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目的为了充分了解中下斜坡和颅颈交界区解剖结构,探明颅骨表面标志与其周围重要结构的对应关系,为安全、合理地运用远外侧入路提供显微外科解剖学依据。方法通过对10例(20侧)经甲醛固定的国人成人带颈尸体头颅(不分性别)和干性颅骨10例(20侧)(不分性别)进行解剖、测量拍摄获取相关资料。结果①枕髁、颈静脉孔、舌下神经管、环椎、枕骨大孔、乳突是枕下远外侧入路的重要骨性标志;②枕下三角和头外侧直肌、二腹肌是保护深部重要血管、神经的重要肌学标志;③舌下神经管后缘至枕髁后极距离(9.91±0.93)mm(左),(9.99±0.85)mm(右);舌下神经管下缘至枕裸下极距离(8.77±1.07)mm(左),(8.80±1.l l)mm(右);舌下神经管上缘至颈静脉孔下缘距离(9.48±0.87)mm(左),(9.28±1.04)mm(右);舌下神经管长度(10.68±1.07)mm(左),(10.40±1.03)mm(右);舌下神经管与正中矢状面角度(48.3±4.7°)(左),(47.9±4.5°)(右)。结论远外侧入路可以以最短的距离到达脑干和颈延髓的腹侧和外侧,直接的显露下斜坡和颈延髓的腹侧和外侧,为颅神经和椎动脉提供了良好的显露,易于利用颅神经的自然间隙;避免对脑干和颅神经的牵拉,提高手术切除率,降低手术损伤及术后并发症。
Objective To understand the anatomic structure of the junction between the middle and lower slopes and the craniocervical neck and to find out the corresponding relationship between the skull surface sign and the surrounding important structures so as to provide microsurgical anatomical basis for the safe and rational use of the far lateral approach. Methods Ten cases (20 sides) were fixed with formalin-fixed adult Chinese adults with cervical cadaver heads (regardless of sex) and dry skull in 10 cases (20 sides) (regardless of gender) were dissected and measured by shooting to obtain relevant information. Results ① The occipital condyle, jugular foramen, hypoglossal canal, circular spine, foramen magnum and mastoid were the important skeletal signs of suboccipital far lateral approach. ② The suboccipital and lateral rectus muscles were (9.91 ± 0.93) mm (left), (9.99 ± 0.85) mm (right); hypoglossal nerve canal (8.77 ± 1.07) mm (left) and (8.80 ± 1.11) mm (right), respectively. The distance between the inferior margin of the hypoglossal canal and the inferior margin of the jugular foramen was (9.48 ± 0.87) mm (9.28 ± 1.04) mm (right). The length of hypoglossal nerve canal (10.68 ± 1.07) mm (left) and (10.40 ± 1.03) mm 4.7 °) (left), (47.9 ± 4.5 °) (right). Conclusions The distal approach can reach the ventral and lateral of the brainstem and cervical medulla oblongata with the shortest distance, revealing the ventral and lateral of the inferior ramus and medulla oblongata directly, providing a good exposure for the cranial nerves and vertebral arteries and is easy to use Cranial nerve of the natural gap; to avoid the brain stem and cranial nerve traction, improve surgical resection rate and reduce surgical injury and postoperative complications.