【作者】 宋千；

【导师】 张庆林；

【作者基本信息】 山东大学 ， 外科学， 2006， 博士

【摘要】 目的：研究颅后窝远外侧入路在颅颈交界区腹外侧病变，以及高颈部哑铃型肿瘤手术中的应用解剖学。采用何种方式可以减少对延颈髓的牵拉，最大限度的全切肿瘤是本研究的目的。 方法与结果：对5例10侧经10％福尔马林充分固定的国人成人头颅湿标本按如下步骤进行解剖学研究。 该入路颅骨外层分为三个解剖步骤。 第一步，形成皮瓣，显露枕下浅层肌肉：胸锁乳突肌和斜方肌，二者之间形成枕三角，枕三角的底由头夹肌和头半棘肌构成。 第二步，分离胸锁乳突肌，在附着点下方分离，并保留条状肌肉和筋膜于附着点上以便缝合，向外侧牵拉胸锁乳突肌显露头夹肌的上部。斜方肌上方附着于上项线和枕外隆凸，分离斜方肌，并在皮瓣下缘切断斜方肌，将斜方肌牵向内侧。第二层，可见头夹肌和头半棘肌上部。头夹肌附着于上项线，分离头夹肌，在其上部附着点保留一小肌袖以便缝合，并将其向内侧翻开，显露头最长肌和头半棘肌。 第三步，分离头最长肌和半棘肌，将两者联合翻向下方，显露上、下斜肌和寰椎横突，横突有一凸起可透过皮肤在乳突和下颌角之间触及。并显露枕下三角，枕下三角由三条肌肉围成：上内侧为头后大直肌，上外侧为上斜肌，下外侧为下斜肌。 开放枕下三角，完整显露颅颈交界区的骨性结构。 一、枕下颅骨成型和椎管开窗： 硬膜外阶段开始于枕下颅骨切除或开颅，确认枕髁，至少切除寰椎后弓的二更多还原

【Abstract】 Objective:To research the clinical anatomy of far-lateral approach applying on the cranio-cervical junction .The objection of this research was to find a better mode to reduce the injury of medulla and spinal cord in the operation. Methods and results:Five adult cadaveric head specimens with arteries and veins perfused with colored latex were dissected by using microsurgical skill, according to the procedures of the far lateral approach.The anatomy process as follows:The stage of extra-skull in this approach is divieded three phases.The first step includes the skin incision, exposure suboccipital superficial muscle. The sternocleidomastoid and trapezius are in the first layer encountered , that forming the occipital triangle.The second step, dividing the sternocleidomastoid just below and with preservation of its upper attachment for closure and reflecting it laterally exposes the upper extension of the splenius capitis. Detaching the trapezius and dissect it at inferior border, then reflecting it medially. The splenius capitis muscles and upper part of semispinalis capitis muscle was exposured while preserving a cuff of the formers upper attachments for closure, and reflecting them medially exposes the longissimus capitis muscle and semispinalis capitis muscle. The更多还原