寰椎椎动脉沟的解剖学观测
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摘要
目的:研究寰椎椎动脉沟的形态结构,为寰椎相关疾患的诊治提供解剖学依据。方法:在成年干燥寰椎标本上,对椎动脉沟和椎动脉沟后结节进行分类,并对椎动脉沟、椎弓根进行相关解剖学测量。结果:椎动脉沟分型,浅沟型占70%,深沟型占12.92%,半环型占13.75%和全环型占3.33%。椎动脉沟后结节分型,突起型占27.59%、平坦型占16.81%和隆起型占55.60%。椎动脉沟宽度和高度分别为(8.50±1.39)mm、(7.44±1.18)mm。寰椎椎弓根厚度(4.14±0.96)mm;椎弓根最小宽度3.33mm。在所有标本中,仅有6侧骨桥尖锐利。结论:椎动脉沟均能容纳大于4mm的椎动脉,骨桥尖并不都锐利。因此,诊断沟环症不能仅凭沟环的存在与否。
Objective:To provide morphological basis for the diagnosis and treatment of diseases on the atlas.Methods:The morphology of vertebral artery groove and its posterior tubercle in intact dry atlas of 120 Chinese adults was investigated and classified.The significant clinical data were observed and measured in the vertebral artery groove and pedicle.Results:The vertebral artery grooves were classified into 4 types:shallow groove type(70%),deep groove type(12.92%),incomplete bony ring type(13.75%)and complete bony ring type(3.33%).The vertebral artery groove posterior tubercles were classified into 3 types:hump shape(27.59%),smooth shape(16.81%)and buterositas shape(55.60%).The width and height of vertebral artery groove were(8.50±1.39)mm and(7.44±1.18)mm.The height of atlas pedicle was(4.14±0.96)mm.The minimum width of atlas pedicle was 3.33 mm.There were only 6 sides of sharp ponticleses in all specimens.Conclusion:All vertebral artery grooves are bigger than vertebral arteries.Not all of the ponticleses are sharp.Therefore,the anatomical characteristic of the bony ring can not be the only indicator for diagnosis and treatment of groove-atlas syndrome.
Objective:To provide morphological basis for the diagnosis and treatment of diseases on the atlas.Methods:The morphology of vertebral artery groove and its posterior tubercle in intact dry atlas of 120 Chinese adults was investigated and classified.The significant clinical data were observed and measured in the vertebral artery groove and pedicle.Results:The vertebral artery grooves were classified into 4 types:shallow groove type(70%),deep groove type(12.92%),incomplete bony ring type(13.75%)and complete bony ring type(3.33%).The vertebral artery groove posterior tubercles were classified into 3 types:hump shape(27.59%),smooth shape(16.81%)and buterositas shape(55.60%).The width and height of vertebral artery groove were(8.50±1.39)mm and(7.44±1.18)mm.The height of atlas pedicle was(4.14±0.96)mm.The minimum width of atlas pedicle was 3.33 mm.There were only 6 sides of sharp ponticleses in all specimens.Conclusion:All vertebral artery grooves are bigger than vertebral arteries.Not all of the ponticleses are sharp.Therefore,the anatomical characteristic of the bony ring can not be the only indicator for diagnosis and treatment of groove-atlas syndrome.
引文
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[16]Ma X Y,Yin Q S,Wu Z H,et al.Anatomic considerations for the pedicle screw placement in the first cervical vertebra[J].Spine,2005,30(13):1519-1523.
[17]陈其昕.寰椎后弓变异患者寰椎椎弓根螺钉的置钉策略[J].中国脊柱脊髓杂志,2013,23(5):426-430.
[18]何帆,尹庆水,赵廷宝,等.寰椎椎弓根形态分类与椎弓根螺钉植钉方法研究[J].中国修复重建外科杂志,2008,22(8):905-909.
[2]刘仰斌,李启华.寰椎椎动脉沟的解剖学测量及其临床意义[J].赣南医学院学报,2003,23(1):17-19.
[3]张朝佑.人体解剖学[M].北京:人民卫生出版社,2009:48-51.
[4]陈关富,罗杰,孙祝娟.寰椎沟环综合征的临床诊断与针刀治疗[J].中国全科医学,2011,14(2):638-639.
[5]徐洪法,钱晓泽,杨芳.伴寰椎椎动脉沟环的颈性眩晕诊治体会[J].医学理论与实践,2016,29(15):2026-2028.
[6]朱海波,贾连顺,孙启全,等.寰椎测量及临床意义[J].解剖学杂志,1997,20(6):517-520.
[7]移平,谭明生.寰椎椎弓根螺钉固定的解剖学基础及置钉技术[J].中国脊柱脊髓杂志,2017,27(1):89-94.
[8]Tan M,Wang H,Wang Y,et al.Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass[J].Spine,2003,28(9):888-895.
[9]曹正霖,钟世镇,徐达传.寰枢椎的解剖学测量及其临床意义[J].中国临床解剖学杂,2000,18(4):299-301.
[10]陈前芬,金大地,肖增明,等.寰枢椎椎弓根螺钉技术的应用解剖研究[J].广西医科大学学报,2009,26(3):365-367.
[11]蔡小军,何斌,韩建华.寰椎椎动脉沟后结节的观测及其临床意义[J].中华外科杂志,2010,48(9):709-710.
[12]Kimmerle A.Positicus[J].Rntgenprax,1930,2:479.
[13]陈诚,王新伟.寰椎骨折的诊断与治疗进展[J].中国脊柱脊髓杂志,2017,27(1):75-77.
[14]Resnick D K,Benzel Ec.C1~C2pedicle screw fixation with rigid cantilever beam contract:case report and technical note[J].Neurosurgery,2002,50(2):426-428.
[15]Lapsiwala S B,Anderson P A,Oza A,et al.Biomechanical comparison of four C1to C2rigid fixative techniques:anterior transarticular,posterior transarticular,C1to C2pedicle,and C1to C2intralaminar screw[J].Neurosurgery,2006,58(3):516-521.
[16]Ma X Y,Yin Q S,Wu Z H,et al.Anatomic considerations for the pedicle screw placement in the first cervical vertebra[J].Spine,2005,30(13):1519-1523.
[17]陈其昕.寰椎后弓变异患者寰椎椎弓根螺钉的置钉策略[J].中国脊柱脊髓杂志,2013,23(5):426-430.
[18]何帆,尹庆水,赵廷宝,等.寰椎椎弓根形态分类与椎弓根螺钉植钉方法研究[J].中国修复重建外科杂志,2008,22(8):905-909.