颈静脉孔区的显微解剖及定位标志研究

目的:研究颈静脉孔区的显微外科解剖,探讨寰椎横突(TPA)、头侧直肌、二腹肌沟、颈静脉突等解剖标志在颈静脉孔区病变手术中的定位意义。方法:成人头颈标本15例,男13例,女2例,红色乳胶灌注颈总动脉和椎动脉。手术显微镜下(×3～×30)逐层显露颈静脉孔区结构,明确该区显微解剖特征、相关的解剖标志及其定位意义。结果:颈静脉孔区多数重要的解剖结构均可以TPA为参照标志予以明确。二腹肌后腹位于其浅层。TPA的后方为枕下三角,三角内有椎动脉、椎静脉丛和颈1神经通过。头侧直肌起始于TPA的外表面,止于枕骨颈静脉突的下表面,可作为确定颅外颈静脉孔的解剖标志。茎突位于TPA的前方,颈内静脉、迷走神经、副神经、舌下神经穿行于茎突与TPA之间,颈内动脉位于颈内静脉的前内侧。二腹肌、颈静脉突、颈动脉嵴对定位面神经、颈静脉孔及舌咽神经等结构具有重要意义。结论:颈静脉孔区解剖结构复杂,利用寰椎横突、头侧直肌、二腹肌沟、颈静脉突等解剖标志有助于明确此区域重要的解剖结构,避免术中不必要的损伤。

Microsurgical anatomy and landmarks of the jugular poramen region

Objective: To study the microsurgical anatomy of the jugular for amen region and to assess the usefulness of the TPA (transverse process of atlas ), rectus capitis laterralis muscle, jugular process and sulcus of the digastric muscle which are taken as reference guides in the exposure of the jugular foram en region. Methods: The microsurgical anatomy of the jugular foramen region and the relation to the TPA were investigated in fifteen cadaveric head-neck specime ns of adults. Results: Many of the important structures in this region can be id entified systematically. Laterally to the TPA sat the posterior belly of the dig astric muscle and the occipital artery. Posterior to the TPA, the suboccipital t riangle can be recognized. Within the triangle, the vertebral artery and its acc ompanying venous complex can be identified. The rectus capitis laterralis muscle extended vertically behind the internal jugular vein from the TPA to the jugula r process of the occipital bone. Anterior to the TPA, the styloid process could be exposed. The internal jugular vein and cranial nerve X, XI and XII sat betwee n the styloid process and the TPA. Conclusions: Surgeons can use the TPA, rectus capitis laterralis muscle, jugular process, sulcus of the digastric muscle as v ery useful landmarks in the jugular foramen region to help identify the importan t structures and to prevent unnecessary morbidity.