寰椎的解剖学测量与改善椎基底动脉供血不足的相关性分析

背景椎基底动脉供血不足是缺血性脑血管病发病的重要原因,在其众多的发病机制中,颈椎因素是不容忽视的,因此对其椎动脉沟及横突孔角度的测量有利于阐明其发病机制.目的探讨寰椎因素致椎基底动脉供血不足的发病机制及为手术切开横突孔减压提供解剖学依据.设计单一样本研究.单位郧阳医学院解剖学教研室.对象实验于2002-06/2003-06在郧阳医学院解剖学教研室完成.标本为郧阳医学院解剖学教研室收集的中国成年人干燥寰椎标本50例.方法在50例中国成年人干燥寰椎标本上,对具有临床意义的数据进行解剖学测量.主要观察指标①寰椎的角度测量结果.②寰椎横突孔前、后壁厚度测量.结果寰椎横突孔与椎动脉沟的成角左侧为(67.875±5.394)°,右侧为(69.844±4.546)°;椎动脉沟绕寰椎侧块成角左侧为(62.456±4.662)°,右侧为(63.612±2.310)°.寰椎横突孔前壁厚度左侧为(2.959±0.541)mm,右侧为(3.206±0.402)mm;横突孔后壁厚度左侧为(2.280±0.567)mm,右侧为(2.019±0.257)mm.以上数据左、右侧比较差异无显著性意义.结论椎动脉行经在寰椎横突孔与椎动脉沟内时,骨性结构上有明显的两个成角,即横突孔与椎动脉沟的成角和椎动脉沟绕过侧块的成角,椎动脉的这两个成角增加了血液循环的阻力,同时在头颈部旋转运动时,椎动脉与骨性成角间更加贴近,这两个成角与椎基底动脉供血不足的发生有关.

Anatomical measurement of the atlas in relation to vertebrobasilar insufficiency

BACKGROUND: Vertebrobasilar insufficiency is one of the most common causes of ischemic cerebrovascular diseases. Of the various mechanisms involved, the role of cervical vertebra is by no means important in the pathogenesis of ischemic cerebrovascular diseases, which might be explained through anatomical measurement of the angles of the transverse foramen and vertebral artery groove of the atlas.OBJECTIVE: To investigate the mechanism of vertebrobasilar insufficiency involving the atlas and provide anatomical basis for decompression measures by opening the transverse foramen for the treatment.DESIGN: A single-sample study.SETTING: Department of Anatomy, Yunyang Medical College.PARTICIPANTS: The experiment was completed in the Department of Anatomy, Yunyang Medical College during the period from June 2002 to June 2003, using 50 dry Chinese adult atlas specimens.METHODS: The clinically significant data were measured in 50 dry Chinese atlases specimens.MAIN OUTCOME MEASURES: The angles of the vertebral artery groove and the thickness of the anterior and posterior wall of transverse foramen were measured.RESULTS: The angle between the transverse foramen and the vertebral artery groove in atlas was(67.875±5.394)° on the left side and (69. 844 ±4. 546) ° on the right side. The angle formed by the vertebral artery groove around the lateral mass of the atlas was(62. 456:14. 662) ° on the left and(63. 612 ±2. 310)° on the right. The thickness of the anterior wall of the transverse foramen of the atlas was(2. 959 ±0. 541) mm and (3.206 ±0. 402) mm on the left and right, respectively, and that of the posterior wall was(2. 280 ±0. 567) mm and(2. 019 ±0. 257) mm, respectively. There was no significant difference in the above measurements between the left and right sides.CONCLUSION: There are two apparent bony angles on the atlas in the course of the vertebral artery that winds in the vertebral artery groove through the atlas, which increase the resistance of blood circulation in the vertebral artery. During the rotation of the head and the neck, the vertebral artery approaches the bony angles where compression or constriction occurs to contribute to vertebrobasilar insufficiency.