喉返神经在颈椎前入路手术中的应用解剖学研究  

Applied Anatomy Research of Recurrent Laryngeal Nerve in Anterior Cervical Approach Operation

作　　者：骆明炎 范伟杰[1] 谢兴国[2] 吴亚琼 唐芳[1] 周可为[1] 

机构地区：[1]南华大学附属第一医院骨科,湖南衡阳421001 [2]川北医学院解剖学教研室 [3]正阳县人民医院

出　　处：《中南医学科学杂志》2015年第5期529-531,共3页Medical Science Journal of Central South China

摘　　要：目的为临床颈椎前入路手术保护喉返神经提供解剖学依据。方法取成人尸体标本40具（男23,女17）,共80侧。在颈动脉鞘与气管食管间的颈根部找到喉返神经,测量各侧喉返神经起点、入气管食管沟点和入喉第一分支点各部横径及其与颈椎对应的位置关系。结果右侧喉返神经在T2椎体水平绕右锁骨下动脉上行,T1椎体水平自颈动脉鞘内侧缘穿出椎前筋膜,C7T1椎体水平向内、上、前进入气管食管沟;左侧喉返神经在T4椎体水平绕主动脉弓上行,在T2椎体水平进入气管食管沟,在沟内行走无脏筋膜穿入点,双侧喉返神经入喉第一分支在C6椎体水平。结论左侧喉返神经的解剖结构比右侧相对恒定,C3~C7颈椎手术选择左侧前入路较右侧更利于保护喉返神经。Objective To provide anatomical basis for anterior approach to cervical spine surgery protecting the recurrent laryngeal nerve. Methods Forty formalin-fixed adult cadavers（ 23 male/17female） were dissected bilaterally to expose the path of the recurrent laryngeal nerve（ RLN）. The starting point,the first branch and the entering tracheoesophageal groove point were observed corresponding with vertebral body level. Results The right RLN looped around the subclavian artery at the level of T2. It crossed the prevertebral fascia from the carotid sheath medial border at T1 level,entered the tracheoesophageal groove at C7-T1 level and entered the larynx at C6. The left RLN looped around the aortic arch at T4 level,entered the tracheoesophageal groove at T2 level and entered the larynx at C6 level. The RLN traveled superiorly,slightly anterior to the tracheoesophageal groove and its diameter tapered. The first branch diameter minimum value is 0.02 mm. The starting point of RLN diameter maximum value is 4. 76 mm. Conclusions The left RLN anatomical structure is relatively more constant than the right side. The left or right anterior approach to cervical spine surgery at or superior to C7 level is safe,but inferior to C7 level the left anterior approach is better. Mastering the anatomical characteristics of RLN is important to reduce the iatrogenic injury.

关 键 词：颈椎 前入路手术 喉返神经 解剖 

分 类 号：R681.55[医药卫生—骨科学]