15具人尸枕动脉解剖  

Occipital artery anatomy in 15 cadavers

作　　者：韩永刚[1] 高亦深 孙明阳[1] 佟小光[2] 

机构地区：[1]天津医科大学研究生院,天津300000 [2]天津市环湖医院

出　　处：《山东医药》2015年第7期5-7,I0001,共4页Shandong Medical Journal

基　　金：天津市科技计划项目(13ZCZDSY01600)

摘　　要：目的观察15具人尸的枕动脉解剖特点,探讨以枕动脉作为颅内—颅外后循环搭桥术的桥血管时,如何安全准确获取该血管。方法采用远外侧入路,开颅显微解剖15例尸头共30侧枕动脉,观察枕动脉的起源、行程、分支、邻近结构,并测量枕动脉各段的直径、椎动脉V3的直径、可移植段的长度以及与周围临近结构的距离。结果枕动脉一般在二腹肌后腹下缘起源于颈外动脉后壁或外壁,与颈外动脉平行、沿二腹肌后腹向上,然后转向二腹肌后腹深面,内侧紧邻颈内静脉,行于寰椎横突前上方,接近乳突尖或二腹肌沟转向内侧走行,途中经胸锁乳突肌、头夹肌和头最长肌深面(4侧经胸锁乳突肌、头夹肌深面及头最长肌浅面),在上项线下方的头半棘肌后面继续向内侧行走,经过斜方肌、头半棘肌的上方附着点,在此穿过斜方肌的附着点至上项线,与枕大神经相伴,继续在头皮浅筋膜内上行,并分出一个或两个终末支,远端分布于头皮。枕动脉起点直径为(2.3±0.3)mm,平行于寰椎横突上缘至越过上项线处的长度为(93.2±2.6)mm,平行于寰椎横突上缘处的外径为(1.9±0.4)mm,越过上项线处的外径为(1.8±0.3)mm。椎动脉V3段中点的直径为(3.2±1.4)mm,枕动脉距枕外隆突的距离为(21.4±0.9)mm,枕下段距离上项线最远距离为(23.7±1.2)mm。结论颅内—颅外后循环搭桥术术中以枕外隆突外侧25 mm、上项线下方30 mm以内、乳突、寰椎横突为标志,能安全准确获取枕动脉。Objective To observe the anatomical features of occipital arteries in 15 cadavers, and to discuss how to obtain the occipital artery effectively in the posterior circulation vascular bypass operation by using occipital artery as the bridge vessel .Methods Using craniotomy to dissect 30 occipital arteries in 15 cadaveric heads in the far lateral ap-proach, and we observed the origin , course branches and adjacent structures .The diameter of the occipital artery segments and vertebral artery , and the distance from the adjacent structures were measured .Results The occipital artery at the two abdominal ventral posterior inferior originated from external carotid artery wall or the outer wall , and accompanied by greater occipital nerve , continued to uplink to the scalp in the superficial fascia , and separated one or two terminal or distal bran-ches distributing on the scalp .The diameter of starting point of the occipital artery was （2.3 ±0.3） mm, the length of the occipital artery which paralleled to the superior border of transverse process and crossed the superior nuchal line was （93.2 ±2.6） mm, and the outer diameter of vertebral artery which paralleled to the superior border of transverse process was （1.9 ±0.4） mm, the outer diameter of vertebral artery which crossed the superior nuchal was （1.8 ±0.3） mm.The mid-point diameter of V3 segment of vertebral artery was （3.2 ±1.4） mm, the distance from occipital artery to the external oc-cipital protuberance was （21.4 ±0.9） mm, and the maximal distance from OA to SNL is （23.7 ±1.2） mm.Conclusion In the intra-extra posterior circulation bypass surgery , the occipital artery could be safely and accurately obtained by u-sing lateral 25 mm from the external occipital protuberance , within 30 mm bellow SNL , the mastoid process and transverse process of the atlas as the markers .

关 键 词：后循环搭桥术 桥血管 显微解剖 枕动脉 血管重建 

分 类 号：R622.4[医药卫生—整形外科]