颈胸交界区后方项部肌肉的手术解剖：颈椎椎板成形术中保留C7棘突的意义
Surgical anatomy of the nuchal muscles in the posterior cervicothoracic junction: significance of the preservation of the C7 spinous process in cervical laminoplasty.
作者信息
Ono Atsushi, Tonosaki Yoshikazu, Yokoyama Toru, Aburakawa Shuichi, Takeuchi Kazunari, Numasawa Takuya, Wada Kanichiro, Kachi Takashi, Toh Satoshi
机构信息
Department of Orthopaedics Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
出版信息
Spine (Phila Pa 1976). 2008 May 15;33(11):E349-54. doi: 10.1097/BRS.0b013e31817152cc.
STUDY DESIGN
An anatomic study investigated the attachment of the nuchal muscles to the spinous process.
OBJECTIVE
To investigate the anatomic details of the attachment of the nuchal muscles to the spinous process, and which muscles are spared, and to what extent, when the C7 spinous process is preserved in the cervical laminoplasty.
SUMMARY OF BACKGROUND DATA
In previous studies, it was reported that the incidence of postoperative axial pain was lower in C3-C6 laminoplasty than in C3-C7 laminoplasty, emphasizing the effectiveness of the former procedure where discission of the nuchal muscles that are attached to the C7 spinous process is avoided. However, there have been no detailed anatomic studies of the attachment of the nuchal muscles to the spinous process at the cervicothoracic junction.
METHODS
The anatomy of the speculum rhomboideum of the trapezius, rhomboideus minor, rhomboideus major, serratus posterior superior, splenius capitis, and splenius cervicis to the spinous processes of the cervicothoracic junction were studied using 50 cadavers.
RESULTS
The possibility of total discission of the speculum rhomboideum of the trapezius was 0% with C3-C6 laminoplasty and 18% with C3-C7 laminoplasty. More than 50% preservation of the speculum rhomboideum of the trapezius is possible in 72% in C3-C6 laminoplasty and 16% in C3-C7 laminoplasty. In C3-C7 laminoplasty, the possibility of partial preservation of the rhomboideus minor, serratus posterior superior, and splenius capitis at the spinous process was 0%, 66%, and 29%, respectively. The rhomboideus major in 16% and the splenius cervicis in 56% could be completely preserved without partial discission of the muscle attachment. On the other hand, in C3-C6 laminoplasty, the muscles that were spared without complete discission of the muscular attachment at the spinous process were the rhomboideus minor in 35%, the serratus posterior superior in 100% and the splenius capitis in 67%. The rhomboideus major in 76% and the splenius cervicis in 80% were completely spared without partial discission of the muscular attachment.
CONCLUSION
The current study confirmed that C3-C6 laminoplasty in which the C7 spinous process is preserved reduces invasion of the nuchal muscles.
研究设计
一项解剖学研究调查了项部肌肉与棘突的附着情况。
目的
研究项部肌肉与棘突附着的解剖学细节，以及在颈椎椎板成形术中保留C7棘突时哪些肌肉得以保留及保留程度。
背景资料总结
在先前的研究中，据报道C3-C6椎板成形术后轴性疼痛的发生率低于C3-C7椎板成形术，这强调了前者避免切断附着于C7棘突的项部肌肉的有效性。然而，对于项部肌肉在颈胸交界处与棘突附着的详细解剖学研究尚无报道。
方法
使用50具尸体研究了斜方肌菱形部、小菱形肌、大菱形肌、上后锯肌、头夹肌和颈夹肌在颈胸交界处棘突的解剖结构。
结果
C3-C6椎板成形术时斜方肌菱形部完全切断的可能性为0%，C3-C7椎板成形术时为18%。C3-C6椎板成形术中有72%、C3-C7椎板成形术中有16%的情况可使斜方肌菱形部保留超过50%。在C3-C7椎板成形术中，小菱形肌、上后锯肌和头夹肌在棘突处部分保留的可能性分别为0%、66%和29%。大菱形肌在16%的情况以及颈夹肌在56%的情况可在不部分切断肌肉附着的情况下完全保留。另一方面，在C3-C6椎板成形术中，在棘突处未完全切断肌肉附着而得以保留的肌肉有：35%的小菱形肌、100%的上后锯肌和67%的头夹肌。76%的大菱形肌和80%的颈夹肌在不部分切断肌肉附着的情况下完全得以保留。
结论
本研究证实，保留C7棘突的C3-C6椎板成形术可减少项部肌肉的侵袭。
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