改良的RSSMA显微应用解剖学研究

发布时间：2018-03-24 19:04

本文选题：应用研究　切入点：乙状窦后入路　出处：《重庆医科大学》2012年硕士论文

【摘要】：【目的】采用数字化可视人（首例中国女性）的数据集，对颞骨及其相邻结构的空间位置关系进行断面解剖学研究，并对颞骨及相邻结构进行计算机三维重建和虚拟现实显示；在此基础上再将现代影像技术与神经导航仪相结合应用于改良的乙状窦后-内耳道上入路（Retrosigmoidal suprameatal approach，RSSMA）来进行量化研究内耳道上结节和岩尖的扩大磨除的范围以及其安全性、有效性和实用性。【材料】数字化可视人（中国首例女性）数据集中的头部连续薄层断面图像, Adobe photoshop CS3、Amira和Maya软件；10%甲醛固定好的成人尸头标本15例（双侧共计30组数据）、64排螺旋CT（0.625mm层厚）、Mimics V10.0软件、神经导航仪等。【方法】该研究中，我们采用数字化可视人（中国首例女性）的数据集（该断层层厚较薄，重建图像更逼真，数据更精确），对颞骨及PICA进行断面解剖学观察，提取相关断面图像信息，分别应用Adobephotoshop CS3、Amira和Maya软件，对颞骨及PICA进行计算机三维重建和虚拟现实显示。在神经导航仪的精确引导下模拟该手术入路，并进行逐层显微解剖定位，从后向前对内耳道上结节和岩尖的骨质进行安全磨除，以提高骨质磨除的安全性，并采用CT测量的方法来观察和测量内耳道上结节和岩尖的磨除范围以及三叉神经等结构的显露范围；并借助Mimics V10.0软件来三维重建内耳及颞骨，以此来估算岩骨骨质磨除相对比较安全的范围。【结果】通过3个正交切面中典型的二维层面（如外半规管层面、前庭窗层面、咽鼓管层面），对其主要结构的断面形态及毗邻关系进行描述。重建三维模型可清楚地显示颞骨内部结构和PICA的形态和空间位置关系，同时尚可任意角度旋转、切割、组合和整体显示相关结构。PICA水平段与PICA弯曲部和内耳道内侧缘连线的夹角平均值为67.5度。通过本次实验研究，在改良的RSSMA中，内耳道上结节前-后、中线-侧方的骨质可以全部磨除；岩尖的上-下（可磨除8.22mm骨质）、前-后、中线-侧方的骨质可以部分磨除；其中三叉神经在磨除后可增加显露9.26±1.25mm；内耳道前后壁夹角可扩大33.06±5.75度的手术视野；可显露上斜坡的范围约93.08±7.50mm2，中颅窝底约148.76±8.21mm2。【结论】采用三维重建技术重建的颞骨及PICA结构清晰，其构建模型可较为准确地揭示颞骨内部结构及与PICA的毗邻关系，，为解剖学习和临床应用提供更为直观便捷的参考;在现代医学影像技术与神经导航仪相结合的条件下进行改良的RSSMA较传统入路更简便、安全、实用、微创,改良的RSSMA是岩斜区肿瘤手术治疗的较佳选择。
[Abstract]:[objective] to study the sectional anatomy of temporal bone and its adjacent structures by using the data set of digitized visual human (the first Chinese female), and to reconstruct the temporal bone and adjacent structures by computer and virtual reality. On this basis, a modified retrosigmoidal suprameatal approach was applied to the modified retrosigmoidal suprameatal approach (RSSMAA), which was combined with a neural navigator to quantify the extent and safety of the enlarged removal of nodules and petrous apex in the inner ear canal. Effectiveness and practicability. [materials] continuous thin-layer sectional images of the head in a digital visual human (the first female case in China), 15 adult cadaveric head specimens fixed with 10% formaldehyde with Adobe photoshop CS3Amira and Maya software (30 groups of bilateral data) were collected by Mimics V10.0 software. A neural navigator, etc. [methods] in this study, we used the data set of digitized visible human (the first female in China) (the slice thickness is thinner, the reconstructed image is more realistic, the data is more accurate), and the sectional anatomy of temporal bone and PICA were observed. The relevant sectional image information was extracted, and the temporal bone and PICA were reconstructed by computer and virtual reality display using Adobephotoshop CS3Amira and Maya software respectively. The surgical approach was simulated under the accurate guidance of the neural navigator, and the microanatomical localization was carried out layer by layer. To improve the safety of bone removal, the tubercle and petrous apex of the inner auditory canal were removed from the posterior front. The removal range of tubercle and petrosal apex on the inner ear canal and the exposure range of trigeminal nerve structure were observed and measured by CT, and the inner ear and temporal bone were reconstructed by Mimics V10.0 software. This is used to estimate the relatively safe range of bone removal from petrosal bone. [results] the typical two-dimensional plane in three orthogonal sections (such as external semicircular canal, vestibular window, etc.). In the eustachian tube, the cross-section and adjacent relationship of its main structure are described. The reconstructed three-dimensional model can clearly display the internal structure of the temporal bone and the relationship between the shape and spatial position of PICA, and can rotate and cut at any angle with fashion. The average angle between the horizontal segment of PICA and the PICA curve and the medial edge of the inner auditory meatus was 67.5 degrees. In this experimental study, in the modified RSSMA, the superior tubercle of the inner ear canal was pre- and post-nodule. The midline-lateral bone can be completely removed, the upper-lower (8.22mm) bone can be removed, the midline-lateral bone can be partially removed. The angle of anterior and posterior wall of the internal auditory canal could be enlarged by 33.06 卤5.75 degrees, and the range of upper slope was 93.08 卤7.50 mm 2, and the bottom of middle cranial fossa was 148.76 卤8.21 mm 2. The trigeminal nerve could be exposed 9.26 卤1.25 mm after grinding, and the angle between anterior and posterior wall of the internal auditory canal could be enlarged by 33.06 卤5.75 degrees. [conclusion] the structure of temporal bone and PICA reconstructed by 3D reconstruction is clear, and the model can accurately reveal the internal structure of temporal bone and its adjacent relationship with PICA, and provide a more direct and convenient reference for anatomical study and clinical application. Under the condition of the combination of modern medical imaging technology and neural navigator, the modified RSSMA is more convenient, safe, practical and minimally invasive than the traditional approach. The modified RSSMA is a better choice for the surgical treatment of tumors in the petroclival region.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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