Configuration of the connective tissue in the posterior atlanto-occipital interspace - A sheet plastination and confocal microscopy study
Configuration of the connective tissue in the posterior atlanto-occipital interspace - A sheet plastination and confocal microscopy study
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DOI：
10.1097/01.brs.0000166159.31329.92
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发表时间：
2005-06-15
期刊：
影响因子：
3
通讯作者：
Zhang, M
中科院分区：
文献类型：
--
作者：
Nash, L;Nicholson, H;Zhang, M
研究设计：使用E12薄片塑化技术和共聚焦显微镜对寰枕后区的结缔组织结构进行研究。
目的：明确寰枕后间隙中小直肌（RCPm）、寰枕后膜（PAO）、项韧带与硬脊膜之间的关系。
背景资料概述：据推测，寰枕后间隙中硬脊膜与肌肉和/或韧带之间的连接可能将来自颈椎关节复合体的力传递至对疼痛敏感的硬脊膜，从而引发颈源性头痛。参与这些连接的解剖结构包括小直肌、寰枕后膜和项韧带。然而，关于这些连接的性质以及这些解剖结构之间的关系信息甚少。
方法：本研究采用综合方法，包括对9具尸体进行大体解剖以及对13具成人尸体采用E12薄片塑化方法，其中5具尸体进一步使用共聚焦显微镜进行检查。
结果：研究表明：（1）小直肌内侧和深部的腱纤维向前下与硬脊膜连续；（2）寰枕后膜是小直肌筋膜、肌腱以及血管周围鞘的一部分；（3）寰枕后膜向前下与硬脊膜融合，而非与寰椎融合；（4）项韧带在寰枕后间隙中不存在。
结论：在寰枕后间隙中将硬脊膜与小直肌连接的结缔组织结构是小直肌筋膜、腱纤维以及血管周围鞘。
Study Design. The connective tissue structures in the posterior atlanto-occipital region were investigated using E12 sheet plastinations and confocal microscopy.Objectives. To define the relationship between rectus capitis posterior minor (RCPm), posterior atlanto-occipital (PAO) membrane, nuchal ligament, and the spinal dura in the PAO interspace.Summary of Background Data. It has been speculated that connections between the dura and muscles and/or ligaments in the PAO interspace may transmit forces from the cervical spine joint complexes to the pain-sensitive dura, generating cervicogenic headaches. Anatomic structures involved in these connections include the RCPm, PAO membrane, and nuchal ligament. However, there is little information about the nature of these connections and the relationships between these anatomic structures.Methods. The study used a combined approach, consisting of the gross anatomic dissection of nine cadavers and the E12 sheet plastination method for thirteen adult human cadavers, five of which were further examined using confocal microscopy.Results. The study demonstrates that (1) the tendinous fibers from the medial and deep part of the RCPm muscle are continuous antero-inferiorly with the spinal dura; (2) the PAO membrane is part of the RCPm fascia and tendon and the perivascular sheathes; (3) antero-inferiorly the PAO membrane fuses with the spinal dura rather than the atlas; and (4) the nuchal ligament does not exist in the PAO interspace.Conclusions. The connective tissue structures that connect the spinal dura to the RCPm muscle in the PAO interspace are the RCPm fascia and tendinous fibers and perivascular sheathes.