内镜经口入路寰枢椎解剖及临床可行性研究

doi:10.6040/j.issn.1673-3770.0.2016.015

山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (3): 47-51.doi: 10.6040/j.issn.1673-3770.0.2016.015

内镜经口入路寰枢椎解剖及临床可行性研究

谢畅¹,颜滨²,李建兴³,卢永田¹

1.安徽医科大学深圳第二人民医院临床学院耳鼻咽喉头颈外科, 广东深圳 518035;
2.深圳市第二人民医院脊柱外科, 广东深圳 518035;
3.深圳市龙华新区中心医院耳鼻咽喉头颈外科, 广东深圳 518110

收稿日期:2016-01-16 出版日期:2016-06-16 发布日期:2016-06-16
通讯作者: 卢永田. E-mail:lutongtian@263.net E-mail:1216836358@qq.co
作者简介:谢畅. E-mail:1216836358@qq.co
基金资助:
深圳市科技研发资金项目(JCYJ20150330102720136)

Anatomical and clinical evaluation of the endoscopic transoral transpharyngeal approach to the atlantoaxial.

XIE Chang¹, YAN Bin², LI Jianxing³, LU Yongtian

1. Department of Otolaryngology &Head and Neck Surgery, Shenzhen Second Peoples Hospital of Clinical College, Anhui Medical University, Shenzhen 518035, Guangdong, China;2. Department of Spine Surgery, Shenzhen Second Peoples Hospital Clinical College, Shenzhen 518035, Guangdong, China;3. Department of Otolaryngology &Head and Neck Surgery, Central Hospital of Longhua New District, Shenzhen 518110, Guangdong, China

Received:2016-01-16 Online:2016-06-16 Published:2016-06-16

摘要/Abstract

摘要： 目的通过内镜经口入路研究寰枢椎解剖,探索寰枢椎腹侧病灶清除、减压及临床内固定应用可行性。方法在5 具完整灌注尸头标本上行内镜模拟手术,并行寰枢椎CT测量。结果 (1) 内镜经口可显露寰枢椎腹侧,包括:寰椎、枢椎椎体,寰椎前弓、侧块,齿突及两侧椎动脉;(2) 上方常规可显露至寰椎前弓上缘或斜坡下部,下方可显露至C2/3椎间盘或C3椎体上部,两侧安全边界可界定:上方为寰枢侧块关节外缘,下方为枢椎体外缘。(3) CT数据测量结果示:寰椎前弓长度(19.5±2.8)mm、寰椎前结节厚度(8.0±0.4)mm、寰椎侧块横径(左)(12.7±2.3)mm、寰椎侧块横径(右)(12.7±1.6)mm、寰椎侧块矢状径(左)(15.0±2.5)mm、寰椎侧块矢状径(右)(15.3±1.4)mm、寰椎横突孔内侧间距(47.2±1.6)mm、寰椎横突孔外侧间距(60.4±1.4)mm、齿突后倾角(10.2±1.3)°、枢椎横突孔内侧间距(29.2±1.7)mm、枢椎横突孔外侧间距(44.3±1.6)mm。结论内镜经口寰枢椎手术入路简单、视野清晰、操作方便、创伤小、术后恢复快,符合当前临床发展趋势。

关键词: 寰椎, 枢椎, 解剖学, 内窥镜外科技术

Abstract: Objective To evaluate the feasibility of endoscopic transoral transpharyngeal approach to the atlantoaxial. Methods Endoscopic transoral approach was performed in 5 cadaveric heads and necks. The atlantoaxial was measured with CT. Results (1) The range from clivus to C3 could be exposed by this approach, including atlas, axis, lateral mass, odontoid process and vertebral artery. (2) The anterior tubercle of the atlas could serve as a landmark leading to the endoscopic transoral atlantoaxis surgery. The arch could be drilled either from the tubercle to the lateral side or broken from the junction to the lateral mass. Endoscopic odontoid dissection should begin at the apex of the odontoid, and proceeded inferiorly. There was a “safe zone” in the front of atlantoaxis of transoral-transpharyngeal approach. (3) CT results showed: length of anterior arch of atlas 19.5±2.8 mm, the thickness of anterior tubercle of atlas 8.0±0.4 mm, atlas lateral horizontal diameter(left/right)12.7±2.3mm/12.7±1.6 mm, atlas lateral sagittal diameter(left/right)15.0±2.5 mm/15.3±1.4 mm, spacing of atlas transverse process the inside hole 47.2±1.6 mm, spacing of atlas lateral transverse process hole 60.4±1.4 mm, angle of odontoid 10.2±1.3°, spacing of axis transverse process the inside hole 29.2±1.7 mm, spacing of axis lateral transverse process hole 44.3±1.6 mm. Conclusion Endoscopic transoral transpharyngeal approach to the atlantoaxial is technically feasible, which provides a good exposure and the same decompressing size as conventional transoral-transpharyngeal approach. It is safe and minimal invasive, and can be widely applied in clinical practice.

Key words: Endoscopic technique, Axis, Anatomy, Atlas

中图分类号:

R762.6

谢畅,颜滨,李建兴,卢永田. 内镜经口入路寰枢椎解剖及临床可行性研究[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 47-51.

XIE Chang, YAN Bin, LI Jianxing, LU Yongtian. Anatomical and clinical evaluation of the endoscopic transoral transpharyngeal approach to the atlantoaxial.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(3): 47-51.

参考文献

[1] Hsu W, Wolinsky J P, Gokaslan Z L, et al. Transoral approaches to the cervical spine[J]. Neurosurgery, 2010, 66(3):119-125.
[2] 黄选兆. 实用耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2008: 288-289.
[3] Doherty B J, Heggeness M H. The quantitative anatomy of the atlas[J]. Spine, 1994, 19(22):2497-500.
[4] 柏树令. 系统解剖学[M]. 8版. 北京: 人民卫生出版社, 2009: 17-46.
[5] 胥少汀. 实用骨科学[M]. 4版. 北京: 人民军医出版社, 2012: 1935-1969.
[6] Doherty B J, Heggeness M H. Quantitative anatomy of the second cervical vertebra[J]. Spine, 1976, 20(5):513-517.
[7] Li Shi, Chai Yu, Li Yikai, et al. Quantitative anatomy of the tubercle of lateral mass of atlas and dens of axis and its clinical significance[J]. Chin J Anat, 2014, 37(2):212-216.
[8] Fine A D, Cardoso A, Rhoton A L Jr. Microsurgical anatomy of the extracranial-extradural origin of the posterior inferior cerebellar artery[J]. J Neurosurg, 1999, 91(4):645-652.
[9] Wang Z, Xia H, Wu Z, et al. Detailed anatomy for the transoral approach to the craniovertebral junction: an exposure and safety study[J]. J Neurol Surg B Skull Base, 2014, 75(2):133-139.
[10] Wang Y, Yang M, Zhang H, et al. Exploring the Safety Range via the Transoral Approach to the Craniovertebral Junction[J]. J Craniofac Surg, 2014, 25(4):1473-1475.
[11] Urculo-Bareño E, Alfaro-Baca R, Astudillo-Alarcón E, et al. Transoral decompression of the brain stem in a basilar impression secondary to rheumatoid arthritis. Description of a case and survey of the literature[J]. Rev Neurol, 2003, 36(9):846-851.
[12] Tanriverdi O, Tugcu B, Gunaldi O, et al. The selective odontoidectomy: endoscopic endonasal approach to the craniocervical junction[J]. J Craniofac Surg, 2014, 25(4):1482-1487.
[13] Song K J, Lee K B, Kim K N, et al. Treatment of odontoid fractures with single anterior screw fixation[J]. J Clin Neurosci, 2007, 14(9):824-830.
[14] Ma W, Xu N, Hu Y, et al. Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach[J]. Eur Spine J, 2013, 22(10):2232-2239.
[15] Ai F, Yin Q, Wang Z, et al. Applied anatomy of transoral atlantoaxial reduction plate internal fixation[J]. Spine, 2006, 31(2):128-132.
[16] Kandziora F, Schulze-Stahl N, Khodadadyan-Klostermann C, et al. Screw placement in transoral atlantoaxial plate systems: an anatomical study[J]. J Neurosurg, 2001, 95(1):80-87.

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内镜经口入路寰枢椎解剖及临床可行性研究

Anatomical and clinical evaluation of the endoscopic transoral transpharyngeal approach to the atlantoaxial.

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