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颅颈交界处详细影像解剖及创伤后表现
颅颈交界处的解剖结构复杂，日常颈椎MRI横断位一般均匀扫描椎间盘为主，寰枢关节及寰枕关节处的韧带易被忽视，头颅与颈部的过渡区域,主要解剖结构包括枕骨、寰椎、枢榷及各种韧带等,由于强健的韧带维系和灵活的骨性关节结构,颅颈交界处的损伤临床少见,但并不罕见,多由车祸或高空坠落造成,且多在现场立即死亡,能够存活来诊者寥寥无几.颅颈交界处涉及3组关节及9条韧带.3组关节是寰枕关节、寰齿关节和椎间关节(寰枢外侧关节),后两者均属寰枢关节;9条韧带包括前纵韧带、十字韧带(包括横部和竖部,横部又称寰横韧带)、顶盖膜、寰齿韧带、翼状韧带、齿状尖韧带、前枕寰膜、后寰枕膜和项韧带.当作用力来得突然而迅猛,力量集中时,则可引起此处损伤,包括骨质的损伤(骨折)、韧带的损伤(脱位)或复合伤等，而且这么多的韧带还存在一定变异概率，影像科大夫有必要学习。
·论 著·经口咽入路的颅颈交界区及其周围解剖学结构研究王新慧 姜姗姗 胡芳菲 葛琳娜 钟 升 任佳欣 姜淑娥【摘要】 目的 本研究旨在提供准确、全面的颅颈交界区及其周围解剖学结构数据，提供避免相关手术并发症发生的解剖数据。
方法 本研究120例患者血管造影图像进行了回顾，在三维体积重建后分别在冠状位、矢状位和轴位进行了相关结构的测量。
以门齿为基准，定位咽结节、枕骨大孔以及寰椎前结节，同时对其他重要的骨性标志、颈内动脉和椎动脉进行充分研究，以此确定经口咽入路的最佳角度与深度，从而避免在手术中伤及这些结构。
结果 在颅颈交界区的神经内镜手术中，内镜的弯转角度14.27±4.51℃，进入深度应约为72.57±8.72 mm。
在枕骨大骨水平，（横切面）轴位平面内安全手术的角度为77.73±3.15℃，而轴位中线处，安全穿透宽度为20.05±3.11 mm。
从轴位中线M到舌下神经管内口，颈动脉管外口（CC）和颈静脉内缘（JF）的距离分别为9.78±0.72 mm、24.50±1.26 mm和24.33±1.68mm。
结论 本数据有助于理解颅颈交界区周围的解剖学结构，降低手术并发症发生以及最大限度地提高手术的安全性。
【关键词】 解剖学关系；颅颈交界区；经口咽入路手术中图分类号：R741 文献标识码：A 文章编号：1006-351X（2020）07-0397-05Anatomical study of craniocervical junction and its surrounding structures in endoscopic transoral-transpharyngeal approachWang Xinhui, Jiang Shanshan, Hu Fangfei, Ge Linna, Zhong Sheng, Ren Jiaxin, Jiang Shue Department of Oncology,the First Hospital of Jilin University, Changchun 130021, ChinaCorrespondingauthor:JiangShue,Email:**********************[Abstract] Objective This study aims to provide accurate and comprehensive data of craniocervicaljunction and its peripheral structures in order to provide a profound insight of craniocervical junction as well as toavoid complications during surgical procedures related to it. Method Computer topographic angiography images of120 individuals were reviewed, the measurements were performed on coronal, sagittal and axial planes after three-dimension volume reconstruction. We measured pharyngeal tubercle, foramen magnum and tuberculum anteriusatlant which located based on the position of incisor. The anatomic features of other important bony landmarks,internal carotid artery and vertebral artery were also fully studied so as to avoid being injured during the transoral-transpharyngeal procedure. Results During the endoscopic surgery to craniocervical junction, the bending angle ofneuro endoscopy should be 14.27±4.51℃and the entering depth should be about 72.57±8.72 mm. It is safe to workwithin the angle of 77.73±3.15℃in axial plane and the safe penetration width from the axial midline is 20.05±3.11mm in the level of foramina magnum. The distance from axial middle line M to hypoglossal canal, external opening ofcarotid canal (CC) and inner edge of jugular foramen (JF) was 9.78±0.72 mm, 24.50±1.26 mm and 24.33±1.68 mm,respectively. Conclusion The data in this study are valuable for neurosurgeons in clinical practice to reduce thepossibility of complications and maximize the safety of surgeries, these data also contribute to the understanding of theanatomy of craniocervical junction and its surrounding structures.[Key words] Anatomical relationship; Craniocervical junction; Transoral-transpharyngeal surgery基金项目：吉林省发展计划项目（20160101086JC）作者单位：130021 长春，吉林大学第一医院肿瘤科（王新慧），神经肿瘤外科（钟升、姜姗姗）吉林大学（姜姗姗、胡芳菲、任佳欣）；鸡西矿业总医院（葛琳娜）通信作者：姜淑娥，Email：**********************颅颈交界区位于颅底和颈椎上缘之间，其腹部区域包括斜坡下部，枕骨大孔前缘和寰椎前缘等结构。
颅颈交界区的显微解剖研究作者：岳双柱张新中史耀亭周文科周国胜王仲伟王剑新惠磊来源：《中国医药导报》2008年第21期[摘要] 目的：提供颅颈交界区翔实的显微解剖学资料，以提高该区手术的安全性。
方法：对10例成人尸头标本进行显微解剖，对颅颈交界区相关的重要解剖结构进行观察、测量和拍照；在10例干性颅骨标本上，对颅颈交界区相关的骨性结构进行观察、测量和拍照。
结果：颅颈交界区包括众多的肌肉、血管、神经结构，它们的关系复杂；椎动脉在该区行程曲折。
结论：观察和测量的结果有助于术中重要结构的识别和保护。
[关键词] 颅颈交界区；显微解剖；椎动脉[中图分类号] R322 [文献标识码]A [文章编号]1673-7210（2008）07（c）-042-03Microanatomy of the craniocervical junction regionYUE Shuang-zhu, ZHANG Xin-zhong, SHI Yao-ting, ZHOU Wen-ke,ZHOU Guo-sheng, WANG Zhong-wei,WANG Jian-xin,HUI Lei(Department of Neurosurgery, the First Affiliated Hospital of Xinxiang Medical University , Weihui453100 ,China)[Abstract] Objective: To supply full and accurate microsurgical anatomic data on the craniocervical junction region in order to help surgeons to do operations relating to this region more safely.Methods:10 adult cadaveric head specimens were dissected by using microsurgical anatomic skills, and observation and measurement were performed on related anatomic structures of craniocervical junction region. And photographes were taken with a digital camera. 10 dry skulls were studied at the same time. Results: There were many important anatomic structures related to this region, and their ubiety is complicated. The vertebral artery runs a tortuous course in thisregion.Conclusion: The results of observation and measurement are helpful for identifying and protecting vital structures during surgery related to the craniocervical junction region.[Key words] Craniocervical junction region; Microanatomy; Vertebral artery颅颈交界区位于枕骨与寰、枢椎之间，该区常见的病变包括肿瘤、外伤、血管性疾病、先天性疾病和退行性病变等；由于该区位置深在，毗邻重要且复杂的血管、神经结构，如椎动脉及其分支、乙状窦及颈内静脉、延髓与上颈髓、后组颅神经等，手术处理该区病变难度大，术后并发症多，致死致残率高[1-4]。
