成人颈椎小关节间隙穿刺路径的应用解剖  

Clinical anatomy of the facet joint puncture in adult cervical vertebra

作　　者：张贵源[1] 朱文仁[2] 杨兵[2] 闫军浩[3] 王建伟[3] 张卫光[3] 

机构地区：[1]黔南民族医学高等专科学校外科学教研室,贵州都匀558003 [2]黔南民族医学高等专科学校人体解剖学教研室,贵州都匀558003 [3]北京大学医学部人体解剖学与组织胚胎学系,北京100191

出　　处：《解剖学报》2012年第6期789-791,共3页Acta Anatomica Sinica

摘　　要：目的探讨颈椎小关节的关节类型、关节角大小、关节面倾角等,为临床行颈椎间隙穿刺提供可参考的路径。方法采用正常成人脊柱标本38例(男27、女11),通过断层解剖方法,从横断面上对C2-3～C6-7关节类型、关节角进行观测,并对40套成人椎骨标本的颈椎小关节关节面倾角及形态进行观测。结果 C2-3～C6-7关节类型主要为平面椭圆形(79.2%)和曲面形(20.8%);自C2-3至C6-7颈椎关节突的关节角逐渐增大;关节面倾角C3>C4>C5<C6<C7,倾角值呈"U"分布;关节中部位置在颈部后正中线外侧,相应上下颈椎棘突后缘中点之间,与后正中线距离由上到下逐渐增加;穿刺路径经皮肤、浅筋膜、项韧带和头夹肌至关节囊后壁。结论颈椎小关节穿刺应根据关节类型、关节角大小、关节面倾角选择相应颈椎间隙中点的外17.2～20.5mm(平均18.8 mm)处进行,穿刺方向选择尾倾55°～67°(平均60°)斜向上推进。Objective To study the type, the angle and the obliquity of facet joints and to identify the approach for the facet joint puncture in adult cervical vertebra. Methods Thirty eight spines of 27 male and 11 female cadavers were used to observe the type and angle of C_（2-3）-C_（6-7） on the transverse section. The obliquity and shape of the facet joint were also studied in 40 adult＇cadaveric spines. Results The joints in C_（2-3）-C_（6-7） were classified as the plane oval（79. 2% ） or curved surface（20. 8% ） types. The joint angles and articular processes were gradually increased from C_（2-3） to C_（6-7）. The obliquities of joint planes were C3 〉 C4 〉 C5 〈 C6 〈 C7, and their values were distributed as a ＂U＂ shape. The middle part of the joints was located at the outside of the posterior midline and at the midpoints between spinous processes of cervical vertebra. The distance from the middle part to the posterior midline increased gradually downward from 17.19mm, 17.51mm, 18.76mm, 19.83mm to 20.52mm. The tissue layers during the puncture approach went through skin, superficial fascia, ligamentum nuchae, splenius capitis muscle and the posterior of joint capsule. Conclusion In adult cervical vertebra, facet joint puncture should be performed at the outside （17.2-20. 5mm） of the midpoint between corresponding cervical space according to the type, the angle and the obliquity of joint plane. The puncture direction should be caudally tilted at 55°-67°（ average 60°） and advanced obliquely cranially.

关 键 词：颈椎小关节 关节类型 关节角 穿刺路径 应用解剖学 人 

分 类 号：R332[医药卫生—人体生理学]