颅颈交界区的显微外科解剖研究

Microsurgical Anatomy of the craniovertibral junction area

目的 研究颅颈交界区的显微外科解剖 ,评价寰椎横突 (TPA)在颅颈交界区病变手术中的定位意义。方法 成人头颈标本 10例 ,男 8例 ,女 2例 ,红色乳胶灌注颈总动脉和椎动脉。手术显微镜下 (× 3～× 2 0 )逐层显露颅颈交界区结构 ,明确不同解剖结构与TPA的位置关系。结果 颅颈交界区所有重要的解剖结构均可以TPA为参照标志予以明确。二腹肌后腹位于其浅层。TPA的后方为枕下三角 ,枕下三角内有椎动脉、椎静脉丛和C1神经通过。头侧直肌起始于TPA的上表面 ,止于枕骨颈静脉突的下表面 ,可作为确定颅外颈静脉孔、茎乳孔的解剖标志。茎突位于TPA的前方 ,颈内静脉、迷走神经、副神经、舌下神经穿行于茎突与TPA之间 ,颈内动脉位于颈内静脉的前内侧。结论 TPA是颅颈交界区病变手术的重要外科解剖标志 ,利用这一标志有助于明确此区域重要的解剖结构 。

ObjectiveTo study microsurgical anatomy of the craniovertibral junction area, assess the usefulness of the TPA (transverse process of atlas) as a reference guide in the dissection of the craniovertibral junction area. MethodsWith the aid of surgical microscope, the microsurgical anatomy of the craniovertibral junction and the relation to the C1 transeverse process were investigated in ten cadaveric head-neck specimens of adults. ResultsAll the important structures in this region can be identified systematically. Lateral to the TPA sits the posterior belly of the digastric muscle and the occipital aretery. Posterior to the TPA, the suboccipital triangle can be recognized. Within the triangle, the vertebral artery and its accompanying venous complex can be identified. The rectus capitis lateralis muscle extends vertically behind the internal jugular vein from the TPA to the jugular process of the occipital bone. Anterior to the TPA, the styloid process can be exposed. The internal jugular vein and cranial nerve X, XI, and XII sit between the styloid process and the TPA. ConclusionsTPA as a very useful landmark, can be used in the craniovertibral junction area to help identify the important stuctures and to prevent unnecessary morbidity.