肌硬膜桥的临床解剖学研究

The “myodural bridge” which is a connective tissue existing between the deeper muscles of the suboccipital region and nuchal ligament and the spinal dura mater was discovered in recent years. Studies on the composition and functions of this connective tissue have been gradually concerned. Previous studies in our team showed that, the “myodural bridge” was composed of several muscles of the suboccipital region. The pulling from the “myodural bridge” to the posterior wall of spinal dura mater was great. Accordingly, it was supposed that the movements of the head and neck were likely to contribute to the circulations of cerebral spinal fluid via the connection between the “myodural bridge” and spinal dura mater. In this study, in order to further refine the anatomical structures of the “myodural bridge” in morphology, P45 plastinated technology and other techiniques will be conducted. A possible new concept of the “myodural bridge complex” will be proposed. To assess the effect of head rotations on CSF flow waveforms as well as to determine the existence of a correlation between myodural bridges and CSF circulation, healthy adult volunteers will be investigated with a cine phase-contrast MR imaging. To analysis the relationships between pathology changes of the “myodural bridge” and chronic unexplained headache, MR images were random obtained from patients with chronic unexplained headache and normal volunteers.. In this study, a possible new concept of the “myodural bridge complex” will be proposed for the first time. New evidences will be provided for the hypothesis that the pulling from the deep suboccipital muscles contracting will affect the circulations of cerebral spinal fluid via the myodural bridge. Meanwhile, a new mentality will be provided for the etiology and direction of treatment for chronic unexplained headache.

肌硬膜桥是近年来新发现的枕下区肌肉组织及韧带与硬脊膜的连接结构。对于其组成及功能的研究逐渐被各国学者所关注。本课题组前期工作结果显示，枕下区多块肌肉均参与组成肌硬膜桥，此结构对硬脊膜的牵拉作用十分明显。据此我们提出一个新的关于脑脊液循环动力来源的假说，即枕下肌的收缩会通过肌硬膜桥和硬脊膜的连接对脑脊液循环产生一定的影响。本课题将采用P45断层塑化等多种技术从形态学上进一步细化肌硬膜桥的解剖学结构，提出肌硬膜桥复合体这个全新的概念。并利用磁共振电影相位对比法，对健康志愿者头颈部行MR扫描，从功能方面探究枕下肌通过肌硬膜桥对脑脊液循环的影响。同时筛选临床慢性不明原因头痛患者及健康志愿者，分析肌硬膜桥病理变化与慢性不明原因头痛的关系。.本课题将首次提出肌硬膜桥复合体的概念，并为该复合体可以影响脑脊液循环的假说发现新的证据，同时为慢性不明原因头痛的病因及治疗方向，提供新的思路。

肌硬膜桥是近年来新发现的枕下区肌肉组织及韧带与硬脊膜的连接结构。对于其组成及功能的研究逐渐被各国学者所关注。根据前期研究基础，本课题组对肌硬膜桥的功能提出了新的假说，即头部运动时，枕下区肌硬膜桥会通过对硬脊膜的牵拉，影响局部脑脊液循环，参与脑脊液的循环动力机制。. 因此本课题采用P45断层塑化、大体解剖、组织学染色、扫描电镜及三维重建技术，对肌硬膜桥及参与形成肌硬膜桥的枕下区其他结构进行了进一步的研究分析。利用磁共振电影相位对比法，对健康志愿者头颈部行MR扫描，从功能方面探究枕下肌通过肌硬膜桥对脑脊液循环的影响。同时筛选临床慢性不明原因头痛患者及健康志愿者，分析肌硬膜桥病理变化与慢性不明原因头痛的关系。. 目前的研究结果显示于寰枕及寰枢间隙，肌硬膜桥纤维与硬脊膜存在切实的连接。肌硬膜桥是主要由Ⅰ型胶原纤维构成的腱性结构。在头部运动过程中，肌硬膜桥能够承载较强的拉力，枕下肌可能经其对硬脊膜产生较大的拉力。肌硬膜桥并不是由单一肌肉或者韧带发出的纤维所组成的结构，而是以“肌硬膜桥复合体”这种复杂形式存在。不同来源的肌硬膜桥纤维相互联系，协同发挥对硬脊膜的牵拉作用，应视为整体的结构和功能复合体，基于此提出肌硬膜桥复合体这个全新的概念。.发现健康成年志愿者在转头及俯仰运动后，上颈部脑脊液的流速和流量均有变化。证明了肌硬膜桥对硬脊膜的牵拉是脑脊液循环动力影响因素。在慢性头痛患者中，头后小直肌有肥大的病理变化。推测头后小直肌的肥大现象可能是慢性头痛的一个病因。. 本课题首次提出肌硬膜桥复合体的概念，并为该复合体可以影响脑脊液循环的假说发现新的证据，同时为慢性不明原因头痛的病因及治疗方向，提供新的思路。