经口咽至斜坡区手术入路的应用解剖学  

Applied anatomy of the oropharynx approach to the clivus

作　　者：纪荣明[1] 李玉泉[1] 张煜辉[1] 熊剑[2] 刘波[1] 周晓平[2] 黄章翔[1] 李亮[1] 陈志刚[1] 金玲艳[1] 王群超[1] 

机构地区：[1]第二军医大学解剖学教研室 [2]长海医院神经外科,上海200433

出　　处：《中国临床解剖学杂志》2003年第6期549-551,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的 :为经口咽至斜坡区的手术入路提供解剖基础。方法 :整颅 60个 ,颅的水平切面 2 0个 ,正中矢状切面 2 0个 ;头颈部尸体标本 2 5个 ,其中 10个行正中矢状切面。测量切牙孔、前、后鼻棘至咽结节的距离 ;咽结节、正中线与卵圆孔、颈静脉、颈动脉管外口和舌下神经管外口内缘以及与枕骨大孔前端的间距 ;测量斜坡高及其上、中、下段的厚度。斜坡区硬膜的厚度以及观测蝶窦与斜坡的位置关系等。结果 :正中线距卵圆孔内侧缘、破裂孔、颈动脉管外口、舌下神经管外口内侧缘分别为 2 3 .3 3± 2 .0 4mm ,10 .5 4±2 .65mm ,2 5 .2 4± 2 .85mm和 17.18± 1.86mm。斜坡的高和上、中、下段的厚度分别为 3 4.63± 4.3 6mm和 17.78± 3 .72mm ,10 .46± 2 .40mm ,7.3 6± 1.91mm。结论 :切牙孔或前鼻棘至咽结节的深度为 70 .99mm和 78.2 7mm ,切开咽后壁至颅底外面 ,以咽结节为圆心 ,以 2 0mm为半径作圆行斜坡区开骨窗 ,可有效防止伤及舌下神经。Objective: To provide anatomical basis for operation from oropharynx to clivus. Methods: whole skull specimens were employed : 60 horizontal planes , 20 median sagittal planes. In addition 25 normal adult skull-neck specimens including 10 median sagittal plane were taken as complement. The distance from incisive foramen, anterior and posterior nasal spina to pharynxgeal tubercle, from central line to oval foramen, to lateral border of jugular foramen, to outer entrance of carotid canal, to inner border of outer entrance of hypoglossal canal and to anterior part of great occipital foramen were measured. The height of slope and the thickenss of its upper, middle and lower part were measured, as well the thickenss of dura mater of clivus and position relation between sphenoidal sinus and clivus were explored too. Results: The distance from central line to inner border of oval foramen, to lacerated foramen, to outer entrance of carotid canal and to inner border of outer entrance of hypoglossal canal were 23.33±2.04 mm, 10.54±2.65 mm, 25.24±2.85 mm, and 17.18±1.86 mm respectively. The height of clivus and the thickness of its upper, middle and lower part were 34.63±4.36 mm, 17.78±3.72 mm, 10.46±2.40 mm and 7.36±1.91 mm respectively. Conclusions: The depths from incisive foramen and anterior nasal spina to pharyngeal tubercle are 70.99 mm and 78.27 mm. After cutting retropharyngeal to outer part of base of skull and making a window in the clivus region which centered with pharyngeal tubercle and definited the radius of 20 mm, the damages to hypoglossal nerve, internal carotid artery can be effectively avoid in operation of this area.

关 键 词：颅底 斜坡 手术入路 应用解剖 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]