枕大神经的应用解剖.DOCVIP

临床医学论文-枕大神经的应用解剖 【摘要】? 目的? 探讨枕大神经痛发病的解剖学基础。方法? 防腐固定成人尸体标本10具(20侧)和新鲜标本2具(4侧)，观察枕大神经的走行分布及其与邻近组织的关系。结果? 根据枕大神经走行特点，可将其分为肌肉段和筋膜内段。肌内段活动度大，不易受压。筋膜内段位于致密纤维管道内易致卡压。神经自椎管穿出进入肌肉处，穿出肌肉进入筋膜处，神经浅出皮下处，此3点最易造成卡压。枕大神经浅出皮下处始与枕动脉伴行。结论? 枕大神经穿行的骨性纤维孔、纤维管道及项部肌群的腱性交叉纤维对神经的固定作用，是颈部运动或组织劳损时造成枕大神经卡压的解剖学基础。 　　【关键词】? 枕大神经；卡压征；应用解剖??? 　　【Abstract】? Objective? To investigate the anatomic basis of the greater occipital neuralgia and discuss its clinical significance.Methods? The origin,course ramification,distribution of the greater occipital nerve and its anatomic relationship with the adjacent tissues of the cervical vertebra were observed on 10 adult antiseptic cadaver specimens and 2 fresh cadaver specimens.Results?The course of the nerve could be divided into two parts:the part in muscles,which passed through the nuchal muscles,where there seemed to be an ample space for cutting through of the nerve and the part in subcuits,which ran and anchored to the subcuits of the scalp.There were three points which were easy be compressed:1.Its exit point to the subcuit.2.The point after outside its respective intervertebral and starting to pass through the muscless.3.The point which throughout the muscles and starting run into subcuits.Conclusion?The osteofibrous apertures,osteofibrous canal and the tendious decussating fibers of the nuchal muscles passed through by the greater occipital nerve are the anatomic basis of the greater occipital nerve compression syndrome. 　　【Key words】? the greater occipital nerve;compression syndrome;applied anatomy ??? 颈性头痛也称颈性头痛综合征，多由颈椎及其周围支持组织结构改变引起。枕后部头痛多为枕大神经受卡压刺激引起。为明确枕大神经痛的确切病因和枕大神经的定位，本文对枕大神经及其与周围组织结构关系进行一系列观察分析，以期探讨枕大神经痛的解剖学基础，为临床治疗提供相关理论指导。 　　1? 材料与方法 　　本组10具(男6具，女4具)为经福尔马林固定的成人尸体头颈部标本，另有2具新鲜标本。对项部按层次进行解剖，对枕大神经自椎管内发出后直至浅出皮下、分支支配枕后皮肤的整个行程进行解剖，观察其走行、分段、分布及其与周围组织毗邻关系，入肌点、出肌点及出筋膜点位置。用游标卡尺测量枕大神经穿行的骨纤维孔、骨纤维管位置、长度及走向等。头前屈30°，以C2棘突为横坐标，后正中线为纵坐标，观察枕大神经体表投影。 　　2? 结果 　　枕大神经的走行、分布与分段分别为：(1)枕大神经为C2神经后支的内侧支，出椎管后呈弧形绕过头下斜肌下缘，向上内行走，与矢状面约呈70°角，冠状面呈60°角，穿行于头半棘肌和头最长肌之间。(2