颈交感神经干与筋膜的关系及在颈椎前外侧手术入路中的临床意义
Clinical significance of the cervical sympathetic trunk in anterior lateral cervical surgical approach
目的 了解颈交感神经干（cervical sympathetic trunks, CST）与颈筋膜的解剖关系，为颈椎前外侧手术入路中避免CST损伤提供更为可靠的方法。 方法 福尔马林固定的成人尸体标本42具，标本分为两组，第1组30具，观察CST与椎前筋膜浅层（Alar筋膜）的位置关系及联系的紧密程度。在第2组12具，观察CST与颈动脉鞘关系。 结果 在第1组中，CST在第7颈椎椎体水平距离椎体中线的距离最小，约20 mm，所有标本中CST在第7颈椎椎体以上均紧密黏贴于Alar筋膜后面，有的甚至可视为被颈筋膜浅层包裹，不易与Alar筋膜钝性分离，当Alar筋膜被向外侧牵开时CST被一并牵开。在第2组中，所有标本中CST均紧贴于颈动脉鞘后面。 结论 CST紧贴于椎前筋膜深面，可随Alar筋膜被自然牵开，在颈椎前外侧入路的手术中不需要辨认、分离CST，仅通过牵开颈筋膜浅层即可对CST进行有效保护。
Objective To understand the anatomical relationship between sympathetic nerve and the cervical fascia，and provide a more reliable method for avoiding sympathetic trunk injury in the anterolateral cervical surgery. Methods 42 specimens of Faure Marin's fixed adult cadavers were divided into two groups, with 30 in the first group and 12 in the second group. The spatial relationship between the sympathetic trunk and the superficial layer of the prevertebral fascia（Alar fascia）and the degree of connection were investigated. In the second group，relationship between the cervical sympathetic trunk and the carotid sheath was observed. Results In the first group, the distance between the cervical sympathetic trunk and the centrum of the vertebral body at the 7 cervical vertebra was the smallest, about 20 mm. In all the specimens, the cervical sympathetic trunk was closely adhered to the Alar fascia above the seventh cervical vertebrae, and some even could be seen as being wrapped in the superficial fascia of the cervical fascia. It was not easy to be separated from the Alar fascia. The cervical sympathetic trunk was also pulled apart together when the Alar fascia was pulled outward in the second group. In all specimens the cervical sympathetic trunk were tightly adhered to the posterior aspect of the carotid sheath. Conclusion The cervical sympathetic trunk is tightly adhered to the deep surface of prevertebral fascia and can be pulled away naturally with the Alar fascia. In the anterolateral cervical approach，there is no necessity to identify or separate sympathetic trunk. The cervical sympathetic trunk can be effectively protected by pulling the superficial cervical fascia merely.
Anterolateral cervical spine surgical approach; / Cervical fascia; / Cervical sympathetic trunk; / Anatomy
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