颈部相关血管和神经与颈椎间关系的应用解剖

背景颈椎病手术治疗时,常用颈椎前外侧途径,主要显露颈椎椎体、椎间盘、钩椎关节等部位.近年来这方面的报道多为对其局部性的研究,特别是对颈椎与对应的血管神经距离数据的观测研究较少.目的观测颈部血管与神经的关系及其与颈椎的距离,为颈椎病手术治疗中预防医源性血管和神经损伤提供帮助.设计以解剖学标本为实验对象,单一样本研究.单位一所医学院解剖教研室.对象2003-07/2004-05在长治医学院解剖教研室完成,成人防腐标本20具40侧(由长治医学院解剖教研室提供),男36侧,女4侧.方法观测了40侧成人标本颈部血管与神经的伴行关系,颈部血管的长度及起止点与相邻颈椎间的距离.主要观察指标①相关动脉与神经的伴行关系.②相关动脉的长度及其起止点与相邻颈椎的距离.结果20具标本40侧均进入结果分析.面动脉与舌神经伴行,起点距相邻椎体C3为(18.5±7.2)mm.舌动脉与舌下神经伴行,起点距相邻椎体C2～3为(19.7±8.4)mm.甲状腺上动脉与喉上神经外支伴行,起点距相邻椎体C3为(17.0±5.7)mm,止点距相邻椎体C5为(18.2±2.5)mm.喉上动脉与喉上神经内支伴行,起点距相邻椎体C3为(15.7±6.7)mm,止点距相邻椎体C3为(19.7±5.8)mm.甲状腺下动脉起点距相邻椎体C7为(17.3±5.5)mm,止点距相邻椎体C7为(11.3±3.4)mm.结论在颈椎病手术中,不同部位的手术途径,应该注意特定部位的解剖结构,以减少医源性血管、神经损伤.

Applied anatomy of the relation of the blood vessels and the nerves in the neck to cervical vertebrae

BACKGROUND: The operation on cervical spondylosis is usually done through anterolateral cervical vertebrae to mainly expose cervical vertebrae,intervertebral disc, hook joint and so on. The recent reports are mostly local studies. The observation data of the distance between cervical vertebrae and the corresponding nervus vascularis is limited.OBJECTIVE: The relation of the blood vessels and nerves to cervical vertebrae was observed in neck so as to prevent iatrogenic blood vessels and nerve injuries in the operation on cervical spondyloisis.DESIGN: A single sample trial based on the anatomic samples SETTING: The department of anatomy of a medical college PARTICIPANTS: The experiment was conducted in the Department of Anatomy of Changzhi Medical College from July 2003 to May 2004. Twenty adult antiseptic samples with 40 sides including 36 from males and 4 from the females supported by the Department of Human Anatomy, Changzhi Medical College.METHODS: The accompanying relation of the blood vessels to the nerves,the length of the blood vessels, and the distances from their starting point and end to the neighboring cervical vertebrae were observed and measured in 40 adult antiseptic samples of the neck.the distances from their starting point and end point to the neighboring cervical vertebrae.RESULTS: Totally, 40 sides of 20 samples entered the stage of the result analysis. The facial artery followed the lingual nerve, and the length from its starting point to the neighboring cervical vertebrae C3 was ( 18.5 ± 7.2) mm. The lingual artery followed the hypogolossal nerve, and the distance from its starting point of the lingual artery to C2 -3 was( 19.7 ± 8.4)mm. The superior thyroid artery followed the lateral branch of the superior laryngeal nerve, and the distance rom its starting to the point of the superior thyroid artery to C3 was (17.0 ± 5.7) mm, and the length from the end of the superior thyroid artery to C5 was (18.2 ± 2.5 ) mm. The superior laryngeal artery followed the medial branch of the superior laryngeal nerve, and the distances from its starting point and end point to C3 were( 15.7 ± 6.7) mm and(19. 7± 5.8) mm respectively. As for the inferior thyroid artery, the distances from its starting point and the end point to C7 were ( 17.3 ± 5.5 ) mm and ( 11.3 ± 3.4 ) mm respectively.CONCLUSION: In the operation on cervical spondylosis, attention should be paid to the anatomic stricture of the special position at different positions so as to reduce the iatrogenic blood vessels and nerve injuries.