颈长肌血管来源与分布及临床意义

Study of the origin and distribution of blood vessel of longus colli and their clinical significance

中文关键词:  颈长肌  颈椎前路手术  血管来源

英文关键词:Longus colli  Anterior cervical spine surgery  Origin of blood vessels

中文摘要:

  【摘要】 目的：分析颈长肌（longus colli，LCo）血管的来源及其在肌肉中的分布并探讨其临床意义。方法：成人防腐尸体标本12具（8男，4女），在标本上进行解剖学研究。通过乳胶灌注显影血管，记录LCo血管来源，各分支血管在LCo的入肌点、走行、终点。分别测量入肌点、终点距离同侧同水平LCo内侧缘的直线长度，并记录相对应的椎体或者椎间盘节段，分析其临床意义。结果：根据血管与LCo的解剖位置关系，分为：（1）LCo上表面血管（上、中、下支），主要来源于甲状腺下动脉、甲状颈干等血管。上支入肌点分布在C6~C7椎体距离LCo内侧缘16.80±9.87mm处，斜向内上方走行，止于C5~C6距离LCo内侧缘11.75±8.93mm处。中支入肌点分布在C6~T1距离LCo内侧缘16.62±5.96mm处，斜向内上方走行，偶有分叉，在C4~C7椎体，66.7%止于LCo内侧缘，33.3%止于距离LCo内侧缘7.87±4.27mm处。下支入肌点分布在C6~T2，距离LCo内侧缘15.65±4.47mm处。发出1~4个分支，成网状结构止于C6~T3的LCo内侧或向下进入心包外脂肪组织形成血管网；（2）LCo肌肉内走行血管，为上表面血管入肌后的延续，属肌肉营养血管，或向下穿行肌肉深部，进入椎体；（3）LCo下表面血管，分布于肌肉下表面与椎体之间。C5、C6的血管来源于椎动脉和甲状腺下动脉，C7和T1来源于颈深动脉。血管扭曲走行，形成血管簇进入椎体，从C3~T1不同椎体平面到LCo内侧缘距离分别为：1.85~4.60mm、1.89~2.61mm、2.60~7.27mm、1.19~7.95mm、2.06~8.61mm及2.47~8.08mm。结论：LCo血管分布具有规律性，表面血管形成上、中、下三支，深部血管多止于椎体上1/3两侧滋养孔。颈椎前路手术中，避免剥离椎体上部或上终板下方的LCo，可减少出血和术后颈部血肿的发生概率。

英文摘要:

  【Abstract】 Objectives: To explore the potential clinical significance of longus colli(LCo) through analyzing the origin and distribution of the vessels of LCo. Methods: An anatomical study was performed on 12 embalmed adult cadaveric specimens(8 males, 4 females). Blood vessels were visualized with latex perfusion. The origin of blood vessles of LCo, and the entry point, distribution and end point of the blood vessels of each branch at LCo were recorded. The lengths between entry point/end point and the medial border of the ipsilateral and horizontal LCo were measured separately, and the corresponding vertebral body or intervertebral disc segment was recorded to analyze the clinical significance. Results: According to anatomical position, the relationship between the vessels and LCo was divided into: (1) The vessels passing over LCo(upper, middle, and lower branches) were mainly from the inferior thyroid artery and thyrocervical trunk. The entry point of upper branch was distributed at C6-C7 vertebrae, with a distance of 16.80±9.87mm to the medial border of LCo. Running a superomedial course obliquely, the vessels ended at 11.75±8.93mm from the medial border of LCo at C5-C6 vertebrae. The entry point of the middle branch was distributed at C6-T1 vertebrae at a distance of 16.62±5.96mm from the medial border of LCo. Running a superomedial course obliquely, with occasional bifurcation, 66.7% of the vessels ended at the medial border of LCo and 33.3% at 7.87±4.27mm from the medial edge of LCo at C4-C7. The entry point of lower branch was distributed at C6-T2, 15.65±4.47mm away from the medial border of LCo. It sent out 1 to 4 branches, forming a mesh structure, and ended at the medial side of C6-T3 LCo or ran down into the lateral pericardial adipose tissue to form a vascular network; (2) The intramuscular vessels of LCo were the continuation of the upper surface vessels after entering the muscle, which were muscle-nourishing blood vessels that passing through the deep part of the lower muscle and entering the vertebral body; (3) The blood vessels on the lower surface of LCo were distributed between the lower surface of the muscle and the vertebral body. The blood vessels of C5 and C6 were derived from the vertebral artery and inferior thyroid artery, and those of C7 and T1 were derived from the deep carotid artery. The blood vessels were twisted in distribution, forming blood vessel clusters into the vertebral body, and the distances from different vertebral planes from C3-T1 to the medial border of the LCo were 1.85-4.60mm, 1.89-2.61mm, 2.60-7.27mm, 1.19-7.95mm, 2.06-8.61mm and, 2.47-8.08mm, respectively. Conclusions: The blood vessels of LCo is regular in distribution, which branches into upper, middle, and lower branches at the surface of LCo and mostly end at the nutrient foramina on both sides at the upper 1/3 of the vertebral body under the lower surface of LCo. In anterior cervical spine surgery, avoiding dissecting LCo above the vertebral body or below the upper endplate can reduce the probability of bleeding and postoperative cervical hematoma formation.