枕髁形态学分类对下斜坡病变的手术意义  

Occipital Condyle： morphometric classcification and surgical significance for the lesions of lower clivus

作　　者：冯东侠[1] 叶富华[2] 徐卫东[2] 周新民[2] 高恒[2] 周良辅[1] 

机构地区：[1]上海复旦大学附属华山医院神经外科,200040 [2]东南大学微侵袭神经外科研究所,江苏江阴市

出　　处：《中华神经外科杂志》2007年第4期253-256,共4页Chinese Journal of Neurosurgery

基　　金：江苏省青年科技基金资助项目（BQ20000022）

摘　　要：目的通过对国人颅骨的枕髁和枕大孔进行解剖测量和分析，提出枕髁的形态学分类方法，为枕下外侧入路处理下斜坡和枕大孔腹侧病变的手术中，是否需要磨除枕髁提供解剖学依据。方法在100例成人颅骨标本和20例成人3D—CT上，测量枕大孔和枕髁的相关解剖数据，观察分析两者的相对位置关系，按枕髁分类指数（OCindex）进行分类，并对各类枕髁（组）磨除后部1／3，前、后的手术观察角度进行统计学对比分析。结果100例成人颅骨标本分为Ⅰ型（小枕髁型8．0％），Ⅱ型（中枕髁型74％），Ⅲ型（大枕髁型18％）。Ⅰ型中磨除枕髁后部1／3，前后观察角度无统计学意义（P〉0．05），但在Ⅱ型（P〈0．05）和Ⅲ型中有统计学意义（P〈0．01）。结论枕髁的形态学变异较大。术前应用3D—CT明确枕髁的形态学类型，对手术中是否需要磨除枕髁具有指导意义。Objective The classification protocol of occipital condyle （ OC ） was established based on the morphometric measurements and analysis for the OC and foramen magnum （FM） , to provide scientific basis in determining whether or not partially remove the OC, for the lesions of lower clivus by suboccipitallateral approach. Methods The correlated anatomical structures were measured and evaluated in 100 dry adult skulls and 20 measurements obtained from three-dimensional computed tomography （3 D-CT） , including the length of FM（FML） ,the width of FM（FMW） ,anterior-posterior distance of OC（AOCP） and Axis of OC （OCA）. The OC classification index （OC index） was defined as the ratio of AOCP/FML. After morphological classification for 100 skull specimens, the viewing angle of pre and post-drilling of posterior 1/ 3 condyle were statistically compared in each group. Results In cadaveric study the mean distance of FML, FMW,AOCP and OCA were （34.81 ±2.24） mm, （29. 11 ±2.24）mm, （15.99 ± 1.66）mm, （23.92 ± 2.44） mm respectively. According on 3D-CT measurements their mean data were （34.79 ± 1.77）mm, （29.19 ±2.24）mm,（ 16.05 ± 1.68）mm,（4.78 ±2.39）mm. Based on the OC index, the 100 skulls were classified into type Ⅰ （ small condyle, 8.0% ）, type Ⅱ （ middle condyle, 74% ） and typeⅢ （ large condyle, 18% ）. There was no statistical difference between the pre and post-drilling viewing angle in type Ⅰ group（P 〉 0.05 ）, but statistical difference was demonstrated in type 11 （P 〈 0.05 ）and particularly significant in type m group （ P 〈 0.01 ）. Conclusion Great morphometric variations were found in occipital condyle. Identifying the type of condyle using preoperative 3D-CT scans, was indispensable for the surgical planning in dealing with the lesions of lower clivus.

关 键 词：枕髁 分类 斜坡 手术 

分 类 号：R686[医药卫生—骨科学]