对颈动脉鞘解剖的再认识及其意义
Recognition of the anatomy of carotid sheath
目的 通过对颈动脉鞘与颈筋膜关系的解剖观察,探讨对颈动脉鞘的正确认识。 方法 福尔马林处理的成人尸体标本20具(40侧)。解剖观察构成胸锁乳突肌筋膜后鞘的颈筋膜浅层与颈动脉鞘是否联结、联结的紧密程度;解剖观察颈动脉鞘与颈筋膜中层、椎前筋膜浅层、深层之间的关系、联结的质地与紧密程度。 结果 颈筋膜浅层与颈动脉鞘相联结,但较疏松,钝性分离可将二者分开;颈筋膜中层由舌骨下肌群各肌肉筋膜鞘汇合后向外侧续行汇入颈动脉鞘前部;椎前筋膜浅层向外侧分为浅、深两层,浅层包绕颈总动脉、颈内静脉和迷走神经,深层不参与构成颈动脉鞘。颈筋膜中层和椎前筋膜浅层与颈动脉鞘的联结质地韧厚,联结紧密。 结论 颈动脉鞘与颈筋膜各层存在密切的联系,颈筋膜中层和椎前筋膜浅层是构成颈动脉鞘的主体。
Objective To acquire the correct and accurate knowledge of carotid sheath by investiating the relationships between carotid sheath and cervical fascia. Methods 20 adult cadavers (40 sides) were dissected. The posterior part of envelope fascia(superficial layer of cervical fascia)was dissected to observe whether it connected with carotid sheath, and to observe the characteristics of the connection. The relationships of carotid sheath to middle cervical fascia and superficial and deep layers of deep cervical fascia were observed. Meanwhile, the characteristics of connection were observed. Results Envelope fascia connected with carotid sheath loosely could be separated easily by blunt dissection. Middle layer of the cervical fascia was composed of the junction of facial sheath of infrahyoid muscles, joining the anterior carotid sheath. Prevertebral fascia was composed of two parts, the superficial layer and deep layer, the former enveloping the carotid artery, jugular veinand vagus nerve, the latter not forming the carotid sheath. The junction fascia between middle layer of the cervical fascia and superficial layer of prevertebral fascia and carotid sheath was thick and tight. Conclusion Carotid sheath was closely associated with every layer of cervical fascia. Middle layer of the cervical fascia and superficial layer of prevertebral fascia forms the main body of carotid sheath.
[1] 郭世绂. 骨科临床解剖学[M]. 济南: 山东科学技术出版社,2002: 31.
[2] 柏树令. 系统解剖学[M]. 北京:人民卫生出版社,2005:72-73.
[3] 丁自海,杜心如. 脊柱外科临床解剖学[M]. 济南: 山东科学技术出版社,2008: 153.
[4] Grodinsky M, Holyoke EA. The fasciae and fascial space of the head,neck and adjacent region [J]. Am anat,1938, 63: 367.
[5] Bradford DS. 脊柱[M]. 张永刚,王岩,译. 沈阳. 辽宁科学技术出版社,2003: 14-15.
[6] Standring. 格式解剖学[M]. 第39版. 徐群渊,译. 北京: 北京大学出版社,2008: 612-613.
[7] 赵定麟. 现代颈椎病学[M]. 北京:人民军医出版社,2001:200-205.
[8] Emery SE, Boden SD. 颈椎外科学[M]. 第4版. 赵学凌,黄河,陈仲,等,译. 昆明:云南科技出版社,2008: 7-8.
[9] Robinson RA, Smith G. Anterolateral cervical disk removal and interbody fusion for cervical disk syndrome[J]. Bull Johns Hopkins Hosp,1955, 96:223.
[10]Southwick WO, Robinson RA. Surgical approach to the vertebral bodies in the cervical and lumbar regions[J]. J Bone Joint Surg Am, 1957, 39:631-644.
[11] Rollin M, Johnson MD, Michael J, et al. Surgical approach to the spine[M]//Rothman RH, Simeone FA. The Spine. 4th ed. 北京:科学出版社,2001: 1463-1537.
[12]吕厚山,主译. 脊柱内固定学[M]. 第2版. 北京:中国医药科技出版社,2000. 36.
[13]Chozick BS, Watson P, Greenblatt SH. Internal carotid artery thrombosis after cervical corpectomy[J]. Spine, 1994, 19: 2230-2232.
/
〈 |
|
〉 |