Clinically Relevant Anatomy of High Anterior Cervical Approach
Clinically Relevant Anatomy of High Anterior Cervical Approach
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DOI：
10.1097/brs.0b013e31820408af
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发表时间：
2011-12-01
期刊：
影响因子：
3
通讯作者：
Shen, Francis H.
中科院分区：
文献类型：
--
作者：
Haller, Justin M.;Iwanik, Michael;Shen, Francis H.
研究设计。 11具防腐尸体颈前路解剖学研究及颈椎相关结构测量。目的。确定舌下神经 (HN)、喉上神经和喉外神经 (ESLN)、甲状腺上动脉 (STA) 和喉上动脉 (SLA) 与颈椎的解剖关系，并证明任何脆弱性。背景数据摘要。前路入路是颈椎的常见入路。高颈区的大部分手术发病率与神经血管损伤有关，导致吞咽困难、发声困难、高音发声受损和咳嗽反射受损。方法。对 11 具成人尸体（5 名男性/6 名女性）进行双侧解剖，以暴露高颈前区的结构。结果。 HN 始终向 C2-3 处的中线行进，并在 C3-4 尾部安全。在 95% 的解剖中，上喉内神经 (ISLN) 在 C3-4 1 厘米范围内暴露。 ESLN 的路径是可变的，但在 C3-4 以上和 C6-7 以下是安全的。 ESLN 深入 STA，并且在所有解剖中都比 ISLN 体积小、绷紧。 STA 的起源沿颈动脉变化很大，但最常见的是位于 C4。观察到 SLA 的两种解剖变异。在 15 次解剖中，SLA 从上甲状腺分支出来。在六次解剖中，SLA 直接从颈外动脉分支。研究的神经血管结构没有明显的左右变化。结论。在这项研究的基础上，脊柱外科医生可以增强颈椎前路解剖学的知识。本研究中的神经血管结构没有表现出左右解剖学变异；因此，患者的病理情况和外科医生的偏好应决定手术一侧。
Study Design. An anatomic study of anterior cervical dissection of 11 embalmed cadavers and measurement of structures relative to cervical spine.Objective. To determine the anatomic relationship of the hypoglossal nerve (HN), internal and external superior laryngeal nerves (ESLNs), superior thyroid artery (STA), and superior laryngeal artery (SLA) to cervical spine and demonstrate any vulnerability.Summary of Background Data. The anterior approach is a common approach to the cervical spine. Much of the operative morbidity in high cervical region is related to neurovascular injury leading to dysphagia, dysphonia, impaired high-pitch phonation, and impaired cough reflex.Methods. Eleven adult cadavers (5 male/6 female) were dissected bilaterally to expose structures of the high anterior cervical region.Results. The HN consistently traveled toward the midline at C2-3 and was safe caudal to C3-4. In 95% of dissections, the internal superior laryngeal nerve (ISLN) was exposed within 1 cm of C3-4. The path of the ESLN was variable, but it was safe above C3-4 and below C6-7. The ESLN was deep to the STA, and it was less bulky and tauter than the ISLN in all dissections. The origin of the STA was quite variable along the carotid artery, but it was most commonly located at C4. Two anatomic variants of the SLA were observed. In 15 dissections, the SLA branched off the superior thyroid. In six dissections, the SLA branched directly from external carotid artery. There was no appreciable side-to-side variation in the neurovascular structures studied.Conclusion. On the basis this study, spine surgeons can have enhanced knowledge of high anterior cervical anatomy. The neurovascular structures in this study did not demonstrate side-to-side anatomic variation; therefore, patient pathology and surgeon preference should dictate the operative side.