JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
Buoc dSu nhan xet \h giai phau dong mach dot song viin duoi cham
Initial Comments on the Applied Anatomy of Vertebral Artery i Suboccipital Region
Nguyen Truong Due Duong, Ly NgliTii Kliiii
Tom tat
Oe hieu rd hon cau triic giai phau cua ddng mach dot song vdng dUdi cham (thanh phan tham gia cau true he thdng mach mau nao), chung tdi tien hanh nghien cdu de tai vdi muc tieu: nghien cdu giai phau dpng mach ddt sdng vung dUdi cham' dudng di va cac thanh phan giai phau lien quan. PhUOng phdp nghien cdu giai phau viing co gay tren 7 tU thi tai hoc vien Trung Tay y ket hop thude dai hpc y Phuang Nam, Quang Chau, Trung Quoc trong thdi gian tU 3/2012 den 1/2013./Cet qud; tat ca cle ddng mach dot sdng deu cd hinh dang quanh co va bi mot so Idn dam roi tinh mach che phu, khdng cd dUdng dl bat thudng, Dpng mach dUOe chia lam 2 phan: doan di len thang ddng (tUC; den C,) va doan ngang (tU Ci den Id vao dUdi mang cUng), Ooan dong mach ddt song di phia ngoai trung binh cd chieu dai 4,9
± 0,7mm Doan t d dUdi mang cdng den doan di thang trung binh cd chieu dai 15,9 + 2,4mm. £)oan di t h i n g tdi C2 trung binh cd chieu dai 7,0 ± 1,3mm, Chieu dai trung binh cua doan thang dUng la 16,1 ± 1,4mm; chieu dai trung binh cua doan di ngang la 34,6 ± 2,7mm. Khoang each tU dong mach dot sdng den dudng giUa cO the cd chieu dai trung binh 13,8 + 0 , 8 m m .
TUkh6a:G\a\ phau ddng mach, dot sdng vung dudi cham
Summary
Objective- To explore the shape, branches and possible anomalies of the vertebral artery in the suboccipital region in adult cadavers. Methods: 7 suboccipital segment embalmed vertebral artery specimens from discipline of Anatomy Southern Medical University ,were dissected and studied.
Dissection was performed and was carried out from the skin up to the vertebral artery in layers. The shape, and the branches of the vertebral artery were studied and measurements were taken using vernier calipers. Results: All the vertebral arteries had a tortuous shape and were covered with rich venous plexuses. None of the specimens had an anomalous shape. The artery was divided into a vertical segment between C2 and CI vertebra and a horizontal segment from the CI transverse foramina to Its dural entry. The mean diameter of the artery was 4,9 ± 0.7mm, The shortest distance of vertical segment from the dural tube was 15.9 ± 2.4mm, and the distance from the C2 ganglion was 7.0 ± 1.3mm. The average length of the vertical segment was 16.1 ± 1.4mm and the average length of the horizontal segment was 34.6 ± 2,7mm, The average of the shortest distance between the vertebral artery and the midline was 13,8 ± 0,8mm, Conc/us/'ons; The vertebral artery has a tortuous shape and is prone to various injury, especially rotatory manipulation here. Thorough anatomical knowledge of this segment is essential for the physicians
Keywords: Anatomy of Vertebral Artery, Suboccipital Region
Phan bien khoa hoc: GS.TS NGUYEN VAN THONG 130
TAP CHi Y DU'Q'C tAM S A N G 108 Tap 8-So 2/2013
I . D a t v a n d e
Vung CO gay dUOe tao thanh bdi cac d o t sdng CO, cac CO vung eo gay, d d n g mach va tmh mach than nen. Cau true giai phau v u n g co gay phu hop vdi chdc nang g i d o n d i n h tU the cua dau, d o n g thdi tham gia vao c i c hoat d d n g cua dau va co, d i m bao cung cap m i u eho phan sau cua nao v.v... Oe hieu ro hon cau true giai phau cua d d n g mach ddt song VLing dudi cham (thanh phan t h a m gia cau true he thong mach mau nao), t d d d giup cho q u i trinh nghien cdu benh ly cua he t h d n g mach mau nao
• cung nhu cd duoc cac p h u o n g phap chan doan, dieu trj, d u phdng t o t nhat cho cac benh ly nay, chung toi tien hanh nghien eUu de tai vdi muc tieu:
Nghien cdu giai phau dong mach dot song vung dddi cbarr]:dudng di vd cdc thdnh phdn gidi phdu lien quan.
2. Chat lieu va p h U d n g p h a p n g h i e n c d u 2.1. Chat lieu nghien cdu
DiJng 7 xac ngUdi da duoc x l e dinh chinh xac tU vong, 5 nam, 2 nU. Tien hanh giai p h l u t d thi vung CO gay bSng c i c d u n g cu giai phau thdng t h u d n g .
2.2. Phdang phap nghien cdu
Dung dung cu giai phau t h o n g t h u d n g tien hanh giii phau tU thi, bdc t i c h cac Idp da va eo tU ngoai vao trong, tdi khi bdc Id toan bd vung cham gay, ed the nhin thay cung sau cua dot ddi va gai dot song. Dua vao co cheo dau tren va co cheo dau dUdi, CO the dinh vi dUOc m d m ngang dot dpi. GiUa dot doi va dot true cd rat nhieu mo lien ket Idng leo.
Dung dung cu bdc tach dau tu tien hanh bdc t i c h t6i khi nhin thay nhanh trUde cua re than kinh C2, tiep tuc bdc tach ve phia trUdc, tdi khi tim duoc fipng nnach dot sdng, ngoai ra cdn ed the nhin thay tac tinh mach thudc dam rdi t i n h mach vung dUdi cham. Cat bd cac co v u n g dudi cham, c i t bd hoan toan cung sau CI tdl hai ben m o m ngang, cat bo iiang xuong. Sau do tien hanh giai phau dong mach
^ox song tdi sat v u n g tuy. Quan sat dudng di va phan nhanh cua d o n g mach d o t song, do chieu dai
b i n g thude kep cd du xich cd Qd chinh xac den 0,1 m m , ghi lai sd lieu da do.
2.3. Dia diem nghien cdu: Hoe vien Trung Tay y ket hap, Oai hoc Y Phuong Nam, Quang Chau, Trung Quoc.
2.4. Thdi gian nghien cdu: 3/20)2 -1/2013.
3. Ket qua n g h i e n COTU
Odng mach dot song sau khi di vao 16 mdm ngang dot sdng, di len tren chui qua 16 mdm ngang 6 dot sdng cd tren, tdl phia trUdc ranh ddng mach dot sdng cua ddt ddi. Tai d i y , ddng mach dot sdng cung vdi c l e eo vung sau gay, phan tiep giap phia sau cua dot doi va xUcJng cham dUdc ca cheo dau tren, eo t h i n g dau sau ldn va khdi eo thang bao phu.
Trong tat ca cac tieu ban, ddng mach dot sdng vung dudi cham deu di cong va bi mdt sd ldn dam rdi tinh mach che phu (hinh 1), d 16 mdm ngang, noi ddng mach di vao, cd 1 Idp mang xUong ed gidi han rd rang bao phu. Cic dong mach deu khdng ed dudng di bat thUdng, Vi vay, de thuan tien eho viec md t l va do dac. chung tdi chia dpng mach ddt sdng vung dudi cham ra lam 2 phan: doan di thang len va doan di ngang (hinh 2). TU C2 den CI la doan di t h i n g dUng nen gpi la doan t h i n g dUng; tU mdm ngang CI den 16 vao dUdi mang eUng goi la doan di ngang. Hai doan ddng mach nay cd 4 lan di gap khue:
- Lan 1 la sau khi ddng mach di xuyen qua mdm ngang cua dot true lien hUdng ra phia ngoai, len tren va xudng dudi, h o l e hUdng ra phia ngoai va xudng dudi, hinh thanh nen doan gap khue sd 1.
- Lan 2: tiep theo doan 1 tdi phia ngoai khdp dot dpi, hudng ra phia ngoai, rdi di xuyen qua mdm ngang dot ddi, tao thanh doan gap khue sd 2.
- Lan 3: dpng mach dot sdng sau khi ra khoi m d m ngang CI se hUdng vao phia trong de hinh thanh nen doan gap khuc sd 3.
- Lan 4: ddng mach dot sdng men theo cung sau cua dot song sd 1 (CI), chay vao trong, hinh thanh nen doan gap khuc sd 4, (Hinh 2)
Ca doan di thang va doan di ngang deu ed hai n h l n h c o d j n h :
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY V o l 8 - N ° 2 / 2 0 1 3
- O o a n di thang p h i n thai ih n'. i n h co va n h l n h d p n g mach. Hai n h l n h nay cd nhieu cau ndi vdi nhanh xudng cua d o n g mach d o t song v u n g dudi cham.
- Ooan di ngang p h i n thanh n h l n h ca v l n h l n h d o n g mach mang nao sau.
Ooan d d n g mach d o t sdng di phia ngoai t r u n g binh cd chieu dai 4,9 ± 0,7mm. Doan t d dudi m a n g cdng den doan dl t h i n g trung binh cd chieu dai 15,9
± 2,4mm. Doan di t h i n g tdi C2 t r u n g binh cd chieu dai 7,0 ± 1,3mm. NhU vay, chieu dai t r u n g binh cua doan t h i n g dUng la 16,1 ± 1,4mm; chieu dai t r u n g binh cua ooan di ngang la 34,6 ± 2,7mm. K h o i n g each tU d d n g mach ddt sdng den dUdng giUa co the cd chieu dai trung binh 13,8 ± 0,8mm, Bang 3.1 cho thay d u d n g di cua ddng mach dot song ben phai d m d t ddi tUong nghien cUu, bang nay cho thay d d n g mach dot sdng dUOc bao hoan toan bdi cung sau cua dot sdng cd 1
IHinh T.Dani roi tinh mach dl theo dong mach dot song vung dudi cham
JC2
Hinh 2. Dudng di cua ddng mach dot sdng vung dUdi cham sau khi cdt cung sau CI, bdc Id mdng cdng tuy song vd tiet doan thdn kinh C2: dogn di thang (Vv), vd doan dl ngang (Vh); trong do cd 4 Idn gdp khuc (tdU
den L4), mom ngang Ci (CUp), cung sau CI (ClPa)
Hinh 3.1. Doan dong mach dot song vung dudi cham gdp khuc Idn 3 (L3) bi ranh ddng mach cua
dot dgi bao phu hoan todn B^ng 1 . T r u n g b i n h c h i e u d a i d o n g m a c h d o t
s o n g v u n g d U d i c h a m
Phan doan dong mach Ooan thang ddng [gida CI vaC2)
Ooan di ngang (td mdm ngang CI den lo vao dudi mang cUng)
Khoang each t d liet doan than kinh C2 den doan thang ddng
Khoang each tir doan di ngang den dUdng gida co the Khoang each td mang cdng tuy sdng den doan thang ddng
Doan dpng mach ddt sdng vung dudi cham di phia ngoai
Chieu dai cac doan dpng mach X ± SD (mm)
16.1 ±1.4
34 6 + 2.7
7.0 ±1.3
13.8 ±0.8
15.9 ± 2.4
4.9 ± 0.7
4. Ban l u a n
Oa ed nhieu cdng t r i n h t r o n g va ngoai nddc nghien cUu g i l l phau d o n g mach d o t song nhU:
- El-Bary va cpng su n g h i e n cUu tren 14 t d thi va do duoc khoang each t d d p n g mach d o t song den xUong c h u m la 2 1 m m , k h o i n g each t r u n g binh t d
T^p CHl Y DU'OC L A M S A N G 108 Tap 8-So 2/2013
dau mdm ngang CI den xuang chum la 19,6mm., di/dng kinh cua d o n g mach d o t song 2 ben vao khoang 3,9mm - 4 m m , khoang each gan nhat giQa dpng mach d o t sdng vdi d u d n g giUa ca the la 16,8mm.
Goel va cdng sU phat hien doan t h i n g dUng cua dong mach dot sdng vung dudi cham cd chieu dai trong binh 15,7mm, t r o n g d d , chieu dai tU doan thang ddng tdi tiet doan than kinh C2 va mang tuy CLfng lan luot la 7,5mm va 15,3mm, doan di ngang CO chieu dai 35,7mm.
- Ebraheim va cpng su n h i n thay khoang each xis dong mach d o t song tdi d u d n g giUa co the la 12mm.
- Shizhen Zhong va cdng sU cho r i n g dUdng kinh ngoai cua ddng mach d d t sdng k h o i n g 4 - 5mm, su chenh lech ve d u d n g kinh ddng mach dot song gida eae t d thi la 7,29%.
Sd lieu nghien cdu cua chung tdi cung ed sU ti/ong ddng vdi cac nghien cUu tren.
Trong bao e l o cua Rhoton, m d t phan cua dong mach ddt song bi mang cham - doi sau bao phu, cac ranh xUang tren d o t sdng ngay cang sau.
Trong sd 50 mau nghien cUu, ed 24 m i u (48%) cd ranh xUong dot sdng t u o n g ddi ndng, 12 m i u n i m mpt phan trong r i n h xUong, 14 mau nam hoan toan trong ranh xuong.
- Senoglun tien hanh nghien eUu tren 166 mau xac kho, phat hien tha'y ed 8 t r u d n g hop ed cau xi/ong hai ben, 10 trudng h o p ed cau xUong mot ben, mat tren cung sau CI hinh thanh ranh xUong.
Trong qua trinh nghien cUu, chung tdi cung phat hien thi'y cd 1 trudng hop d d n g mach dot song gan nam hoan toan trong ranh xuang (hinh 3).
Chung tdi cho rang cac ranh xUong tren dot sdng diroc hinh thanh de bao ve, l i m g i i m nguy co ton thuong ddng mach dot sdng.
Ddng mach d o t sdng vung dudi cham di quanh CO, ed nhieu doan gap khuc, cd k h i n i n g la do de thich Ung vdi pham vi van d p n g tUOng doi Idn cua flau CO. Cle doan gap khue giup eho d d n g mach tranh duoc c l e ton t h u a n g khi van dong, vi d u : ton thtrong do cac d p n g t i c xoa bop khdng d u n g , hoac ton thuang do phau thuat v.v.., Tuy nhien, d u d n g di
quanh co cua ddng mach ddt song vung dudi ehi'm cung la mot trong nhUng nguyen nhan lam c i n trd ddng m i u len nao. Khi do, neu kem theo c l e benh k h i c nhu vUa xo ddng mach hoac dp nhdt mau tang cao cung cd the tao nen cue lap mach, gay thieu mau cho da g i l c Willis, anh hUdng den viec cap m i u eho vung trong tai, gian nao, than nao, tieu n i o , gay ra c l e trieu chUng nang ne.
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JtSaWallcnbcrg ^fiEiffJ ^ [ J ] . * ^ ^ S ' ^ ^••
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