成人颈椎小关节间隙穿刺路径的应用解剖 

目的 探讨颈椎小关节的关节类型、关节角大小、关节面倾角等，为临床行颈椎间隙穿刺提供可参考的路径。方法 采用正常成人脊柱标本38例（男27、女11），通过断层解剖方法，从横断面上对C SUB>2-3/SUB>～C SUB>6-7/SUB>关节类型、关节角进行观测，并对40套成人椎骨标本的颈椎小关节关节面倾角及形态进行观测。结果C SUB>2-3/SUB>～C SUB>6-7/SUB>关节类型主要为平面椭圆形(79.2％)和曲面形(20.8％)；自C2-3至C6-7颈椎关节突的关节角逐渐增大；关节面倾角CSUB>3/SUB>＞CSUB>4/SUB>＞CSUB>5/SUB>CSUB>6/SUB>CSUB>7/SUB>，倾角值呈

Clinical anatomy of the facet joint puncture in adult cervical vertebra

Objective To study the type, the angle and the obliquity of facet joints and to identify the approach for the facet joint puncture in adult cervical vertebra. Methods Thirty eight spines of 27 male and 11 female cadavers were used to observe the type and angle of CSUB>2-3/SUB>-C SUB>6-7/SUB>on the transverse section. The obliquity and shape of the facet joint were also studied in 40 adult cadaveric spines. Results The joints in CSUB>2-3/SUB>-C SUB>6-7/SUB> were classified as the plane oval(79.2%) or curved surface(20.8%) types. The joint angles and articular processes were gradually increased from C2-3to C6-7. The obliquities of joint planes were CSUB>3/SUB>＞CSUB>4/SUB>＞CSUB>5/SUB>CSUB>6/SUB>CSUB>7/SUB>, and their values were distributed as a “U” shape. The middle part of the joints was located at the outside of the posterior midline and at the midpoints between spinous processes of cervical vertebra. The distance from the middle part to the posterior midline increased gradually downward from 17.19mm, 17.51mm, 18.76mm, 19.83mm to 20.52mm. The tissue layers during the puncture approach went through skin, superficial fascia, ligamentum nuchae, splenius capitis muscle and the posterior of joint capsule. Conclusion In adult cervical vertebra, facet joint puncture should be performed at the outside (17.2-20.5mm) of the midpoint between corresponding cervical space according to the type, the angle and the obliquity of joint plane. The puncture direction should be caudally tilted at 55°-67°（average 60°）and advanced obliquely