远外侧经枕髁手术入路防止椎动脉损伤的应用解剖

Applied anatomy for the prevention of the vertebral artery injury during the procedure of far-lateral trans-condylar approach

目的:为远外侧经枕髁入路手术保护椎动提供较详细的解剖资料。方法:应用20具(40侧)成人尸头湿标本进行显微解剖研究。结果:寰椎横突、第2颈神经前支、肩胛提肌、椎动脉周围静脉丛、头外侧直肌为确认第2、3段椎动脉的重要标志。寰、枢椎横突孔间距左侧为(15.3±1.6)mm,右侧(15.8±2.2)mm;枕骨大孔后缘中点距椎动脉入硬脑膜口处左侧(21.6±2.0)mm,右侧(21.5±2.0)mm;椎动脉于寰椎后弓上方向后呈弓形弯曲,其外侧跨度左侧(17.9±3.2)mm,右侧(17.7±3.2)mm;内侧跨度左侧(9.8±2.5)mm,右侧(9.8±2.2)mm;向后距椎板高左侧(7.4±2.3)mm,右侧(6.3±3.3)mm。结论:熟悉椎动脉第2、3、4段的毗邻关系及解剖标志,对保护椎动脉、安全地施行远外侧经枕髁入路手术至关重要。

Objective: To supply microsurgical anatomic materials for protecting vertebral artery during the procedure of the far-lateral trans-condylar approach. Method: Twenty adult cadaveric head specimens fixed with 10% formalin were studied. Results: Transverse process of atlas, ventral ramus of C2, levator scapulae muscle, vertebral venous plexus which surrounding vertebral artery, rectus capitis lateralis were important signs for identifying the second and third segments of vertebral artery. The distances between the transverse foramina of the atlas and axis were 15. 3±1. 6 mm(left) and 15. 8±2. 2 mm (right). The distances from the middle point of the posterior margin of the foramen magnum to the site of the vertebral artery penetrating the dura were 21. 6± 2. 0 (left) and 21. 5±2. 0 (right). Above the posterior arch of the atlas, the vertebral artery looped posteriorly and the outer width of the loop were 17. 9± 3. 2 mm (left) and 17. 6±3. 2 mm (right); its inside width were 9. 8± 2. 5 mm (left); 9. 8± 2. 2 mm (right); its height to the posterior arch of the atlas were 7. 4± 2. 3 mm (left) and 6. 3±3. 3 mm (right). Conclusions: The anatomic materials of the second, third and fourth segments of vertebral artery are very important for protecting the artery and helpful for the far-lateral trans-condylar surgical approach.