颅底颈静脉孔区骨性测量的应用解剖
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摘要
目的:通过研究颅底颈静脉孔及其周围结构形态学参数,为国人颅底应用解剖学和骨学体质调查积累资料,为颅底外科突破手术禁区提供形态学基础。方法:选取100例成人骨性颅底标本,测量了骨性颅底颈静脉孔的前后径、内外径及颈静脉窝的深度,颈静脉孔与邻近结构之间的距离,以及枕髁的长度、宽度及枕髁与周围结构之间的距离。结果:颈静脉孔的前后径左侧为(7.90±2.01)mm,右侧为(8.80±1.63)mm;内外径左侧为(13.9±2.44)mm,右侧(14.47±2.52)mm。颈静脉窝深度左侧(12.28±2.41)mm,右侧(13.79±3.67)mm。乳突尖与颈静脉孔的外侧缘的距离左侧为(23.47±2.65)mm,右侧为(22.84±2.88)mm;茎乳孔与颈静脉孔外缘的间距左侧为(7.44±1.36)mm,右侧为(6.78±1.61)mm。颈静脉孔内侧缘至舌下神经管内口外侧缘的距离左侧为(9.09±0.76)mm,右侧为(9.86±1.25)mm;枕髁前端距舌下神经管外口前缘间距左侧(14.46±1.23)mm、右侧(11.41±1.91)mm;枕髁后端距舌下神经管外口后缘间距左侧(11.09±2.75)mm,右侧(14.39±1.85)mm。结论:在颈静脉孔区肿瘤远外侧入路手术中,磨除孔外侧与乳突间骨质时,自乳突尖约16mm处注意保护自茎乳孔出颅的面神经;在内侧入路手术中可磨除枕髁前半部不超过11mm;枕髁磨除的厚度不超过10mm,以防在磨除枕髁时伤及横过髁中部深面的舌下神经。在切除颈静脉孔前缘或前上缘的肿瘤采用经口咽入路时磨除颈静脉结节的厚度在8mm以内可防止伤及舌下神经。
Objective:To provide anatomical basis for the skull base surgery by collecting data of morphological parameters of the jugular foramen and its surrounding structures.Methods:100 cases of bony skull base were selected,the anteroposterior and transverse diameters of jugular foramen,the depth of jugular fossa,the distance between the jugular foramen and adjacent structures,the length and width of occipital condyle and the distance between occipital condyle and surrounding structures were measured respectively in 100 skull base specimens.Results:The anteroposterior and transverse diameter of jugular foramen was(7.90±2.01)mm(left),(8.80±1.63)mm(right),(13.9±2.44)mm(left)and(14.47±2.52)mm(right),respectively.The depth of jugular fossa was(12.28±2.41)mm on the left and(13.79±3.67)mm on the right.The distance between lateral margin of jugular foramen mastoidale was(23.47±2.65)mm on the left and(22.84±2.88)mm on the right,while the distance between lateral margin of jugular foramen and stylomastoid foramen was(7.44±1.36)mm on the left and(6.78±1.61)mm on the right.The distance between medial margin of jugular foramen and lateral margin of internal orifice of hypoglossal canal was(9.09±0.76)mm on the left and(9.86±1.25)mm on the right.The distance between anterior margin of occipital condyle and anterior margin of external orifice of hypoglossal canal was(14.46±1.23)mm on the left and(11.41±1.91)mm on the right.The distance between posterior margin of occipital condyle and posterior margin of external orifice of hypoglossal canal was(11.09±2.75)mm on the left and(14.39±1.85)mm on the right.Conclusion:In the resection of jugular foramen tumors by far lateral approach,when grinding the bone between the lateral jugular foramen and the mastoid,the facial nerve from stylomastoid foramen must be protected at about 16 mm from the mastoidale tip.In the medial approach,the anterior half of occipital condyle can be grinded less than 11 mm,and the thickness must be less than 10 mm so as to protect the hypoglossal nerves across the middle part of occipital condyle.In the oropharyngeal approach to remove the tumors anterior or antero-superior to the jugular foramen,the thickness of the jugular tubercle must be grinded less than 8 mm so as to protect the hypoglossal nerve.
Objective:To provide anatomical basis for the skull base surgery by collecting data of morphological parameters of the jugular foramen and its surrounding structures.Methods:100 cases of bony skull base were selected,the anteroposterior and transverse diameters of jugular foramen,the depth of jugular fossa,the distance between the jugular foramen and adjacent structures,the length and width of occipital condyle and the distance between occipital condyle and surrounding structures were measured respectively in 100 skull base specimens.Results:The anteroposterior and transverse diameter of jugular foramen was(7.90±2.01)mm(left),(8.80±1.63)mm(right),(13.9±2.44)mm(left)and(14.47±2.52)mm(right),respectively.The depth of jugular fossa was(12.28±2.41)mm on the left and(13.79±3.67)mm on the right.The distance between lateral margin of jugular foramen mastoidale was(23.47±2.65)mm on the left and(22.84±2.88)mm on the right,while the distance between lateral margin of jugular foramen and stylomastoid foramen was(7.44±1.36)mm on the left and(6.78±1.61)mm on the right.The distance between medial margin of jugular foramen and lateral margin of internal orifice of hypoglossal canal was(9.09±0.76)mm on the left and(9.86±1.25)mm on the right.The distance between anterior margin of occipital condyle and anterior margin of external orifice of hypoglossal canal was(14.46±1.23)mm on the left and(11.41±1.91)mm on the right.The distance between posterior margin of occipital condyle and posterior margin of external orifice of hypoglossal canal was(11.09±2.75)mm on the left and(14.39±1.85)mm on the right.Conclusion:In the resection of jugular foramen tumors by far lateral approach,when grinding the bone between the lateral jugular foramen and the mastoid,the facial nerve from stylomastoid foramen must be protected at about 16 mm from the mastoidale tip.In the medial approach,the anterior half of occipital condyle can be grinded less than 11 mm,and the thickness must be less than 10 mm so as to protect the hypoglossal nerves across the middle part of occipital condyle.In the oropharyngeal approach to remove the tumors anterior or antero-superior to the jugular foramen,the thickness of the jugular tubercle must be grinded less than 8 mm so as to protect the hypoglossal nerve.
引文
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[11]付旭东,马林,王新军,等.骨性颈静脉孔区的应用解剖[J].解剖学杂志,2009,32(1):103-106.
[12]王凤林,赵保东.国人颈静脉孔的测量[J].人类学学报,1989,8(1):91-92.
[13]陈光贵,牛朝诗,韩卉.颅后窝内外面有关骨性结构的应用解剖学研究[J].解剖与临床,2008,13(2):81-84.
[14]李玉泉,王玉海.头颈部临床解剖学实物图谱[M].第2版.北京:人民卫生出版社,2017.
[2]王海波,张华,韩月臣,等.颈静脉孔区肿瘤的手术治疗[J].中华耳鼻咽喉头颈外科杂志,2008,43(8):570-576.
[3]张秋,华清泉,江洋,等.颈静脉孔区肿瘤临床表现及影像学分析[J].中国耳鼻咽喉头颈外科,2010,17(5):229-231.
[4]闫婧,卢洁,李宝生,等.CT与MRI图像融合在颅内肿瘤三维适形放疗中的应用[J].中华肿瘤杂志,2007,29(12):935-937.
[5]杨秀军,彭仁罗.颈静脉孔区肿瘤的MRI和MRA诊断[J].中华放射学杂志,1996,30(5):131-132.
[6]黄德亮,刘良发.颅底外科30年[J].中华耳科学杂志,2012,10(3):291-296.
[7]庞刚,韩卉,孟庆玲,等.骨性颈静脉孔区的显微解剖学研究[J].解剖学研究,2003,25(1):58-61.
[8]Navsa N,Kramer B.A quantitative assessment of the jugular foramen[J].Ann Anat,1998,180(3):269-273.
[9]Katsuta T,Rhoton A L Jr,Matsushima T.The jugular foramen:microsurgical anatomy and operative approaches[J].Neurosurery,1997,41(1):149-201.
[10]徐领领,王玉海.两种联合入路处理颈静脉孔区沟通性肿瘤的应用解剖比较[J].中国临床解剖学杂志.2017,35(4):361-366.
[11]付旭东,马林,王新军,等.骨性颈静脉孔区的应用解剖[J].解剖学杂志,2009,32(1):103-106.
[12]王凤林,赵保东.国人颈静脉孔的测量[J].人类学学报,1989,8(1):91-92.
[13]陈光贵,牛朝诗,韩卉.颅后窝内外面有关骨性结构的应用解剖学研究[J].解剖与临床,2008,13(2):81-84.
[14]李玉泉,王玉海.头颈部临床解剖学实物图谱[M].第2版.北京:人民卫生出版社,2017.