颈筋膜中层的解剖特点及其在颈椎前路手术中的意义.docVIP

颈筋膜中层的解剖特点及其在颈椎前路手术中的意义 姜恒1 单建林2 李放2 孙天胜2 （610083 四川 成都， 成都医学院临床技能中心1；100700 北京， 北京军区总医院骨科2） 【摘要】 目的 了解颈筋膜中层的解剖特点，使颈椎前路手术更安全、合理。方法 成人尸体标本22具，于颈中部纵形切开，显露颈动脉鞘和舌骨下肌群，观察颈筋膜中层的形态、质地、与颈动脉鞘的关系。向两侧分离脏器鞘和颈动脉鞘，过程中观察二鞘之间的连结组织的多少、质地，感觉其可能对颈椎前路手术中钝性分离的影响，观察喉返神经、甲状腺下动脉与颈筋膜中层的解剖关系，观察喉返神经、甲状腺下动脉与颈动脉鞘的解剖关系。结果 颈筋膜中层在颈总动脉的前外侧融入颈动脉鞘，层次、境界清楚。除颈筋膜中层外，脏器鞘和颈动脉鞘之间仅有少量疏松组织，容易分离。在颈右侧，喉返神经在约胸1椎体水平自颈动脉鞘内、后缘穿出椎前筋膜，始终不与颈筋膜中层接触。双侧甲状腺下动脉均在约 颈6椎体水平自颈动脉鞘内、后缘穿出椎前筋膜，始终不与颈筋膜中层接触。结论 颈筋膜中层的解剖特点及其与周围结构的关系应被充分理解与利用, 使颈前手术入路更合理和安全。 【关键词】颈筋膜；颈动脉鞘；颈椎病；解剖 Anatomic features of the middle layer of the cervical fascia and its significance in the anterior cervical approach JIANG Heng1, SHAN Jianlin2, LI Fang2, SUN Tiansheng2. (1Department of Clinical Skills, Chengdu Medical College, Chengdu,Sichuan Province,610083;2Department of Orthorpaedics, Beijing General Hospital of PLA ,Beijing 100700, China.) [Abstract] Objective To make the anterior cervical approach more reasonable and safer by means of investigating the anatomic features of the middle layer of the cervical fascia. Methods Twenty-two embalmed cadavers were dissected. At the midline the excise was made to expose the carotid sheath and the infrahyoid muscles so as to observe the morphous, texture of the middle layer of the cervical fascia and its relationships to the carotid sheath. The carotid sheath and visceral sheath were dissected and pulled bilaterally, meanwhile the texture and amount of the connective tissue between the visceral sheath and carotid sheath were observed and assessed, and the degree of difficulty during the blunt dissection between the visceral sheath and carotid sheath in the anterior cervical surgery was evaluated. The anatomic relationships between the middle layer of cervical fascia and the inferior thyroid artery and the right recurrent laryngeal nerve was observed, and The anatomic relationships between the carotid sheath and the inferior thyroid artery and the right recurrent laryngeal nerve was observed. Resul