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1.
目的 研究蝶腭动脉及其分支的解剖特征,为临床获取鼻内黏膜瓣提供解剖学依据。 方法 用10具(20侧)成人尸颅标本在在手术显微镜下对蝶腭动脉及其分支鼻后中隔动脉和鼻后外侧动脉进行观测。 结果 蝶腭动脉是鼻腔的主要供血动脉,在出蝶腭孔前或后分为鼻后中隔动脉和鼻后外侧动脉,鼻后中隔动脉在蝶窦前壁分成两支,主干或上支到蝶窦开口的距离为(3.95±0.74)mm,主干或下支距离后鼻孔的最短距离为(8.96±1.69)mm。鼻后外侧动脉在中鼻甲后端前下约10 mm处分为中鼻甲动脉和下鼻甲动脉。 结论 熟悉掌握蝶腭动脉及其分支的解剖特征对获取鼻内组织瓣有重要意义。鼻中隔粘膜瓣切取时应紧贴蝶窦开口上缘及后鼻孔边缘。在获取下鼻甲、中鼻甲黏膜瓣时,应特别注意靠近下鼻甲的下鼻甲后端10 mm及中鼻甲后端前下约10 mm区域。  相似文献   

2.
目的 探讨蝶窦前壁区的解剖特征及其在经蝶窦入路手术中的意义。 方法 用15例(30侧)成人头部标本及20例(40侧)成人头骨标本,在手术显微镜下对蝶窦前壁骨质、蝶腭动脉及其分支等结构进行观察和测量。 结果 蝶窦前壁的基本形态酷似鸟头,正中线棱状高起,两侧为鸟眼样的蝶窦口,下方为鸟喙样的蝶嘴。蝶窦口距上鼻道末端(14.5±1.1)mm,距后鼻孔上缘(12.2±1.0)mm,距鼻后中隔动脉上支(8.2±0.5)mm。自鼻孔伸入探条探测蝶窦前壁时,所探及的“最浅点”大致位于蝶窦口与后鼻孔之间的中点附近。蝶腭孔位于蝶窦口的外下方和中鼻甲的后端区域,与蝶窦口间距(6.9±1.3)mm,两侧蝶腭孔内侧缘间距(18.2±2.5)mm。 结论 蝶窦前壁具有特征性的形态,蝶窦口大致位于蝶窦前壁的上中1/3交界处,其下方的骨质向前方突起。蝶腭孔位于蝶窦口下外侧方约7 mm处,经蝶窦入路手术中可以依此定位蝶腭孔。  相似文献   

3.
目的 研究鼻腔外侧壁重要解剖结构的显微外科解剖关系,为临床手术治疗相关疾病提供解剖学依据。 方法 成人尸头标本15例(30侧),采用手术显微镜及鼻内镜观察鼻腔外侧壁相关解剖结构。 结果 蝶腭动脉是供应鼻腔外侧壁的主要动脉,经过蝶腭孔时分为鼻后外侧动脉及鼻中隔后动脉两支。80%(24侧)鼻后外侧动脉从蝶腭动脉下方发出,20%(6侧)从蝶腭动脉上方发出,分出处位于筛骨嵴后方。鼻中隔后动脉有86.7%(26侧)在蝶窦前下壁分为上、下两支,13.3%(4侧)在进入鼻中隔后分为上、下2支。上颌窦开口位于中鼻道半月裂孔内,66.7%(20侧)开口位于半月裂孔中1/3段,30%(9侧)位于半月裂孔后1/3段,3.3%(1侧)开口于上鼻道,86.7%(26侧)上颌窦内口高于眶底水平。鼻囟门平均大小为(14.81±4.28)mm(前后径)×(9.71±1.43)mm(上下径)。 结论 蝶腭动脉及其分支和鼻囟门是鼻腔外侧壁手术中重要的解剖标志,熟悉其解剖关系有助于有效安全地开展鼻内镜手术。  相似文献   

4.
目的 通过模拟内镜下经双鼻孔至Meckel腔手术入路,对Meckel腔及入路的相关结构进行解剖学研究,为临床内镜下Meckel腔手术提供解剖学及形态学资料。
方法 对10具(20侧)动静脉灌注乳胶的成人尸头标本,完全模拟经双鼻孔至Meckel腔的手术入路逐层显微解剖,对入路相关解剖标志进行观察、分析、拍摄和测量。 结果 该入路可分4步,即寻找上颌窦口,进入上颌窦,进入翼腭窝和进入Meckel腔。鼻小柱距上颌窦口的距离为(45.07±2.01)mm,与蝶腭孔的距离为(64.84±3.00)mm,距翼管前孔距离为(71.34±2.99)mm。以鼻小柱至鼻后棘的连线为底边,其与鼻小柱与上颌窦口连线的夹角为(38.81±1.72)。其与鼻小柱与蝶腭孔连线的夹角为(25.92±2.05) °。蝶腭动脉及翼管动脉平均外径分别为(2.21±0.24)mm和(1.07±0.27)mm。翼腭窝区结构复杂,其内上颌动脉及其终支蝶腭动脉和腭降动脉变异较大,沿蝶腭动脉逆行解剖有助于寻找上颌动脉及其分支结构。解剖分离翼腭窝内神经、血管等结构,追踪翼管神经血管束,依据翼管后端正对颈内动脉破裂孔段的特点,解剖分离四方形空间可较直接进入Meckel腔。结论 侵犯Meckel腔肿瘤的入路选择应该个体化,应依据肿瘤主体在Meckel腔的位置及范围等决定选1种或联合入路;内镜下经双鼻孔至Meckel腔入路可较直接地暴露Meckel腔的前下内面及翼腭窝区域的解剖结构;手术中重要的解剖标志为蝶腭孔、翼管神经、翼管和上颌神经;翼腭窝中浅部血管结构的解剖有助于深部神经结构的保护,深部神经结构(如翼管神经和上颌神经)和其穿行的骨孔有助于在颅底辨别和控制颈内动脉。  相似文献   

5.
蝶腭孔、翼管前口的应用解剖及临床意义   总被引:15,自引:0,他引:15  
目的 为鼻内窥镜翼管神经切断术等临床应用提供解剖学依据。方法 用15个30侧经防腐处理的成人头颅标本,经正中矢状面剖开,解剖观察测量蝶腭孔、翼管前口及穿过的血管、神经。结果 19例(63.33%)蝶腭孔位于中鼻甲后端前方平均8.09mm;11例(36.67%)位于在中鼻甲后端前上方平均7.24min。蝶腭孔呈圆形24例,直径平均3.25mm;呈卵圆形6例,最大径平均4.92mm穿过蝶腭孔的动脉有蝶腭动脉,或其分支鼻后外侧动脉和鼻中隔后动脉。翼管前口位于蝶腭孔后方约7mm,呈圆形漏斗状,横径约3mm,略向外下方开口,距离鼻小柱平均71.72mm,有翼管神经和翼管动脉穿过。结论 经鼻腔暴露翼管前口及翼管神经,以及进入翼腭窝处理上颌动脉末端的分支时,蝶腭孔及其周围骨质菲薄的部位是理想的手术入路部位。  相似文献   

6.
目的 研究上颌动脉翼腭段的走行及分支规律,为翼腭窝内动脉结扎、肿瘤切除和颅面外科手术提供解剖学依据。方法 采用3种手术入路解剖21具成人尸头,观测上颌动脉翼腭段及分支的行程、管径、长度和毗邻关系。结果 上颌动脉翼腭段行于上颌骨颞下面后上区内,分为5型:Y型26.19%、中间型33.33%、T型21.43%、M型11.90%和其他型7.14%。上颌动脉翼腭段外径为(2.61±0.39)mm,总长为(19.44±3.62)mm;其分支有上牙槽后动脉、眶下动脉、圆孔动脉、翼管动脉、腭降动脉、蝶腭动脉、腭鞘动脉,分支走行变异常见;颞深前动脉可作为确定上颌动脉翼腭段的参考标志。结论 熟悉上颌动脉的分支、分型及走行对指导翼腭窝区手术及降低术后并发症具有重要意义。  相似文献   

7.
目的 研究翼腭窝及其毗邻结构的显微外科解剖关系,为临床开展相关手术提供解剖学依据。方法 成人干性颅骨标本20个(40侧),在手术显微镜及鼻内镜下观测蝶腭孔、筛骨嵴、圆孔、翼腭管、翼管的形态、大小及相关解剖学参数。结果 翼上颌裂高度为(15.30±0.43)mm,蝶腭孔的前后径和上下径分别为(5.10±1.84)mm和(5.09±1.53)mm,蝶腭孔到中线的距离为(12.49±1.51)mm,前鼻棘至蝶腭孔前缘的距离为(51.32±3.28)mm,圆孔的直径为(3.14±1.26)mm,圆孔至中线的距离为(19.95±2.79) mm,前鼻棘至圆孔的距离为(61.86±3.67)mm,翼管至中线的距离为(10.82±2.98)mm,前鼻棘至翼管的距离为(59.47±3.42)mm。结论 熟悉翼腭窝、蝶腭孔、圆孔和翼管等解剖关系,有助于有效安全地开展鼻内镜下翼腭窝手术。  相似文献   

8.
经鼻内窥镜翼腭窝手术的应用解剖学基础   总被引:25,自引:5,他引:20  
目的通过对翼腭窝骨性标志的测量和尸体解剖为经鼻内窥镜翼腭窝手术提供形态学资料。方法对40例干性颅骨进行了骨性标志的观察,同时对10例20侧成人尸头标本按中线锯开后进行解剖,观察翼腭窝周围组织结构及毗邻关系,并测量了有关的数据。结果蝶腭孔、圆孔、翼腭裂距离前鼻嵴的距离分别为(62.3±2.7)、(64.2±4.8)、(51.5±0.6)mm,翼腭窝内的结构可以分为在后内的神经层和在前外的血管层,颈内动脉与蝶腭孔之间的距离为(16.4±3.3)mm。结论经鼻内窥镜翼腭窝手术可以获得相对安全的范围,圆孔可以作为手术中重要的标志结构。  相似文献   

9.
目的为提高内镜下泪囊鼻腔吻合术的有效率和减少并发症提供解剖学基础。方法 15具(30侧)头颈部标本经双侧颈总动脉灌注红色乳胶,在国产手术显微镜下进行解剖,1具保留骨骼的头颈部血管铸型标本。结果①外鼻的动脉:分布到外鼻的动脉非常丰富,主要有鼻背动脉、鼻外侧动脉、鼻翼动脉、鼻翼下缘动脉及上唇动脉的分支等,且在鼻端处它们之间形成非常丰富的吻合;②鼻中隔动脉:鼻中隔血供属多源性,主要来自鼻后中隔动脉上支、下支,筛前?筛后动脉,筛前、筛后动脉主要分布于鼻中隔上部;③鼻腔外侧壁的动脉:蝶腭动脉大多(90%)在蝶腭孔处已分为鼻后外侧动脉和鼻后中隔动脉,鼻后外侧动脉发出下鼻甲动脉和中鼻甲动脉;下鼻甲动脉沿途分支分布于下鼻甲及下鼻道,且有分支与中鼻甲动脉吻合。结论本文结果对鼻内镜下泪囊鼻腔吻合术具有参考价值。  相似文献   

10.
目的 使用三维高分辨率CT(HRCT)重建的方法,观察经鼻内镜至翼腭窝(PPF)的手术入路中的重要解剖结构,探讨翼管(VC)、圆孔(FR)和蝶腭孔(SPF)这些重要解剖标志的三维立体空间关系。方法 回顾性分析17例患者及1例尸体标本的HRCT扫描数据。在CT三维重建的影像中,观察 SPF、VC和FR的形态以及SPF和VC之间的三维立体空间关系。 结果 三维测量SPF,VC,和FR的平均直径分别为(6.26±1.59)mm,(2.35±0.77)mm和(2.75±0.77)mm。VC和SPF后下缘之间的平均距离为(4.03±1.15)mm。三维立体CT重建影像中VC和FR之间的平均垂直和水平距离分别为(4.94±1.35)mm和(9.22±3.07)mm。VC的全部或部分边缘92%(33/36)位于SPF的下缘以上,97%(35/36)位于SPF内缘外侧。结论 深入理解SPF、VC和FR之间的三维空间立体关系,有助于安全实行内镜下经鼻至翼腭窝的手术。  相似文献   

11.

Objectives

To develop a combined pedicled flap comprising the mucoperiosteum and mucoperichondrium of the inferior turbinate, lateral nasal wall, nasal floor, and nasal septum based on the posterior lateral nasal artery, a branch of the sphenopalatine artery, for the reconstruction of skull base defects resulting from endoscopic expanded endonasal approaches.

Methods

Eleven fresh adult cadaver heads were dissected. Arterial distribution patterns of the inferior turbinate, lateral nasal wall, nasal floor, and nasal septum were investigated. The posterior pedicled inferior turbinate–nasoseptal flap was designed, measured, and harvested, and its ability to cover ventral skull base defects was examined.

Results

The inferior turbinate artery and/or posterior lateral nasal artery had 3.19 ± 1.47 (range 2–7) branches [mean outer diameter of largest branch, 0.40 ± 0.10 (range 0.24–0.60) mm] that anastomosed with the nasoseptal artery. These anastomosing arteries allowed the posterior lateral nasal artery to supply arterial blood to the nasoseptal mucoperichondrium and mucoperiosteum. Mean flap length was 100.65 ± 5.61 (range 91.43–109.44) mm, and minimum and maximum widths were 25.21 ± 2.29 (range 22.36–30.23) and 44.53 ± 5.02 (range 36.45–54.10) mm, respectively. Mean flap area was 3090.69 ± 288.08 (range 2612.97–3880.09) mm2. The flap covered defects extending from the frontal sinus to the foramen magnum in all specimens.

Conclusions

Harvesting of a posterior pedicled inferior turbinate–nasoseptal flap is feasible. It should be considered a useful option for the reconstruction of large defects involving the anterior skull base, planum sphenoidale, sella turcica, and/or clivus.
  相似文献   

12.
The extracranial‐intracranial (EC‐IC) bypass using the maxillary artery (MA) has been successfully completed using a radial artery (RA) graft but the complicated anatomy and narrow exposure make it difficult. The purpose of this article is to define the microsurgical exposure of the MA through the middle fossa and describe the branches, diameter, and length of the MA available for the EC‐IC bypass in the sphenopalatine fossa and anterior part of the infratemporal fossa. 5 cadaveric specimens were dissected bilaterally (10 MA dissections) to define the microsurgical anatomy of the MA through an intracranial approach. The exposable branches of the MA at the level of the infratemporal and sphenopalatine fossae were the anterior deep temporal, posterior superior alveolar, and infraorbital arteries. The origin of each branch could be exposed. The available section of the MA for use as a donor vessel is between the origin of the anterior deep temporal artery and the infraorbital artery. The mean exposable length of the MA was 19.4 mm. The mean outer diameter of the donor MA was 3.2 mm. Tension‐free EC‐IC bypass was possible using a RA graft between the MA and the middle cerebral artery, the MA and the supraclinoid internal carotid artery (ICA), or the MA and the petrous ICA. Exposure of the MA at the infratemporal and sphenopalatine fossae is complicated but provides length and diameter suitable as a donor artery for the EC‐IC bypass. Clin. Anat. 31:724–733, 2018. © 2017 Wiley Periodicals, Inc.  相似文献   

13.
The inferior alveolar artery is the major blood supply to the mandible and mandibular teeth. This artery has a very consistent path, originating from the maxillary artery and passing inferiorly until it enters the mandibular foramen, accompanied by the inferior alveolar nerve and vein. During routine dissection of a 90-year-old female cadaver, a unique origin of the inferior alveolar artery was observed on the left side. The artery branched off the external carotid artery, just superior to the stylohyoid and posterior belly of the digastric muscle in the posterior region of the submandibular triangle. From its starting point the artery passed superiorly in the stylomandibular fascia and made a curving arch into the pterygomandibular space to enter the mandibular foramen with the inferior alveolar nerve. The position and branching pattern of the maxillary artery were otherwise typical. The inferior alveolar artery on the right side displayed a normal branching pattern within the infratemporal fossa. Results of surgical procedures in this area, such as sliding osteotomy of the mandible, could be impacted by this anomaly.  相似文献   

14.
Background  The hypoglossal canal (HC) is a region of the skull base whose involvement in many pathological entities is often ignored. Adequate knowledge of the anatomy of the HC and its related bony, neural, and vascular structures is essential for surgery of lesions involving this area. Methods  Ten adult human cadaver heads from a US source fixed by formalin (20 sides) and 20 dry human skulls from Indian sources (40 sides) were used in this study. Various aspects of the anatomy of this region including the size, course and variation of the hypoglossal nerve and its relationship to the adjacent and canalicular course were recorded. Results  The left HC was located at 10 o’clock and the right HC at the 2 o’clock position with respect to the foramen magnum. The canal was surrounded superiorly by the jugular tubercle, superolaterally by the jugular foramen, laterally by the sigmoid sinus and inferiorly by the occipital condyle. All dry skulls were drilled in the horizontal plane at an axis of about 45° and directed slightly upwards. Conclusions  Detailed knowledge of the microsurgical anatomy of the region of the HC is crucial when performing surgery for lesions of the condylar region, the lower clivus, and ventral brain stem. This study provides the knowledge required to achieve accurate orientation and effective maneuvers during surgical procedures for treatment of the patient without injuring the vital neural and bony structures.  相似文献   

15.
目的通过解剖学研究,探讨内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法,寻找手术入路中的重要解剖标志点,测量相关解剖数据,为内镜经鼻入路处理Meckel囊区病变提供解剖学依据。方法 5例共10侧新鲜成人头颅标本,采用内镜经鼻、上颌窦、翼突入路解剖和暴露Meckel囊区,寻找该手术入路中重要的解剖标志,研究具体的解剖方法,测量相关的解剖数据,解剖过程中使用导航。结果鼻小柱下缘至后鼻孔上缘为(66.5±3.3)mm,至蝶窦口下缘为(61.2±1.6)mm,至腭蝶管前口下缘为(64.6±1.4)mm,至蝶腭孔下缘为(62.8±2.3)mm,至翼管前口下缘的距离为(75.4±3.3)mm,翼管前口下缘与腭蝶管前口上缘距离为(2.1±0.7)mm,与圆孔下缘距离为(7.5±0.7)mm,腭蝶管长度为(6.4±0.5)mm,翼管长度为(13.3±1.2)mm。以腭蝶管为解剖标志可以寻找到翼管前口;以翼管为解剖标志可以寻找到岩骨段颈内动脉前膝部,以斜坡旁颈内动脉隆突可以寻找到斜坡旁颈内动脉,以圆孔可以寻找到上颌神经。导航能够准确定位上述解剖标志。结论运用内镜经鼻、上颌窦、翼突入路可以解剖和暴露Meckel囊区。此入路是由Meckel囊前方四边形区域暴露该区域,此四边形内侧为斜坡旁段颈内动脉,下方为岩骨段颈内动脉,上方为展神经,外侧方为上、下颌神经;实验数据和导航可以辅助定位重要的解剖结构和标志。  相似文献   

16.
目的 为翼腭窝内上颌神经手术提供解剖依据。 方法 在15个成人头颅部标本中解剖观测上颌神经出圆孔处到鼻腔外侧壁、正中矢状面的距离,观察上颌神经与上颌动脉的关系。 结果 上颌神经出圆孔处到鼻腔外侧壁的距离为(13.78±2.18)mm;距正中矢状面的距离为(17.89±2.67)mm 。上颌神经与上颌动脉的位置关系是:63.3%动脉位于神经的外下方,37.7%在神经下方。 上颌神经与上颌动脉之间的距离为 (7.68±1.35)mm(6.60~11.10 mm)。 结论 本研究可为上颌神经手术提供解剖学参数。  相似文献   

17.
Purpose  The aim of this study was to evaluate the popliteal artery branching patterns and related measurements. Methods  A cadaveric study in forty lower limbs was performed to improve the understanding of anatomy of the popliteal artery and its main branches. Results  Normal branching of the popliteal artery was present in 36 specimens (90%). High origin of the anterior tibial artery was seen in two specimens (5%). The bifurcation was at the level of proximal border of popliteus, but the posterior tibial artery originated directly from the popliteal artery in one specimen (2.5%). Trifurcation pattern with no trunk was observed in one specimen (2.5%). Conclusions  We believe that a review of the anatomic characteristics of the popliteal artery and its branches will be beneficial for the surgical approaches and the choice of suitable arterial graft sites. This study was presented at 9th Congress of European Association of Clinical Anatomy in Prague, 5–8 September 2007.  相似文献   

18.
This study aims to investigate positions of the antilingula (AL), the midwaist of the mandibular ramus (MW) and the midpoint between the coronoid process and the gonion (MCG) in relation to the lingula of dried mandibles. Bilateral rami of 92 Thai dried mandibles were studied. The AL, the MW, the MCG and the corresponding position of the tip of lingula (L) were marked on the external aspect of the mandibular ramus. The distances from the AL, the MW and the MCG to the L were measured in the anterior–posterior and the superior–inferior planes using computerized image analysis. The results showed the AL was discernible in 80.4% of lateral mandibular rami studied. The most of the AL was found anterior–superior to the L with a maximum distance of 5.9 mm anteriorly and 8.2 mm superiorly. The MW was frequently located anterior–inferior to the L with a maximum distance of 9.3 mm anteriorly and 9.9 mm inferiorly. The majority of the MCG was found anterior–superior to the L with a maximum distance of 9.6 mm anteriorly and 8.9 mm superiorly. A 5 mm radius from the L included 84.5% of the AL, 81.5% of the MW and 79.4% of the MCG. Medians (interquartiles) of distances from the AL, the MW and the MCG to the L were 3.4 (2.3–5.0) mm, 3.8 (2.5–5.3) mm and 4.1 (2.8–5.3) mm, respectively. In conclusion, the AL was identified in 80.4% of lateral mandibular rami studied. The AL and the MCG were commonly found anterior–superior to the lingula, whereas the MW was mostly observed anterior–inferior to the lingula. Therefore, a cut made more than a 5 mm posterior or superior to these landmarks would be in 79% of cases, within a statistically safe area avoiding encroaching upon the inferior alveolar neurovascular bundle passing immediately lateral to the lingula. Although the MW and the MCG might be alternative surgical guides when the AL is absent, their use alone as surgical landmarks is not recommended.  相似文献   

19.
The reconstruction of lip defects through the use of the Abbė flap and other lip flap procedures involves surgical manipulation of one of the major branches of the facial artery, specifically the superior labial artery (SLA). We examined 284 hemifaces derived from 142 formalin fixed cadavers. Observations regarding the distribution patterns of the facial artery were recognized and categorized into five Types, labeled “A” through “E”.Type A (135, 47.5%): facial artery bifurcates into SLA and lateral nasal (the latter gives off inferior and superior alar and ends as angular); Type B (110, 38.7%): similar to Type A, except lateral nasal terminates as superior alar (angular artery is absent); Type C (24, 8.4%): facial artery terminates as SLA; Type D (11, 3.8%): angular artery arises directly from facial arterial trunk rather than as the termination of lateral nasal, with the facial artery ending as superior alar; Type E (4, 1.4%): facial artery terminates as a rudimentary twig without providing any significant branches. Furthermore, we were able to categorize variations within each Type. Sub-Type variations were examined in Types A through C (A: 1–7; B: 1–4; C: 1–3). Our aim was to equip both the anatomist and surgeon with a more thorough understanding of the vasculature of the face, as well as to enable plastic surgeons to have a more confident approach to reconstructive procedures in this region.  相似文献   

20.
目的:为下颈椎前路手术预防椎动脉损伤提供解剖学数据。方法:(1)取20具尸体的C3~7段作为解剖标本,作两侧椎动脉孔内缘间距、椎体横、矢径、椎动脉孔内缘和椎弓根内缘间距、椎动脉孔内缘和椎体外缘间距、 椎动脉孔内缘和钩突关节内外缘间距、椎动脉孔前后缘与椎体前后缘的垂直距离、 椎动脉孔矢径的测量。(2)选30例已确诊为颈椎病患者和50例正常人作为检测对象,用CT测量上述数据。 结果: (1) C3~7两侧横突孔内缘间距、椎体横径、椎体矢径、C3~6椎动脉孔矢径逐渐增大。(2) 钩突内缘与椎动脉孔内缘间距在6 mm之内, C3~6椎体外缘与椎动脉孔内缘间距不超过3 mm。(3) C3~6 横突孔矢径和椎体矢径比值恒定(30.32%~31.86%), C3~5 椎动脉孔前缘与椎体前缘距离逐渐减小,C3~5椎动脉孔后缘与椎体后缘距离逐渐增加。结论:本文的测量数值与不同个体的椎动脉资料相结合,为预防椎动脉损伤提供了解剖学依据。  相似文献   

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