面神经颞骨内段及邻近结构在冠状薄层和HRCT上的应用研究

发布时间：2018-01-23 21:15

本文关键词： 颞骨面神经断层解剖学冠状面火棉胶 HRCT　出处：《南昌大学》2007年硕士论文　论文类型：学位论文

【摘要】： 目的:观测颞骨内面神经各段及邻近结构在耳的冠状薄层断层标本和HRCT (high-resolution computed tomography,HRCT)冠状扫描图像上的形态特点及毗邻关系,探讨其在耳-头颈外科手术中的临床意义,为耳颞区病变的影像诊断和手术治疗提供解剖学依据和形态学基础。方法:10%甲醛固定的成人颅脑标本15例(30侧),以与眦耳线(canthomeatal line, CML)相垂直的定位线为基线,用GE Hispeed N X/ i Sys # CT扫描,获得间隔为1.00 mm,厚度为1.00 mm的HRCT扫描图像,用立体定位仪作出与HRCT扫描层面一致的标记。开颅取脑后,截取8 cm×8 cm×10 cm的组织块,脱钙、脱水、火棉胶浸胶、包埋并切制成厚为1.00 mm的连续冠状薄层切片。HRCT扫描图像和冠状薄层切片上逐一对面神经各段及邻近约45个与临床手术相关的重要结构进行定位与测量,经统计学处理得出结论。结果:经膝状神经节(geniculate ganglion, GG)后2/3层面:GG至鼓室盖上缘垂直距离为(2.43±0.79) mm(右x±smm下同);GG至咽鼓管上壁距离为(6.09±0.93) mm。经锤骨头中部层面:面神经水平段(horizontal facial nerve, HFN)距盾板尖距离为(4.09±0.58) mm;HFN距耳蜗最短距离为(1.37±0.27) mm;锤骨头距鼓室盖上壁垂直距离为(2.23±0.13) mm;HFN距锤骨头内侧最短距离为(3.30±0.08) mm。经匙突中部层面:面神经迷路段(labyrinthine facial nerve,LFN)距耳蜗最短距离为(0.59±0.13) mm; HFN距鼓室盾板尖距离为(5.13±0.59) mm;匙突距锤骨头下缘距离为(2.9±40.34) mm;匙突距耳蜗第二转距离为(1.99±0.69) mm。经砧镫关节层面:HFN至卵圆窗(oval window, OW)外壁距离为(1.78±0.17) mm;HFN至镫骨底板距离为(2.44±0.60) mm;HFN至砧骨短脚距离为(2.89±0.52) mm;经圆窗龛(round window niche, RWN)层面:HFN至鼓索神经距离为(2.54±0.44) mm;面神经隐窝(facial recess, FR)深度平均值为(1.82±0.87) mm;FR横径平均值为(2.70±0.73) mm;RWN横径平均值为(1.67±0.23) mm;RWN深度平均值为(1.36±0.42) mm;锥隐窝平均深度为(2.65±0.58) mm;经面神经垂直段层面:面神经垂直段(vertical facial nerve, VFN)距后半规管(posterior semicircular canal, PSC)距离为(2.50±0.33) mm;VFN至鼓索神经(chorda tympani nerve, CTN)距离为(2.47±0.19) mm;茎乳孔至CTN分叉处的距离为(5.23±0.53)mm;VFN长度平均值为(14.20±1.30) mm;VFN横径平均值为(1.41±0.30) mm。结论:颞骨HRCT冠状扫描图像结合颞骨火棉胶冠状薄层断层标本,能良好显示颞骨内面神经各段及邻近诸解剖结构的毗邻关系。这种对照研究能直观准确地辨认颞骨内诸解剖结构并找出面神经及邻近结构在HRCT图像上的分布规律和定位依据,为耳颞区的医学影像学诊断和颅脑-头颈外科手术治疗提供解剖学依据和形态学基础。
[Abstract]:Objective: to observe the coronal thin sectional specimens and HRCT of the segments and adjacent structures of the temporal facial nerve in the ear. High-resolution computed tomography. To explore the clinical significance of HRCT coronal scan in otolhead and neck surgery. To provide anatomical basis and morphological basis for imaging diagnosis and surgical treatment of auricular and temporal lesions. Methods Fifteen adult craniocerebral specimens fixed with 10% formaldehyde were collected from 30 sides of the craniocerebral specimens. The localization line perpendicular to the canthus auricular line (CML) was used as the baseline. GE Hispeed N X / I Sys # CT scan was used to obtain HRCT scanning images with an interval of 1.00 mm and a thickness of 1.00 mm. After craniotomy, the tissue mass of 8 cm 脳 8 cm 脳 10 cm was cut off, decalcified, dehydrated, and colloid soaked. Bury and cut to make 1.00 thick. Mm continuous coronal thin-layer section. HRCT scanning image and coronal thin-layer slice were used to locate and measure each segment of facial nerve and its adjacent 45 important structures related to clinical operation. The conclusion is obtained by statistical analysis. Results: geniculate ganglion was transgeniculate through geniculate ganglion. The vertical distance from 2/3: GG to the superior margin of tympanic lid was 2.43 卤0.79mm (right x 卤smm). The distance from GG to the superior wall of the eustachian tube was 6.09 卤0.93mm. the medial level of the malleable bone was the horizontal segment of the facial nerve, and the horizontal segment of the facial nerve was facial nerve. The distance from HFN to shield tip was 4.09 卤0.58 mm; The shortest distance from HFN to cochlea was 1.37 卤0.27 mm. The vertical distance between the mallet bone and the superior wall of the tympanic cover was 2.23 卤0.13 mm. The shortest distance from HFN to the medial part of the mallet bone was 3.30 卤0.08 mm. The midway of the spassus was labyrinthine facial nerve. The shortest distance from LFN to cochlea was 0.59 卤0.13 mm. The distance from HFN to the tip of tympanic shield plate was 5.13 卤0.59 mm; The distance between the spassum process and the lower margin of the malleus bone was 2.9 卤40.34 mm. The distance from the second turn of the spassum to the cochlea was 1.99 卤0.69 mm. The oval window was reached from the stirrup joint plane to the oval window. The distance of outer wall of owl was 1.78 卤0.17 mm; The distance between HFN and stapes was 2.44 卤0.60 mm. The distance from HFN to the short foot of the incus was 2.89 卤0.52 mm. The distance between window and chorda tympani nerve was 2.54 卤0.44 mm in the round window niche (RWN). The average depth of facial recess (FR) was 1.82 卤0.87 mm. The mean transverse diameter of FR was 2.70 卤0.73 mm; The average transverse diameter of RWN was 1.67 卤0.23 mm; The average depth of RWN was 1.36 卤0.42mm; The mean depth of cone recess was 2.65 卤0.58 mm. Vertical facial nerve of facial nerve. The distance from posterior semicircular canal to posterior semicircular was 2.50 卤0.33 mm. The distance between VFN and chorda tympani was 2.47 卤0.19 mm. The distance from the stem mammary foramen to the CTN bifurcation was 5.23 卤0.53mm. The average length of VFN was 14.20 卤1.30 mm; The average transverse diameter of VFN was 1.41 卤0.30 mm. Conclusion: HRCT coronal scan of temporal bone combined with coronal slice specimens of the temporal bone. The comparative study can identify the anatomical structures in temporal bone and find out the difference of facial nerve and its adjacent structures on HRCT images. The rule of distribution and the basis of location. To provide anatomical basis and morphological basis for medical imaging diagnosis and craniocerebral-head-neck surgical treatment of ear-temporal region.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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