改良先天性肌性斜颈手术方法的解剖学研究

【摘要】目的：根据颈筋膜解剖特点，改进传统的先天性肌性斜颈的手术方法。方法：选取经福尔马林固定，颈部无肉眼病变的成人尸体标本12具。沿锁骨切开皮肤、颈阔肌，向上在颈筋膜浅层浅面（封套筋膜）进行仔细分离，观察封套筋膜和颈阔肌的相互关系，粘连程度。以锁骨上方1.5 cm水平为中心，在胸锁乳突肌内缘内侧0.5 cm纵行剪开封套筋膜约3 cm，在胸锁乳突肌后鞘深面进行分离达胸锁乳突肌外侧，感觉分离的难易程度，观察封套筋膜和颈动脉鞘的完整性。结果：封套筋膜在颈前完整、致密，将胸锁乳突肌完整套封，颈阔肌与封套筋膜可以轻易地完整分离；在颈中下部胸锁乳突肌后鞘与颈动脉鞘也无粘连，各自独立，很容易完整分离。结论：依据胸锁乳突肌前后筋膜鞘的结构特点，可以将先天性肌性斜颈传统手术加以改进，提高疗效。

Anatomic investigation of modified operation for treating congenital torticollis

【Abstract】 Objective: To improve the routine operation for treating congenital torticollis on the basis of characteristics of cervical fascia. Methods: 12 embalmed adult cadavers were used in this study. Anatomic relationship of the platysma muscle and the superficial layer of cervical fascia(envelope fascia) were dissected and observed. The envelope fascia were cut about 3cm longitudinally 1.5cm above the clavicle and 0.5cm medially to the medial boundary of the sternocleidomastoid muscle, and then, the lateral border of sternocleidomastoid were divided from the deeper of the posterior sheath of the muscle, for the exposure and observation of the deep layer of cervical fascia and carotid sheath. Results: The superficial layer of cervical fascia was intact and compact, which enveloped the sternocleidomastoid thoroughly and can be dissected from platysma muscle easily at the anterior part of the neck. At the middle and inferior part of the neck, the hind fascia sheath of the sternocleidomastoid can be separated from the carotid sheath easily. Conclusions: According to the anatomic features of cervical fascia, it's possible to improve the operation for treating congenital torticollis.