头下斜肌切断术治疗枕大神经痛的解剖学研究  

Treatment of the Greater Occipital Nerve Neuralgia by Cutting the Obliquus Capitis Inferior：the Anatomy Study

作　　者：田云虎[1] 刘亚[1] 王学文[1] 刘文华[1] 陈雪英[1] 

机构地区：[1]潍坊医学院附属医院骨科,山东潍坊261031

出　　处：《潍坊医学院学报》2010年第4期244-246,共3页Acta Academiae Medicinae Weifang

摘　　要：目的 通过探讨枕大神经的走行以及与邻近组织的解剖关系,尤其与头下斜肌的关系,为枕大神经痛的诊断和治疗提供帮助.方法 对15例成人尸体标本进行解剖,观察枕大神经的走行,并分别测量头下斜肌切断前后颈椎后伸30°位（A1,B1）、中立位（A2,B2）、前屈30°位（A3,B3）、前屈60°位（A4,B4）枕大神经长度和张力的变化,并进行统计学处理.结果 颈椎中立位时,枕大神经的张力适中;后伸30°位时,枕大神经相对松弛,张力下降;前屈30°位时,枕大神经的第二段被拉长,张力逐渐增加;前屈60°位时,枕大神经的第二段拉长更明显,张力进一步增加.头下斜肌切断后,颈椎中立位,枕大神经的第一弯曲无明显上移;后伸30°位时,枕大神经的第一弯曲也无上移,甚至还会有轻度下移;前屈30°位及60°位时,枕大神经的第一弯曲均上移;后伸30°组（A1,B1）与中立位组（A2,B2）比较无显著差异;前屈30°位组（A3,B3）与中立位组（A2,B2）比较有显著差异;前屈60°位组（A4,B4）与中立位组（A2,B2）比较有显著差异.结论 切断头下斜肌可解除其对枕大神经的压迫刺激,增加了枕大神经的移动度,为手术治疗枕大神经痛提供了理论依据.Objective To explore the position and anatomy relation to the vicinity tissue of the greater occipital nerve, especially its relation to the obliquus capitis inferior, so as to provide the assistance for the diagnosis and treatment of the greater occipital nerve neuralgia. Methods Fifteen adult persons＇ cadaver specimens were dissected. The position of the greater occipital nerve was observed and the change of the length and tension of the greater occipital nerve was measured before and after the cutting of the obliquus capitis inferior（ at the following position ： cervical extension 30° （ A1, B 1 ）, neutral position （ A2, B2 ）, flexion 30° （ A3, B3 ）, flexion 60° ）. Results In cervical neutral position, the tension of the greater occipital nerve was moderate;in extension 30°position, the greater occipital nerve was relatively loose and the tension decreased;in flexion 30°position, the second segment was prolonged and the tension increased gradually;in flexion 60° ,the second segment was prolonged more severe and the tension increased more and more. After cutting the obliquus capitis inferior, in cervical neutral position,the first curvature of the greater occipital nerve did not move up obviously;in cervical extension 30°position,the first curva- ture of the greater occipital nerve did not move up and sometimes moved down slightly;in flexion 30°and 60°, the first curvature of the greater occipital nerve both moved up;no significant deviation was observed between the extension 30°group and the neutral position group; significant deviation was observed between the flexion 30°group and neutral position group;significant deviation was observed between the flexion 60° group and neutral position group. Conclusion Cutting the obliquus eapitis inferior can relief the compression to the greater occipital nerve, and increase its mobility,which provide theory base for treatment of greater occipital nerve neuralgia by surgery.

关 键 词：枕大神经 头下斜肌 松解术 

分 类 号：R681.5[医药卫生—骨科学]