寰枢椎穿刺入路的应用解剖

Applied anatomy study on the needle approach to atlas and axis

目的 :为临床寰枢椎穿刺入路提供解剖学依据。方法 :对 2 0例上颈段脊柱标本进行了徒手解剖和横切面解剖观察。结果 :①经咽入路至寰椎前弓和枢椎齿突的穿刺点为与腭垂相对的咽后壁正中线上 ,定为A点 ,向后水平进针 ,深度分别为 ( 0 .95± 0 .0 4)cm和 ( 1.5 2± 0 .0 8)cm。经咽后壁至寰椎侧块的穿刺点为A点旁开 1.5cm处 ,深度为 ( 1.2 3± 0 .0 5 )cm。至枢椎体的穿刺点为A点下移 2 .0cm处 ,即B点 ,深度为 ( 1.13± 0 .0 6)cm。至枢椎侧块的穿刺点为B点旁开 1.8cm ,深度为 ( 1.3 6± 0 .0 6)cm。②经颈后外侧入路至寰椎前弓、寰椎侧块和枢椎齿突的穿刺点为枕外隆突至乳突尖连线的中外 1/ 3交界处 ,为C点 ,深度和角度分别为 ( 6.3 2± 0 .97)cm和 66.0 0°± 1.62°、( 4 .2 3± 0 .3 0 )cm和 63 .0 0°± 1.77°、( 5 .85±0 .5 1)cm和 71.0 0°± 1.83°。至枢椎体及侧块的穿刺点为C点向下 2 .0cm处 ,称为D点 ,深度和角度分别为 ( 4 .41± 0 .2 9)cm和 65 .0 0°± 1.68°、( 5 .46± 0 .48)cm和 70 .0 0°± 1.78°。③对穿刺入路的层次结构做了详尽的描述。结论 :上述两种穿刺入路有关测量结果可为术中准确定位有关结构提供参考依据 ,并有效避免损伤颈部大血管和神经。

Objective: To provide morphological basis for the needle approach to atlas and axis. Methods: The upper cervical vertebrae of 20 cadavers were dissected and sectioned in transverse plane for observation. Results: ① The puncture point of transoral pharyngeal approach to anterior arch of atlas and dense of axis was at median line of posterior pharyngeal wall opposite to the basis of uvula, defined as point A. The needle was punctured straightly through backward, and the depths were 0.95±0.04 cm and 1.52± 0.08 cm respectively. To lateral mass of atlas it was 1.5 cm from the point A laterally, the depth was 1.23±0.05 cm. The point to body of axis,termed point B,was 2.0 cm below the point A, whose depth was 1.13±0.06 cm,while the point to lateral mass of axis was 1.8cm from the point B laterally, depth was 1.36±0.06 cm. ② The puncture point of posterolateral cervical approach to anterior arch and lateral mass of atlas and dens of axis was the junction of the lateral and middle one third of a line drawn from the tip of mastoid process to the external occipital protuberance, as point C, the depth and angle were 6.32±0.97 cm and 66°±1.62°,4.23±0.30cm and 63°±1.77°, 5.85±0.51 cm and 71°±1.83°. The point to the body and lateral mass of axis was 2.0 cm below the point C, termed point D, the depth and angle were 4.41± 0.29 cm and 65°±1.68°, 5.46±0.48 cm and 70°±1.78°. ③ The arranged structures go through the approach were also described in detail. Conclusion: These results will provide useful guide for locating some important structures accurately during operation and it will be of great value to avoid injuring the major vessels in occipito-cervical region.