【作者】 李凡；

【导师】 石岫昆；

【作者基本信息】 吉林大学 ， 人体解剖与组织胚胎学， 2015， 硕士

【摘要】 目的：研究椎动脉各段的相关解剖学特点包括其起源、长度、外径、分支及进入横突孔的位置等情况。为临床椎动脉型颈椎病、椎动脉压迫综合征、椎动脉夹层、椎动脉瘤及颅外脑血管狭窄等病的诊治提供解剖学依据,提高相关手术治疗的成功率。材料与方法：选取自2006年1月至2013年1月间,就诊于吉林大学白求恩医学院第一医院患者所做的人脑动脉的CTA扫描影像,选取标准有：1）大于15岁儿童；2）无影响脑部正常血供的严重心脏疾病,大血管疾病；3）无脑动脉病变,以及影响脑部动脉回流的病变,4）均已排除椎动脉畸形,狭窄以及动脉瘤者；5）双侧椎动脉对称者。采用GE公司的DiscoveryTM64排宝石CT机对受试者进行颈部扫描,所得图像在传至AW Volume Share4AW4.5工作站之后再进行加工处理后,进行观测。结果：1．椎动脉可按其行程分为近段、横突段、远段及颅内段4段:近段是指椎动脉从锁骨下动脉发出后进入第6颈椎横突孔前的一段；横突段是指行走于颈椎横突孔内的一段；远段是指椎动脉从寰椎穿出后至硬脑膜的一段,；颅内段是指椎动脉穿硬脑膜后行走于颅内至汇合成基底动脉前的一段。2．左侧椎动脉近段的长度为45.4±10.8mm,起始处的外径为4.9±0.7mm；右侧的长度为42.7±9.6mm,起始处的外径为4.5±0.5mm。3．椎动脉进横突孔的部位可分为四种情况,在第6颈椎进入横突孔的有111侧,占92.5%；第7颈椎进入横突孔的有5侧,占4.2%；第5颈椎进入横突孔的有2侧,占1.7%；第4颈椎进入横突孔的有2侧,占1.7%。4．左侧椎动脉横突段的长度为93.4±9.8mm,其在第六颈椎平面处的外径为3.9±0.4mm,在第三颈椎平面处的外径为3.7±0.5mm；右侧的长度为91.6±6.4mm,其在第六颈椎平面处的外径为4.2±0.6mm,在第三颈椎平面处的外径为4.0±0.9mm。5．左侧椎动脉远段的长度为43.7±10.4mm,其在寰椎平面处的外径为3.5±0.5mm,在入硬脑膜处的外径为3.1±0.3mm；右侧的长度为46.3±8.5mm,其在寰椎平面处的外径为3.6±0.4mm,在入硬脑膜处的外径为3.1±0.6mm。6．左侧椎动脉颅内段的长度为32.5±9.4mm,其在汇合成基底动脉前的外径为2.0±0.2mm；右侧的长度为33.4±8.2mm,其在汇合成基底动脉前的外径为2.2±0.3mm；结论：1.椎动脉近段较长,活动度较大,当椎动脉起始处发生狭窄时,椎动脉近段可以与其他血管进行吻合以改善血供。2.在进行颈椎相关手术操作前,最好先进行椎动脉的CTA造影来明确椎动脉的走行及变异,以达到保护椎动脉的目的。3.椎动脉远端走形较迂曲,介入治疗时需特别注意其弯曲特点。更多还原

【Abstract】 Objective:Research of vertebral artery paragraphs related anatomical featuresincluding its origin, length, diameter, branch and enters the transverseprocess hole position, and so on and so forth. For clinical vertebral arterytype of cervical spondylosis, vertebral artery compression syndrome,vertebral artery dissection, vertebral artery aneurysms and extracranialcerebrovascular stenosis to provide the anatomical basis of diagnosis andtreatment of disease, such as improving relevant surgical treatmentsuccess rate.Materials and methods:Selection since January2006to January2013, Bethune medicalschool, jilin university first hospital patients do CTA scanning images ofthe brain artery, selection criteria are:1) more than15years old children;2) without affecting normal blood flow to the brain of serious heartdisease, vascular disease;3) no cerebral artery lesions, and affects thebrain artery flow of pathological changes,4) have been ruled outvertebral artery malformation, stenosis and aneurysm;5) bilateralvertebral artery is symmetrical. Using the GE DiscoveryTM64linegemstone CT machine to scan the subjects for the neck, in the image toAW Volume Share after4AW4.5workstations before processing, wereobserved.The results:Vertebral artery can be according to their schedule is divided into therecent, the transverse process segment, and far segment intracranial4paragraphs: nearly section refers to the vertebral artery from after theissue into the subclavian artery cervical vertebra transverse process holein front of a period of6; Transverse process section refers to walk in a cervical vertebra transverse process hole; Far paragraph refers to thevertebral artery from atlas wear out after to dura mater,; Intracranialperiod refers to the vertebral artery wear after walking the intracranialdural to merge a before the basilar artery.Vertebral artery in the left side of the length of45.4±10.8mm,starting at the outer diameter of4.9±0.7mm; Length was42.7±9.6mm,on the right side of the start of the outer diameter of4.5±0.5mm.The hole part of the vertebral artery into can be divided into fourkinds of circumstances, in the sixth into transverse process hole111sideof cervical vertebra, accounted for92.5%;7cervical into five side of thetransverse process hole, accounted for4.2%; Cervical vertebra5into thetransverse process hole has two side, accounted for1.7%; Fourth cervicalvertebra into the transverse process hole has two side, accounting for1.7%.The left side of the section of the length of the vertebral artery was93.4±9.8mm, the plane in the sixth cervical vertebra place outsidediameter is3.9±0.4mm, in the third cervical plane of the outer diameterof3.7±0.5mm; On the right side of the length of91.6±6.4mm, the planein the sixth cervical vertebra place outside diameter is4.2±0.6mm, in thethird cervical plane in the outer diameter of4.0±0.9mm.The length of the far end of the left vertebral artery was43.7±10.4mm, the plane in the atlas of outer diameter of3.5±0.5mm, outsidediameter at the dura mater was3.1±0.3mm; Length was46.3±8.5mm,on the right side of the plane in the atlas of the outer diameter of3.6±0.4mm, outside diameter at the dura mater was3.1±0.6mm.The length of the intracranial segment of the left vertebral artery was32.5±9.4mm, the merge in front of the basilar artery diameter was2.0±0.2; On the right side of the length of33.4±8.2mm, the merge infront of the basilar artery diameter was2.2±0.3; Conclusion:1. Vertebral artery in longer, activity is bigger, when start ofvertebral artery stenosis occurs, the vertebral artery at the near end can beconsistent with other blood vessels to improve blood supply.2. Before the related cervical spine surgery operation, best tovertebral artery CTA imaging to clear and variation of vertebral artery, inorder to achieve the purpose of protection of vertebral artery.3. distal contorts the vertebral artery is bent, interventional therapywhen special attention should be paid to the bending characteristics.更多还原