三种经口入路处理颅颈交界区病变的解剖及比较

目的观察3种经口咽入路达到颅颈交界区的解剖特点。方法通过在尸体标本上模拟各种经口咽入路手术,观察解剖层次,测量手术深度、横向和纵向显露范围,重点对椎动脉与颅、颈神经的位置关系以及各段椎动脉的参数进行测量。结果单纯经口入路能显露从斜坡下1/3到C2椎体下缘的范围,水平向和纵向的显露范围分别为（39.4±2.2）mm和（52.1±3.5）mm。软腭切开后纵向显露范围增加到了（66.7±3.9）mm,能显露到从斜坡中部到C2/C3间隙的范围。上颌骨截骨后能将纵向显露提高到（74.6±5.1）mm,能显露至斜坡上1/3及蝶窦,足够暴露椎-基底动脉汇合点。椎动脉颅外段最宽处在C1横突孔内为（25.5±4.5）mm,最窄处在C2/C3间隙内为（11.2±1.5）mm。结论通过改良经口入路手术能直接将显露范围扩展至斜坡上段和蝶窦,椎动脉的解剖特点使其能作为该术式安全边界的标志。

Comparison of three kinds of transoral approaches for craniovertebral junction lesions: an anatomic study

Objective To observe the anatomical structures of craniovertebral junction with three kinds of transoral approaches.Methods Three kinds of transoral approaches were performed on cadaver specimens,and the corresponding anatomical structures of craniovertebral junction were observed.The coronal,axial and sagittal planes of the exposure zones were measured.Anatomical relationship of the vertebral artery（VA） to cranial nerves and cervical nerves was evaluated and data of VA in different segments were measured.Results The exposure zone of the standard transoral approach ranged from the lower third of the clivus to the inferior margin of C2,with the width being（39.4±2.2） mm and the length being（66.7±3.9） mm.While the length of the exposure zone increased to（66.7± 3.9） mm after opening the soft palate,which could display the middle part of clivus to C2/C3 interspace,and to（74.6±5.1） mm after maxillary osteotomy,which could expose a range from the upper third of the clivus to sphenoidal sinus,enough for exposing the vertebrobasilar artery junction.The widest segment of the VA was found located at the C1 level [（25.46±4.5） mm] and the narrowest segment located at C2/C3 level [（11.2± 1.5） mm].Conclusion The exposure zone can be extended to the upper clivus and the sphenoidal sinus by modifying of the transoral approach.The VA can be taken as the landmark of safe zone in this approach.