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1、河南科技大学 硕士学位论文 枕下远外侧经髁入路的显微解剖学定量研究 姓名：吴进松 申请学位级别：硕士 专业：肿瘤学 指导教师：赵勇刚 20080501 摘 要 I 论文题目枕下远外侧经髁入路的显微解剖学定量研究 专 业肿瘤学 研 究 生吴进松 指导教师赵勇刚 教授 摘要 目的 探讨远外侧经髁入路手术区域主要结构的特点和毗邻关系探索获得 枕骨大孔区腹侧良好显露时枕髁磨除的最适范围 方法 对 36 具成人干颅底骨标本的乳突尖枕骨大孔枕髁舌下神经管 颈静脉结节等骨性标志进行观察和测量在 10 例(20 侧)正常成人带颈尸头湿标 本上模拟远外侧经髁手术入路按肌肉层硬膜外硬膜内进行解剖测量磨除 枕髁前磨
2、除枕髁至枕髁后缘与舌下神经管内口后缘长度 1/2 时至舌下神经管 内口后缘时至相当于舌下神经管外口后缘时的手术暴露野最远点至中线的距 离 结果 1.枕髁位于枕骨大孔两侧枕髁后缘至舌下神经管内口后缘的距离左 侧为(9.641.44)mm右侧为(9.141.55)mm 2.舌下神经管位于枕髁的上半部由一薄层骨皮质围成后壁与矢状面的夹 角左侧为(31.36.0)右侧为(31.85.8) 3. 磨 除 枕 髁 前 手 术 暴 露 野 均 未 至 中 线至 中 线 的 距 离 左 侧 为 (2.350.40)mm右侧为(2.260.33)mm磨除枕髁至枕髁后缘与舌下神经管内口 后缘长度 1/2 时手术野
3、最远点即能达到或越过中线至中线的距离左侧为 (0.370.37)mm右侧为(0.420.51)mm磨除枕髁至舌下神经管内口后缘时手 术 野 最 远 点 越 过 中 线至 中 线 的 距 离 为 左 侧 为 (3.990.27)mm右 侧 为 (4.190.27)mm磨除枕髁至相当于舌下神经管外口后缘时手术野又有所增加 至中线距离左侧为(5.290.54)mm右侧为(5.610.40)mm任意两者之间有统计 学差异 结论 1.舌下神经管周围的皮质骨可作为抵达舌下神经管的标志并可估计 枕髁切除的范围 2.寰椎横突是辨认椎动脉的重要标志 3.远外侧经髁入路手术中随着枕髁磨除的增多手术暴露野逐渐增大磨
4、 除枕髁至舌下神经管内口后缘时手术暴露野最远点已能达到中线对侧可获得枕 骨大孔腹侧区的良好显露 河南科技大学硕士学位论文 II 4.研究枕下远外侧经髁入路的显微解剖对提高远外侧经髁入路手术的安全 性和治疗效果有重要实用价值 关 键 词枕下远外侧经髁入路枕髁椎动脉保护显微解剖定量研究 论文类型应用基础研究 摘要 III Subject: Microscopic anatomic quantitative study of far lateral suboccipital transcondylar approach Specialty: Oncology Name: WU Jinsong Sup
5、ervisor: Professor ZHAO Yonggang ABSTRACT Objective To explore the morphological characteristics and relationship of structures in the suboccipital related to the far lateral approach, and to investigate the best amount of occipital condyle removal to expose ventral foramen magnum satisfactorily. Me
6、thods The relationship among the mastoidale, the foramen magnum, the occipital condyle, the hypoglossal canal and the jugular tubercle and so on was observed and measured on 36 dried skulls in the study. The far lateral suboccipital transcondylar approach was simulated on 10 adult cadaveric heads. T
7、hese cadaveric heads were dissected according to muscle layerepidural layer and intradural layer. The distance from the farthest point of the visual field to the midline of the clivus was measured before the occipital condyle was drilled, the occipital condyle was drilled to the half length between
8、the posterior margin of the occipital condyle and the posterior margin of the hypoglossal canal inner foramen, the occipital condyle was drilled to the posterior margin of the hypoglossal canal inner foramen and the occipital condyle was drilled to the posterior margin of the hypoglossal canal outer
9、 foramen, respectively. Results 1. The occipital condyle was located at lateral side of the foramen magnum. The distance from the posterior margin of the occipital condyle to the posterior margin of hypoglossal canal inner foramen was 9.641.44mm(left) and 9.141.55mm(right). 2. The hypoglossal canal
10、located above the occipital condyle, was surround by a lamellate cortical bone. The angle of the hypoglossal canal and the vertical plane was 31.36.0 degree(left) and 31.85.8 degree(right). 3. The visual field did not reach the midline at all before the occipital condyle was drilled, the distance fr
11、om the farthest point of the visual field to the midline of the clivus was 0.850.99mm(left) and 0.900.67mm(right). The distance was 0.370.37mm(left) and 0.420.51mm(right) when occipital condyle was drilled to the 河南科技大学硕士学位论文 IV half-length between the posterior margin of the occipital condyle and t
12、he posterior margin of the hypoglossal canal inner foramen. The visual field exceeded the midline when occipital condyle was drilled to the posterior margin of hypoglossal canal inner foramen, and the distance was 3.990.27mm(left) and 4.190.27mm(right). The visual field increased when the occipital
13、condyle was drilled to the posterior margin of the hypoglossal canal outer foramen, then the distance was 5.290.54mm(left) and 5.610.40mm(right). There was significant difference among them. Conclutions 1.The cortical bone around hypoglossal canal can be seen as the landmark for arrival of the hypog
14、lossal canal and for estimating the extension of the removed occipital condyle. 2.The transverse processes of the atlas were the important landmark for identifying the vertebral artery. 3.The more occipital drilled, the larger the visual field when performing operation via far lateral suboccipital t
15、ranscondylar approach. When the occipital condyle was drilled to the posterior margin of the hypoglossal canal inner foramen, the visual field exceeded the midline, thus, exposing the ventral foramen magnum satisfactorily. KEY WORDS: far lateral suboccipital transcondylar approach; occipital condyle
16、; the protection of the vertebral artery; Microscopic anatomy; quantitative study Dissertation Type: Basic research for application 缩略语词汇表 28 缩略语词汇表 FMforamen magnum枕骨大孔 CCJRcraniocervical juncture region颅颈结合区 VAvertebral artery椎动脉 SCMMsternocleidomastoid muscle胸锁乳突肌 IJVinternal jugular vein颈内静脉 JFjugular foramen颈静脉孔 LMlateral mass of atlas寰椎侧块 AOJatlantooccipital joint寰枕关节 HChypoglossal canal舌下神经管 JTjugular tubercle颈静脉结节 BAbasilar artery基底动脉 第 1 章
