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目的:对枕骨斜坡骨性结构及周围毗邻关系的解剖学测量,为经口咽入路行枕骨大孔扩大术提供详尽的解剖学数据及理论依据。方法:①选取成人干燥颅骨标本40例,分别测量斜坡颅底内面、颅底外面的长度;斜坡咽结节处宽度、斜坡最小厚度、中部厚度和最大厚度;斜坡与水平面的夹角;颈动脉管外口内缘、颈静脉孔内外口内缘、破裂孔内外口内缘、舌下神经内外口内缘、寰枕关节内缘与斜坡中线的距离。②选取完整头颈部标本20例,观察斜坡与周围血管神经的毗邻关系。结果:①斜坡颅底内面长(40.1±2.5)mm,外面长(28.2±3.1)mm;斜坡中部宽度(18.8±2.5)mm,;最小厚度(6.8±2.3)mm,;中部厚度(9.8±2.2)mm,最大厚度(11.5±1.7)mm;咽结节至枕骨大孔前缘距离(12.8±1.5)mm。②斜坡与水平面的夹角(46.8±4.5)°。③颈动脉管外口内缘距离斜坡中线(26.1±3.1)mm,颈静脉孔内口内缘距离斜坡中线(21.8±2.5)mm,颈静脉孔外口内缘距离斜坡中线(25.1±2.7)mm,破裂孔内口内缘距离斜坡中线(10.5±2.9)mm,破裂孔外口内缘距离斜坡中线(11.8±2.5)mm,舌下神经管内口内缘距离斜坡中线(13.8±2.3)mm,舌下神经管外口内缘距离斜坡中线(21.1±2.3)mm,寰枕关节内缘距离斜坡中线(10.5±2.3)mm。④斜坡上部距离后方基底动脉(7.6±1.0)mm,距离后方脑桥(8.3±1.2)mm,斜坡中部距离后方延髓脑桥沟(13.5±1.7)mm,斜坡下部距离后方延髓(6.5±0.8)mm。⑤斜坡上部与后方硬脑膜之间间隙为(1.8±0.2)mm,斜坡中部与后方硬脑膜之间间隙为(1.3±0.1)mm,斜坡下部与后方硬脑、脊膜之间间隙为(1.3±0.1)mm。⑥在斜坡开骨窗的宽度为20mm,高度为15mm,深度为6mm,可以满足经口咽入路枕骨大孔扩大术的要求,并有可靠的安全性。结论:本研究通过对斜坡骨性结构及周围毗邻关系的测量与观察,为临床斜坡区手术提供解剖学数据。
OBJECTIVE: To provide anatomical data and theoretical basis for the anatomic measurement of the bony structure and the adjacent adjacency of the occipital slope, and to provide detailed anatomical data and theoretical basis for the enlargement of the occipital foramen through the oropharyngeal approach. Methods: (1) 40 adult skull specimens were selected to measure the length of the inner skull base and the outer skull base respectively. The width, the minimum thickness, the middle thickness and the maximum thickness of the slopes, the angle between the slope and the horizontal plane, the carotid artery The inner edge of the outer mouth of the tube, the inner edge of the inner and outer mouth of the jugular vein, the inner edge of the inner and outer mouth of the ruptured hole, the inner edge of the inner and outer hypoglossal nerves, the inner edge of the atlanto-occipital joint and the midline of the slope. ② Select 20 cases of complete head and neck specimens, observe the adjacent relationship between the slope and the surrounding vascular nerves. Results: ① The internal length of the skull base was (40.1 ± 2.5) mm in length and 28.2 ± 3.1 mm in length (18.8 ± 2.5) mm in the middle of the slope. The minimum thickness was 6.8 ± 2.3 mm and the thickness in the middle was 9.8 ± 2.2) mm, the maximum thickness (11.5 ± 1.7) mm; the distance from the pharyngeal tubercle to the front of the foramen magnum (12.8 ± 1.5) mm. The angle between the slope and the horizontal plane (46.8 ± 4.5) °. ③ The distance between the inner edge of the carotid artery and the slope was 26.1 ± 3.1 mm, the inner edge of the mouth of the jugular vein was (21.8 ± 2.5) mm from the midline of the slope, the inner edge of the mouth of the jugular vein was 25.1 ± 2.7 mm from the midline of the slope, The inner edge of the inner mouth of the hole is 10.5 ± 2.9 mm from the midline of the slope, while the inner edge of the outer mouth of the hole is 11.8 ± 2.5 mm. The inner edge of the inner mouth of the sublingual tube is 13.8 ± 2.3 mm from the midline of the hypothalamus. The internal margin of the mouth was from the midline of the slope (21.1 ± 2.3) mm and the inner edge of the atlanto-occipital joint was 10.5 ± 2.3 mm from the midline of the slope. ④ The upper part of the slope was (7.6 ± 1.0) mm from the posterior basilar artery (8.3 ± 1.2) mm, the middle part of the slope was 13.5 ± 1.7 mm from the posterior medullary pontine groove, and the lower part of the slope was 6.5 ± 0.8 mm from the posterior medulla oblongata. ⑤ The gap between the upper part of the slope and the rear dura was (1.8 ± 0.2) mm, the gap between the middle part of the slope and the rear dura was (1.3 ± 0.1) mm, and the gap between the lower part of the slope and the dural part of the rear was ± 0.1) mm. ⑥ In the slope of the open-bone window width of 20mm, height 15mm, depth 6mm, to meet the requirements for transoral pharyngeal foramen magnification, and reliable security. Conclusion: This study provides anatomical data for the operation of clinical slope area through the measurement and observation of the slope bony structure and the adjacent adjacency relationship.