一侧额颞顶大骨瓣开颅术的应用解剖学研究  

Applied anatomy of large unilateral frontotemporoparietal decompressive craniectomy

作　　者：张国清[1] 刘佰运[2] 殷金珠[1] 张贺春[1] 王俊平[1] 黄建军[1] 

机构地区：[1]大同煤矿集团有限责任公司总医院神经外科,山西省大同市037003 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《中华神经外科杂志》2017年第8期838-841,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81171144,81471238）

摘　　要：目的 研究国人一侧额颞顶的解剖结构,为大骨瓣开颅手术入路提供解剖依据.方法 选取15例灌注尸头,模拟一侧额颞顶大骨瓣开颅手术,逐层解剖、确定解剖标志,并测量相关数据.结果 皮肤切口绕过顶结节后缘的最远点距外耳道的垂直距离为（79.90 ±4.06） mm;鼻根和枕外粗隆连线的中点距颧弓中点的距离为（144.60±4.73） mm;眉弓距顶结节的距离为（163.50±4.75）mm;骨窗中上矢状窦蛛网膜颗粒最远点距中线的距离为（19.62±3.98）mm;颧弓上缘距外侧裂静脉汇入蝶顶窦的垂直距离为（25.26 ±3.77）mm.结论 为了达到充分的减压效果,皮肤切口的设计应绕过顶结节最远点而且与外耳道的垂直距离应≥8 cm,骨窗应开在距离中线的2 cm处,向下的骨缘位于颧弓上缘安全可行.Objective To study the anatomy of unilateral frontotemporoparietal structures of the Chinese people and to provide the anatomical basis for approach design in large craniectomy.Methods Large unilateral frontotemporoparietal decompressive craniectomy were performed on 15 corpse skulls.Through dissection layer by layer,anatomical landmarks were identified and relevant data were documented.Results The vertical distance between the distal point of posterior edge of parietal eminence and the external auditory canal was 79.90 ± 4.06 mm.The distance from the midpoint between nasal root and external occipital protuberance to the midpoint of zygomatic arch was 144.60 ± 4.73 mm.The distance between the eyebrow arch and the parietal eminence was 163.50 ±4.75 mm.Within the bone window,the longest distance between arachnoid granulation in the superior sagittal and midline was 19.62 ± 3.98 mm.The vertical distance between the superior margin of zygomatic arch and the point where the Sylvian vein drains into sphenoparietal sinus was 25.26 ± 3.77 mm.Conclusions In order to achieve adequate decompression,the vertical distance from the farthest point of skin incision around parietal eminence to the external auditory canal should not be less than 8 cm,the bone window could be 2 cm from the midline,and the lower margin of the bone could be located at the upper margin of zygomatic arch.

关 键 词：颅骨学 解剖学 去骨瓣减压术 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R651.1[医药卫生—基础医学]