远外侧入路不同部位骨质切除与显露范围的对比研究  

Comparative study of bone resection of different positions and exposure extent via far lateral approach

作　　者：陈源锋[1,2] 伊志强[1] 鲍圣德[1] 

机构地区：[1]北京大学第一医院神经外科,100034 [2]龙岩市第二医院神经外科,364000

出　　处：《中国微侵袭神经外科杂志》2012年第1期36-38,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的量化分析枕下远外侧入路中不同部位骨质切除与其相对应的显露范围的差别。方法 15例(30侧)经福尔马林固定的成人头颅湿标本模拟基础远外侧入路,行骨窗成形后分为3组:分别模拟经髁入路、髁旁入路及髁上入路,比较其对应的显露范围。结果基础远外侧入路对斜坡方向显露范围为(15.77±1.67)mm,对枕骨大孔前缘向侧方的显露范围为(-1.85±0.63)mm,距颈静脉孔后缘手术距离为(11.23±0.46)mm,距枕骨大孔前缘的手术距离为(21.78±1.49)mm。与基础远外侧入路比较,经髁入路显著增加斜坡方向和枕骨大孔前缘方向的显露范围,明显缩短距枕骨大孔前缘的手术距离(P<0.05);髁旁入路明显缩短距颈静脉孔后缘的手术距离(P<0.05);髁上入路显著增加斜坡方向的显露范围(P<0.05)。结论磨除枕髁可显著增加枕骨大孔腹侧和下斜坡的显露,磨除颈静脉结节可显著增加中斜坡的显露,磨除髁旁骨质可显著增加颈静脉孔区的显露。Objective To quantitatively analyze the difference between bone resections of different positions and their corresponding exposure extent via far-lateral suboccipital approach. Methods Fifteen specimens of adult cadaveric heads （30 sides） were fixed with formalin and used to stimulate basic far lateral approach, and divided into 3 groups after bony window plasty. The specimens were treated via simulated transcondylar approach, paracondylar approach and supracondylar approach respectively, and their corresponding exposure extent were observed and compared. Results In the basic far lateral approach, the exposure distance in the clival direction was 15.77±1.67 mm, the exposure distance in the contralateral direction of the anterior margin of the foramen magnum was -1.85 ± 0.63 mm, the surgical distance to the posterior margin of the jugular foramen was 11.23 ±0.46 ram, and the surgical distance to the anterior margin of the foramen magnum was 21.78± 1.49 mm. Compared with the basic far lateral approach, the transcondylar approach obviously increased the exposure distance in the clival and direction of the forariaen magnum anterior margin and obviously shorten the surgical distance to the anterior margin of foramen magnum （P〈0.05）, the paracondylar approach obviously shorten the surgical distance to the posterior margin of the jugular foramen （P〈0.05）, the supracondylar approach obviously increased the exposure distance in the clival direction （P〈0.05）. Conclusions Occipital condyle resection can significantly augment the exposure of the ventral foramen magnum and lower clivus. JUgular eminence resection can significantly augment the exposure of the middle clivus. Paracondylar bone resection can significantly augment the exposure of jugular foramen area.

关 键 词：远外侧人路 显露范围 量化研究 

分 类 号：R651.1[医药卫生—外科学]