颈2神经根及其周围静脉丛的临床应用解剖学研究  

Applied anatomy study of C2 nerve root and its surrounding venous plexus

作　　者：雷维维[1] 李俊杰[1] 胡译心 彭林[1] 石瑾[1] 曹阳[1] 刘俊露 陈磊[1] 漆松涛[1] 陆云涛[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2017年第9期931-934,共4页Chinese Journal of Neurosurgery

摘　　要：目的研究寰枢椎（C1/2）侧方关节处C2神经根及其周围静脉丛问的解剖学构成，探讨寰枢椎脱位时行C1/2内固定的最佳手术方式。方法取6具成人头颈标本，解剖显露双侧C2神经根及其周围静脉丛，显微镜下观察其构成，并行相关解剖学测量和分析。结果C1/2侧方关节周围静脉丛丰富，内侧部分静脉丛覆盖于正常硬膜表面，其间有明显的膜性分隔。C2神经根自内上向外下呈斜行穿过静脉丛，静脉丛总宽度为（21．1±2．1）mm；其内侧缘距后正中线的距离为（5．7±1．3）mm，沿其内侧膜性边界可安全剥离静脉丛，最大限度剥离后距后正中线的距离为（14．1±1．0）mm；枢椎椎弓根中点与静脉丛内、外侧的距离分别为（10．7±2．1）mm和（5．9±1．2）mm；C2神经根与穿出侧静脉丛上、下端的距离分别为（6．3±1．3）mm和（2．6±0．6）mm。清理静脉丛并离断C2神经根后，可显示完整的C1/2侧方关节，可显露的C1侧块的高度和宽度分别为（6．6±0．3）mm和（13．7±0．5）mm；C2上关节突的高度为（4．9±0．3）mm，其椎弓根宽度为（8．2±0．3）mm。结论详细了解C2神经根及其周围静脉丛的解剖对手术有指导意义。根据相关解剖数据，行C1/2螺钉固定和关节间松解并植骨时，沿枢椎椎弓根中点处离断C2神经根，可达到最大范围的显露，并减少静脉性出血。Objective To study the anatomical structure of cervical 2 nerve root and its surrounding venous plexus at the lateral joint of atlantoaxial joint, and to explore the optimal operation mode of atlantoaxial dislocation and fixation with cervical screws. Methods Six adult head and neck specimens were perfused. The bilateral C2 nerve roots and their surrounding venous plexuses were dissected and observed under microscope. Measurement and analysis of related anatomical structures were performed. Results Atlantoaxial lateral posterior joint was rich in venous plexus. The medial part of the venous plexus covered the normal dura mater and had a clear membrane boundary. The C2 nerve root coursed inside the venous plexus from the medial superior side towards lateral inferior direction. The total width of the plexus was 21.1 ± 2.1 mm. The distance from the medial border of the venous plexus to the posterior median line was 5.7 ± 1.3 mm. After sufficient dissection of plexus from the dura mater, the distance was increased to 14.1 ± 1.0 mm. The distance from the middle line of C2 pedicle to the lateral and median side of venous plexus was 10.7± 2.1 mm and 5.9 ±1.2 mm, respectively. The upper and lower distances between C2 nerve root and lateral margin of plexus were 6.3 ± 1.3 mm and 2.6 ± 0.6 mm, respectively. Atlantoaxial lateral facet joint was exposed after cleaning of venous plexus and dissection of C2 nerve root. The height and width of exposed C1 lateral joint were 6.6± 0.3 mm and 13.7 ± 0.5 mm, respectively. The height of exposed superior articular process of C2 was 4.9 ± 0.3 mm, and the width of C2 pedicle was 8.2 ±0.3 mm. Conclusions It is of significance in instructing surgical operations to clearly understand the anatomy of C2 nerve root and its surrounding venous plexus. During implantation of C1 lateral mass screw and C2 pedicle screw, the incision along the middle line of C2 pedicle to dissect the C2 nerve root could provide maximal exposure and help reduce venous bleeding.

关 键 词：颈2神经根 静脉丛 C1/2侧方关节 解剖学 

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