颈静脉孔的应用解剖学

#应用解剖#

颈静脉孔的应用解剖学

肖 明, 丁 炯, 韩群颖, 王鹤鸣, 左国平

(南京医科大学解剖学教研室,江苏南京210029) =摘要>目的:为与颈静脉孔相关的影像诊断和临床治疗提供解剖学资料。方法:从颅底内、外面,对80具成年颅骨的颈静脉孔进行观测;并对20具成人尸头进行解剖,观察该区域神经血管解剖关系。结果:¹62.3%右侧颈静脉孔较左侧大,15.9%左侧较大,21.8%两侧大小一致;º14.38%的颈静脉孔有骨桥,85.62%无骨桥;»颈静脉孔内、外侧缘距正中矢状面两侧的平均距离颅外均较颅内大:颅外分别为26.11mm 和33.41mm,颅内分别为22.29mm 和27.52mm 。¼Ù脑神经多沿颈静脉孔前上缘,Ú、Û脑神经沿内侧缘出颅,两者被纤维索(占87.5%)或骨桥(占12.5%)隔开。½Ù脑神经多经颈静脉孔外口前上缘向前下越过颈内动脉表面;Ù脑神经经颈内静脉深面(占57.5%)或其浅面(42.5%)行向后下。结论:右侧颈静脉孔通常较左侧大,左右不对称;影像学观测该区域血管、神经应选择恰当的层面。

=关键词>颈静脉孔; 颈内静脉; 脑神经; 应用解剖学

=中图分类号>R323.1 =文献标识码>A =文章编号>1001-165X(2001)02-0159-03Applied anatomy of jugular foramen XIAO Ming,DING J ong ,HAN Qun -ying,et al.De p a rtment o f A natom y ,Nan j ing Medical University ,Nan j ing 210029,China

=Abstract >Objective:To provide anatomic data for imaging diagnosis and microsurgical treatment of jugular fora -men (JF)lesions.Methods:The JF was observed and measured from internal and external aspects in 80adult skulls.The anatomic relationships between the nerves and vessles in this region were observed i n detail by dissecting 20adult cephalic specimens.Results:¹In 62.3%of all these cases the right JF was larger than the left.In 15.9%the left was larger and in 21.8%they were equal in size.ºBone bridges could be seen in 14.38%and could not in 85.62%.»Measured from extracranial aspect,the average distance from midsagi ttal plane to the medial and lateral border of the JF (medial 26.11mm,lateral 33.41mm),was larger than those measured from intracramial aspect (medial 22.29mm,lat -eral 27.52mm).¼Ùcranial nerve made its ex i t through the anterior superior border of the JF in most cases,meanwhile Úand Ûcranial nerve through the medial border,they were distinctly separated from each other by a band of fibrous tissue (account for 87.5%)or a bone bridge (12.5%).½Jus t outside the J F,Ùcranial nerve appeared at the anter-i

or border and made a loop downward and forward superficial to the internal carotid artery.Ùcranial nerve run down ward and back ward deep (account for 57.5%),or superficially (42.5%)to the internal jugular vei n.Conclusions:T he right J F is usually larger than the left,and not symmetry on both sides.The key to imaging diagnosi s of nerves and ves -sels in the JF region is to select the sectional plane correctly.

=Key w ords >Jugular foramen; Internal jugular vein; Cranial nerve; Applied anatomy

颈静脉孔为枕骨与颞骨岩部之间的一骨性孔道,位于岩枕缝的后端,被颈内静脉结节分为二部或三部[1]

。前部有岩下窦注入,与Ù~Û脑神经通过;后部较大,乙状窦经此延续为颈内静脉。上述诸结构在颈静脉孔内的位置与相互毗邻关系,国内外有关文献描述甚不统一[2,3]

。本实验目的是观察颈静脉孔的形态、内容物的相互关系,具体测量其孔径大小两侧对称性,为影像学观测提供相应的形态学资料。1 材料和方法

材料为教研室标本室提供的80只成年男女颅骨(不分性别),经耳颞线将颅骨锯开。对颈静脉孔大体形态进行观察,并着重观察有无骨桥(完整与否)及其类型与出现率;根据Doclo 制定的原则将骨桥进行分类:位于舌下神经管前上方者为Ñ型,位于舌下神经管后方的为Ò型。分别从颅内测量颈静脉孔的最大、最小横径,矢状径(图1);从颅外测量横径与矢状径,并从颅内、外面对颈静脉孔内、外侧缘距正中矢状面距离进行测

=收稿日期>2000-03-11

=作者简介>肖 明(1972-),男,江苏盐城人,硕士,讲师,主要从

事临床解剖学研究,Tel:(025)6662879,E -mail:renjie@ 。

量。测量仪器为颅骨测径器。另20例成年尸头标本(男12例,

女8例),于颞骨乳突中部与耳颞线平行锯断,移去颅骨的上端,细心将Ù、Ú、Û脑神经从脑干背面剪断,剔除脑组织,保留颈静脉孔周围的硬脑膜,观察上述神经在孔内口的位置及与岩下窦相互毗邻关系;去除颅底肌肉等软组织,暴露颈内静脉孔外口,观察颈内静脉与Ù、Ú、Û脑神经的解剖关系。

AB.横径(transverse diameter)

CD.最大矢状径(maximum sagittal diameter)E F.最小矢状径(minimum sagi ttal diameter)图1 颈静脉孔的各径线颅内测量示意图

Fig.1 Intracranial measuremen ts of the schematic drawing of diameters of the jugular foramen

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159#中国临床解剖学杂志2001年第19卷第2期