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目的通过内镜经口入路研究寰枢椎解剖,探索寰枢椎腹侧病灶清除、减压及临床内固定应用可行性。方法在5具完整灌注尸头标本上行内镜模拟手术,并行寰枢椎CT测量。结果 1内镜经口可显露寰枢椎腹侧,包括:寰椎、枢椎椎体,寰椎前弓、侧块,齿突及两侧椎动脉;2上方常规可显露至寰椎前弓上缘或斜坡下部,下方可显露至C2/3椎间盘或C3椎体上部,两侧安全边界可界定:上方为寰枢侧块关节外缘,下方为枢椎体外缘。3 CT数据测量结果示:寰椎前弓长度(19.5±2.8)mm、寰椎前结节厚度(8.0±0.4)mm、寰椎侧块横径(左)(12.7±2.3)mm、寰椎侧块横径(右)(12.7±1.6)mm、寰椎侧块矢状径(左)(15.0±2.5)mm、寰椎侧块矢状径(右)(15.3±1.4)mm、寰椎横突孔内侧间距(47.2±1.6)mm、寰椎横突孔外侧间距(60.4±1.4)mm、齿突后倾角(10.2±1.3)°、枢椎横突孔内侧间距(29.2±1.7)mm、枢椎横突孔外侧间距(44.3±1.6)mm。结论内镜经口寰枢椎手术入路简单、视野清晰、操作方便、创伤小、术后恢复快,符合当前临床发展趋势。
Objective To study the anatomy of atlantoaxial axis by endoscopic transoral approach and explore the feasibility of application of removal, decompression and clinical internal fixation of atlantoaxial ventral lesions. Methods 5 intact cadaveric cadaver specimens were performed endoscopic virtual surgeries and atlantoaxial computed tomography. Results 1 endoscopy can be revealed ventral atlantoaxial ventral, including: atlas, axial vertebral body, anterior arch arch, lateral mass, both sides of the odontoid and vertebral artery; 2 can be revealed to the top of atlantoically arch The upper edge or the lower part of the slope can be exposed below the C2 / 3 intervertebral disc or the upper part of the C3 vertebral body. The safety margin on both sides can be defined as follows: the upper part is the outer edge of the joint of the atlantoaxial lateral mass, and the lower part is the outer edge of the vertebral body. The results of CT data measurement showed that the length of anterior arch of atlas was (19.5 ± 2.8) mm, the thickness of atlantoaxial anterior tubercle (8.0 ± 0.4) mm, the diameter of lateral mass of atlas (left) (12.7 ± 2.3) mm, The sagittal diameter of lateral mass (left) (15.0 ± 2.5) mm, sagittal diameter of lateral mass (right) (15.3 ± 1.4) mm, (47.2 ± 1.6) mm in lateral transverse foramen, 60.4 ± 1.4 mm in lateral transverse foramen of atlas, 10.2 ± 1.3 ° in pedicle protrusion, and 29.2 ± 1.7 mm in medial transverse plane of transverse axis , Lateral femoral transverse hole spacing (44.3 ± 1.6) mm. Conclusion Endoscopic transoral atlantoaxial surgery is simple, clear vision, easy to operate, less trauma and rapid recovery after surgery, in line with the current clinical trends.