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

doi:10.13418/j.issn.1001-165x.2018.04.002

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (4): 367-370.doi: 10.13418/j.issn.1001-165x.2018.04.002

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

聂政¹，姜恒²，单建林³

1. 成都医学院人体解剖实验室，成都 610500； 2. 成都医学院检验医学院输血教研室，成都 610500；
3. 北京军区总医院骨科，北京 100700

收稿日期:2018-04-23 出版日期:2018-07-25 发布日期:2018-08-21
通讯作者: 单建林，副主任医师，E-mail: shanjianlin100@126.com
作者简介:聂政（1980-），高级实验师，研究方向：临床应用解剖、解剖实验技术及红会遗体接受工作，E-mail：nz360518@163.com
基金资助:
四川省教育厅科研项目（16ZB2076）; 成都医学科研项目资助（cyz13-016）

Clinical significance of the cervical sympathetic trunk in anterior lateral cervical surgical approach

NIE Zheng¹, JIANG Heng², SHAN Jian-lin³

1.Department of Anatomy Laboratory, Chengdu Medical College, Chengdu 610500, China; 2.Department of Transfusion of Laboratory Medicine, Chengdu Medical College, Chengdu 610500, China; 3.Department of Orthopaedics, The Military General Hospital of Beijing, PLA, Beijing 100700, China

Received:2018-04-23 Online:2018-07-25 Published:2018-08-21

摘要/Abstract

摘要：

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。

关键词: 颈椎前外侧手术入路, 　颈筋膜, 　交感神经干, 　解剖

Abstract:

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.

Key words: Anterolateral cervical spine surgical approach; , Cervical fascia; , Cervical sympathetic trunk; , Anatomy

聂政,姜恒,单建林. 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[J]. 中国临床解剖学杂志, 2018, 36(4): 367-370.

NIE Zheng, JIANG Heng, SHAN Jian-lin. Clinical significance of the cervical sympathetic trunk in anterior lateral cervical surgical approach[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(4): 367-370.

参考文献

[1] Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications[J]. Spine, 2007, 32(21): 2310-2317.
[2] Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients[J]. Acta Neurochir (Wien), 1989, 99(1-2): 41-50.
[3] Cuatico W. Anterior cervical discectomy without interbody fusion: an analysis of 81 cases[J]. Acta Neurochir (Wien), 1981, 57(3-4): 269-274.
[4] Dohn DF. Anterior interbody fusion for treatment of cervical disc conditions[J]. JAMA, 1966, 197(11): 897-900.
[5] Bruneau M, Cornelius JF, George B. Microsurgical cervical nerve root decompression by anterolateral approach[J]. Neurosurgery, 2006, 58(Suppl 1): ONS108-13
[6] Tew JM Jr, Mayfield FH. Complications of surgery of the anterior cervical spine[J]. Clin Neurosurg, 1976, 23: 424-434.
[7] Yasumoto Y, Abe Y, Tsutsumi S, et al. Rare complication of anterior spinal surgery: horner syndrome[J]. No Shinkei Geka, 2008, 36(10): 911-914.
[8] Busch G. Anterior fusion for cervical spondylosis[J]. J Neurol, 1978, 219(2): 117-126.
[9] An HS, Vaccaro A, Cotler JM, et al. Spinal disorders at the cervicothoracic junction[J].Spine,1994,19(22): 2557-2564.
[10]Giombini S, Solero CL. Considerations on 100 anterior cervical discectomies without fusion[M]// Grote W, Brock M, Clar HE, Klinger M, Nau HE,eds. Advances in Neurosurgery. Vol 8.Berlin Heidelberg New York:Springer,1980: 302–307.
[11] Hankinson HL, Wilson CB. Use of the operating microscope in anterior
cervical discectomy without fusion[J]. J Neurosurg, 1975, 43(4): 452-456.
[12] Johnston FG, Crockard HA. One-stage internal fixation and anterior fusion incomplex cervical spinal disorders[J]. J Neurosurg, 1995, 82(2): 234-238.
[13] Saunders RL, Bernini PM, Shirreffs TG Jr, et al. Central corpectomy for cervical spondylotic myelopathy: A consecutive series with long-term follow-up evaluation[J]. J Neurosurg,1991, 74(2): 163-170.
[14] Yin Z, Yin J, Cai J, et al. Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli[J]. J Biomed Res, 2015, 29(6): 501-507.
[15] Civelek E, Karasu A, Cansever T, et al. Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine[J]. Eur Spine J, 2008, 17(8): 991-995.
[16] Ebraheim NA, Lu J, Yang H, et al. Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine[J].Spine, 2000, 25(13): 1603-1606.
[17]Kitamura S. Anatomy of the fasciae and fascial spaces of the maxillofacial and the anterior neck regions[J]. Anat Sci Int, 2018, 93(1): 1-13.
[18]Shan J, Jiang H, Ren D, et al. Anatomic relationship between right recurrent laryngeal nerve and cervical fascia and its application significance in anterior cervical spine surgical approach[J].Spine, 2017, 42(8): E443-E447.
[19]单建林, 姜恒, 李放, 等. 颈动脉鞘和椎前筋膜的解剖关系及在颈椎前路手术中的意义[J]. 中国脊柱脊髓杂志, 2005, 15(8): 493-495.
[20]单建林, 姜恒, 李放. 颈椎椎前筋膜的解剖特点及其与周围结构的关系[J]. 中国临床解剖学杂志, 2011, 29(1): 13-16.
[21]聂政, 单建林, 姜恒. 对颈动脉鞘解剖的再认识及其意义[J]. 中国临床解剖学杂志, 2015, 33(5): 520-522.
[22]Robert A, Robinson, George W. Smith. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome[J]. SAS Journal, 2010, 4(1): 34-35.
[23] Gray H. The sympathetic nerves. In: Lewis WH, editor. Anatomy of the Human Body[M]. 20th ed. Philadelphia:Lea and Febiger: 2000，P.1292-1309.

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

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