中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2014年
8期
811-814
,共4页
颈背部肌群%脊神经后支%副神经
頸揹部肌群%脊神經後支%副神經
경배부기군%척신경후지%부신경
Neck back muscles%Dorsal branch of spinal nerve%Accessory nerve
目的 为痉挛性斜颈的手术治疗提供显微解剖参数.方法 通过对成人防腐尸头(8例,16侧)颈背部肌肉及C1～6脊神经后支的解剖学研究,对各肌肉的层次、走行及神经的走行、分支、直径等情况进行描述.结果 (1)颈背部肌肉可分为四层.第一层:胸锁乳突肌和斜方肌,第二层:头夹肌、颈夹肌和肩胛提肌,第三层:头半棘肌、颈半棘肌和头最长肌,第四层:称为枕下短肌群,有头后大直肌、头后小直肌,头上斜肌、头下斜肌.(2)除C1、C2外,各颈部脊神经后支均向后行.各支直径:左侧C1:0.87～1.62 mm(1.28±0.33) mm;C2:2.64～3.92 mm(3.12 ±0.49) mm;C3:1.56 ～2.11 mm(1.79±0.20) mm;C4:0.91～1.98 mm(1.41 ±0.46) mm;C5:0.92～1.39 mm(1.16±0.19)mm;C6:0.93～1.36 mm(1.14 ±0.24) mm.右侧 C1:0.92～1.49 mm(1.23 ±0.23) mm;C2:2.81 ～3.93 mm(3.19 ±0.43)mm;C3:1.52～1.92 mm(1.72 ±0.17) mm;C4:1.02～2.01 mm(1.42±0.39)mm;C5:0.89～ 1.63 mm(1.17±0.31)mm;C6:0.81～1.39 mm(1.17±0.23)mm.(3)在头半棘肌和颈半棘肌间隔内可观察到C2～6脊神经后支.(4)副神经在距离耳大神经出胸锁乳突肌后缘处上方约2 cm浅出于颈后三角区域,其穿出胸锁乳突肌后缘处的外径:左侧1.93 ～2.37 mm(2.10±0.18)mm;右侧1.89～2.23 mm(2.09 ±0.14)mm.结论 颈背部肌肉和颈部脊神经的上述解剖关系可为后颅颈部手术提供依据,特别是为颈部脊神经后支切断治疗痉挛性斜颈的手术中提供重要参考.
目的 為痙攣性斜頸的手術治療提供顯微解剖參數.方法 通過對成人防腐尸頭(8例,16側)頸揹部肌肉及C1～6脊神經後支的解剖學研究,對各肌肉的層次、走行及神經的走行、分支、直徑等情況進行描述.結果 (1)頸揹部肌肉可分為四層.第一層:胸鎖乳突肌和斜方肌,第二層:頭夾肌、頸夾肌和肩胛提肌,第三層:頭半棘肌、頸半棘肌和頭最長肌,第四層:稱為枕下短肌群,有頭後大直肌、頭後小直肌,頭上斜肌、頭下斜肌.(2)除C1、C2外,各頸部脊神經後支均嚮後行.各支直徑:左側C1:0.87～1.62 mm(1.28±0.33) mm;C2:2.64～3.92 mm(3.12 ±0.49) mm;C3:1.56 ～2.11 mm(1.79±0.20) mm;C4:0.91～1.98 mm(1.41 ±0.46) mm;C5:0.92～1.39 mm(1.16±0.19)mm;C6:0.93～1.36 mm(1.14 ±0.24) mm.右側 C1:0.92～1.49 mm(1.23 ±0.23) mm;C2:2.81 ～3.93 mm(3.19 ±0.43)mm;C3:1.52～1.92 mm(1.72 ±0.17) mm;C4:1.02～2.01 mm(1.42±0.39)mm;C5:0.89～ 1.63 mm(1.17±0.31)mm;C6:0.81～1.39 mm(1.17±0.23)mm.(3)在頭半棘肌和頸半棘肌間隔內可觀察到C2～6脊神經後支.(4)副神經在距離耳大神經齣胸鎖乳突肌後緣處上方約2 cm淺齣于頸後三角區域,其穿齣胸鎖乳突肌後緣處的外徑:左側1.93 ～2.37 mm(2.10±0.18)mm;右側1.89～2.23 mm(2.09 ±0.14)mm.結論 頸揹部肌肉和頸部脊神經的上述解剖關繫可為後顱頸部手術提供依據,特彆是為頸部脊神經後支切斷治療痙攣性斜頸的手術中提供重要參攷.
목적 위경련성사경적수술치료제공현미해부삼수.방법 통과대성인방부시두(8례,16측)경배부기육급C1～6척신경후지적해부학연구,대각기육적층차、주행급신경적주행、분지、직경등정황진행묘술.결과 (1)경배부기육가분위사층.제일층:흉쇄유돌기화사방기,제이층:두협기、경협기화견갑제기,제삼층:두반극기、경반극기화두최장기,제사층:칭위침하단기군,유두후대직기、두후소직기,두상사기、두하사기.(2)제C1、C2외,각경부척신경후지균향후행.각지직경:좌측C1:0.87～1.62 mm(1.28±0.33) mm;C2:2.64～3.92 mm(3.12 ±0.49) mm;C3:1.56 ～2.11 mm(1.79±0.20) mm;C4:0.91～1.98 mm(1.41 ±0.46) mm;C5:0.92～1.39 mm(1.16±0.19)mm;C6:0.93～1.36 mm(1.14 ±0.24) mm.우측 C1:0.92～1.49 mm(1.23 ±0.23) mm;C2:2.81 ～3.93 mm(3.19 ±0.43)mm;C3:1.52～1.92 mm(1.72 ±0.17) mm;C4:1.02～2.01 mm(1.42±0.39)mm;C5:0.89～ 1.63 mm(1.17±0.31)mm;C6:0.81～1.39 mm(1.17±0.23)mm.(3)재두반극기화경반극기간격내가관찰도C2～6척신경후지.(4)부신경재거리이대신경출흉쇄유돌기후연처상방약2 cm천출우경후삼각구역,기천출흉쇄유돌기후연처적외경:좌측1.93 ～2.37 mm(2.10±0.18)mm;우측1.89～2.23 mm(2.09 ±0.14)mm.결론 경배부기육화경부척신경적상술해부관계가위후로경부수술제공의거,특별시위경부척신경후지절단치료경련성사경적수술중제공중요삼고.
Objective To provide the microanatomy for surgical operation for spastic torticollis.Methods Through the anatomy research of adult embalmed cadaver (8 cases,16 sides) to description the layer、course、beginning and ending points of muscle and the ramification course、distribution and diameter of spinal nerve dorsal rami nerve.Results Neck back muscles can be divided into four layers.The first layer are trapezius muscle and sternocleidomastoid; The second are splenius capitis muscle、splenius cervicis and levator scapulae muscle; The third layer are semispinalis capitis muscle、semispinalis cervicis muscle and longissimus capitis muscle; The last layer are obliquus capitis superior、obliquus capitis inferior、rectus capitis posterior major and rectus capitis posterior minor.Except C1 、C2 the others dorsal branch of spinal nerve are traveling backward.The diameter of the dorsal branch(mm):Left C1:0.87-1.62 mm(1.28 ±0.33) mm;C2:2.64-3.92 mm(3.12 ±0.49) mm;C3:1.56-2.11 mm(1.79 ±0.20) mm;C4:0.91-1.98 mm(1.41 ±0.46)mm;C5:0.92-1.39 mm(1.16 ±0.19)mm;C6:0.93-1.36 mm (1.14 ±0.24)mm.Right C1:0.92-1.49 mm(1.23 ±0.23) mm;C2:2.81-3.93 mm(3.19 ±0.43) mm; C3:1.52-1.92 mm (1.72 ± 0.17) mm ; C4:1.02-2.01 mm (1.42 ± 0.39) mm ; C5:0.89-1.63 mm (1.17 ± 0.31) mm; C6:0.81-1.39 mm (1.17 ± 0.23) mm.The C2-6 spinal nerve dorsal rami can be observed in the gap between semispinalis capitis and semispinalis cervicis muscle.Accessory nerve at a distance about 2 cm where great auricular nerve pierce the back edge of stemocleidomastoid muscle,the accessory nerve appear in the posterior cervical triangle.The diameter of accessory nerve which pierce the back edge of stemocleidomastoid muscle is 1.93-2.37 mm(2.10 0.18)mm (Left) ; 1.89-2.23 mm (2.09 0.14)mm (Right).Conclusions The above-mentioned anatomic relations of neck back muscles and spinal nerves can be provided foundation for post-cranial and neck surgery.Especially for the spinal nerve dorsal branch cut to treatment spastic torticollis provide an important reference.
