Applied Anatomy Research Of The Upper Cervical Spine Anterolateral Surgical Approach

Objective:Obtained through the cadavers anatomy of upper cervical spine anterior lateral surgical approach involving major blood vessels, nerves and other organizational structure detailed anatomical details, clear relationship between others adjacent, for upper cervical spine anterior lateral surgical approach for clinical reference. Methods:Formalin fixation of cranial-cervical10%complete adult wet specimen20(40), simulated to upper cervical spine anterior lateral surgical approach drill anatomy, detailed observations in the upper cervical spine anterior lateral surgical approach involving the important blood vessels, nerves and measuring the blood vessels and nerves in the length, diameter and the distance between the adjacent and measurement results using SPSS13.0for statistical analysis. Results:1, The superior laryngeal internal broach and the greater horn of the hyoid bone there are three positional relationships:①The greater horn of the hyoid bone:12.5%(five-fortieths);②5mm above the greater horn of the hyoid bone:17,5%(seven-fortieths);③10mm below the greater horn of the hyoid bone:70%(twenty eightfortieths);The internal branch of superior laryngeal nerve from the crossing point to penetrate thyroglossal periosteum distance:left (22.3±3,2) mm (16.5～23.9mm) on the right (23.2±3.8) mm (16.6～25.9mm), on both sides of the combined distance (22.7±3.5) mm (16.5-25.9mm). The external branch of superior laryngeal nerve the diameter (0.7±0.11) mm (0.4～1.1), with the superior thyroid artery blood tubes formed by loose connective tissue enveloping nerve have been thyroglossal periosteum too, located in throat tissue.2. The hypoglossal nerve from hypoglossal canal, walking down, below pillow artery beginning department issued, descending branch of the hypoglossal nerve and descending branch of C2and C3combines formed neck loop, issued branch to Supraomohyoid, and Sternohyoideus, and Sternal thyroid muscle. In the mandibular angle, hypoglossal nerve was a bow-like deep abdominal surface after the digastric, versus digastric after second cross, bending forward to the hyoid muscles of the lower mylohyoid muscle, emits a branch dominated all tongue muscles except for the palate genioglossus.3.digastric and stylohyoid muscle dominant signs between shallow and deep cervical fascia, posterior belly digastric muscle is coarser, stylohyoid muscle is relatively smaller, located in the posterior belly of digastric the lower front, both accompanied by the line, almost parallel to the direction, are attached to the hyoid bone and horn hyoid body, both inside the layer is very easy to find, and the location is more constant, accompanied by the two together, in the anterior lateral cervical spine surgery can be considered both a whole, in order to find transverse process of atlas, internal jugular vein, occipital artery, accessory nerve, external carotid artery, facial artery, hypoglossal nerve.4, The greater horn of the hyoid bone is on cervical anterolateral surgical approach to the carotid triangle be important anatomical landmarks, it visible, palpable, easily recognizable, there are important structures surrounding the thyroid artery, lingual artery, superior laryngeal nerve and hypoglossal nerves. Accessory nerve with the shortest distance:(12.5±3.9) mm (6.9～18.7);(.04±1.6) mm (02～2.5.);(5.2±1.4) mm (1.6～10.8);(5.0±1.7) mm (1.6～9.7),5. Found the hypoglossal nerve retractor to the head, the tail side laryngeal nerve retractor, the carotid sheath to the lateral retractor, visceral sheath (hyoid bone, esophagus and trachea) to the inside of the retractor, ie anatomy course can form a similar wedge-shaped "window","window" corresponds directly to the site of C2/C3and C3vertebral disc, combined with neck hyperextended position and retractor stretch, can be exposed to the maximum range:Up anterior arch of the atlas,3to the lower edge of the neck vertebrae issued, can be exposed to both sides of the transverse..Conclusion:1, In the upper cervical spine anterior lateral surgical approach, digastric and stlohyoid muscle complex, the greater horn of the hyoid bone in search of superior laryngeal nerve and hypoglossal nerve important signs, after founded the two nerve, its free and protect, can reduce the injury rate.2, Through the hypoglossal nerve, superior laryngeal nerve,carotid sheath, Visceral sheath composition similar to wedge-shaped "window" exposed upper cervical spine, can obtain better revealed, and the concept of for further applied micro devices provide a good channel for upper cervical spine surgery.