均小,而左侧小脑下后动脉与椎动脉夹角、小脑下前动脉与基底动脉夹角均大于右侧(P<0.05)。结论正常成人两侧的椎动脉起始处及其穿第6颈椎横突孔下缘的外径、小脑下前动脉起始处外径和椎-基底动脉主要分支与椎动脉、基底动脉夹角存在差异,左右不对称,提示血管介入等治疗时要左右对比,个体化治疗,选择适合的导管导丝,减少损伤,提高效率。

Objective The vertebral basilar artery in adult was applied dissected,measured and analyzed,which provides the basis for the surgical operation and vascular intervention of the head and neck.Methods 16 completed adult head and neck specimens were selected,and they were perfused in subclavian artery. After layer-by-layer dissection,the vertebral basilar artery and adjacent tissue were exposed. The external diameters of starting point and the lower edge of the sixth cervical transverse foramen of vertebral artery on both sides,and external diameters of starting point of anterior inferior cerebellar artery,posterior inferior cerebellar artery,posterior cerebral artery and superior cerebellar artery were observed; and the intersection angle of posterior inferior cerebellar artery,subclavian artery and vertebral artery and that of anterior inferior cerebellar artery,superior cerebellar artery,posterior cerebral artery and basilar artery on both sides were observed and compared. Results On the two sides of the 16 specimen： The external diameters of starting point and the lower edge of the sixth cervical transverse foramen of vertebral artery on the left side are larger than those on the right side（ P〈0.05）; the external diameter of the starting point of the anterior inferior cerebellar artery on the left side was smaller than that on the right（ P〈0.05）; the intersection angle between subclavian artery and vertebral artery and the angle of posterior inferior cerebellar artery,the superior cerebellar artery and basilar artery on the left side were smaller than those on the right,the angle between the posterior inferior cerebellar artery and vertebral artery and the one between anterior inferior cerebellar artery and basilar artery on the left side were larger than those on the right（ P〈0.05）. Conclusion There are difference in the external diameters of starting point and the lower edge of the sixth cervical transverse foramen of vertebral artery on both sides,the external diameter of the starting point of the anterior inferior cerebellar artery,and the intersection angle of vertebral basilar artery＇s main branches and vertebral artery,basilar artery. The left-right asymmetry indicates that the two sides should be compared during the treatments like vascular intervention therapy and individual treatment should be taken. The appropriate catheter guide wire should be used to reduce damage and raise efficiency.