经岩骨前部入路至岩斜区的应用解剖学研究

发布时间：2018-03-10 12:56

本文选题：经岩骨前部入路　切入点：岩斜区　出处：《江西医学院》2005年硕士论文　论文类型：学位论文

【摘要】：目的岩斜区位置深在、毗邻的解剖结构复杂而重要,该区域病变的手术治疗一直是神经外科难点之一。经岩骨前部入路(Kawase 入路)是岩斜区病变的主要手术入路之一,但由于颞骨岩部内耳蜗、颈内动脉、膝状神经节及面听神经等结构的准确定位到目前为止尚缺乏统一的标准,这大大影响了该入路的临床应用和发展。本研究旨在通过对颞骨岩部周围重要结构的观察和测量,来量化各结构之间的位置关系,系统全面地了解经岩骨前部入路至岩斜区的显微解剖,寻找更好更简便的耳蜗、内耳道及颈内动脉岩部的定位方法和定位标志,为手术磨除岩骨尖部及扩大岩斜区术野暴露范围提供可靠依据,进一步探索和改进经岩骨前部入路的操作方法,为该入路的临床应用提供解剖学资料。方法取成人干燥头颅标本10 具20 侧,观察辨认岩骨表面弓状隆起、岩浅大神经沟、面神经管裂孔、三叉神经压迹、棘孔、内耳门等结构,用磨钻磨除岩尖骨质暴露颞骨岩部内耳蜗、骨半规管、内耳道底、颈内动脉管等重要结构,对各结构之间的关系及距离进行解剖观察和测量;取10%福尔马林固定的成人头颅湿标本10 具(20 侧),彩色乳胶分别灌注动静脉血管,在四叠体上丘水平切断脑干,除去大脑半球和间脑, 保留脑干、小脑及完整的小脑幕,去除中颅窝硬脑膜,辨认棘孔、三叉神经、岩浅大神经、弓状隆起、面神经管裂孔、岩骨嵴、岩上窦等结构。磨除岩骨表面骨质暴露颈内动脉岩部、膝状神经节、耳蜗,观察和测量岩骨周围各结构之间的位置关系;取10%福尔马林固定彩色乳胶灌注的头颅湿标本6 具12 侧,在6～25 倍手术显微镜观察下模拟经岩骨前部入路手术操作,对手术入路全程进行操作体会及解剖学观测,并观察手术视野的暴露范围。用游标卡尺及圆规对上述各结构进行测量,分别取三次测量值的平均值,对测量数据进行统计学分析,并对模拟手术操作中的心得体会进行总结。
[Abstract]:The purpose of the petroclival region is deep, the complex anatomy of adjacent important surgical treatment of lesions in this area has been one of the difficulties in the Department of neurosurgery. Anterior transpetrosal approach (Kawase approach) is the main operation of petroclival lesions in one of the road, but because of the petrous bone in the cochlea, internal carotid artery, geniculate ganglion the facial nerve and accurate positioning structure so far is the lack of uniform standards, which greatly affected the clinical application and development of this approach. This study aims to observe and measure around the petrous bone structure, the relationship between the position of each node to quantify the systematic and comprehensive understanding of microscopic anatomy the anterior part of the petrosal bone approach to the petroclival region via different, looking for better and more convenient cochlea, positioning method and sign of ear canal and petrous portion of internal carotid artery, except the petrous apex and expand the petroclival region of field exposure range provided for grinding operation We can further explore and improve the operation method of the anterior approach of the anterior part of the bone, and provide the anatomical data for the clinical application of the approach.
Methods 10 adult dry skull specimens with 20 side observation to identify rock arcuate bone surface uplift, ditch the greater superficial petrosal nerve, hiatus of facial nerve, trigeminal nerve compression, foramen spinosum, inner door structure, the drill ground bone petrous apex exposed petrousbone cochlea, semicircular canal, internal ear bottom, internal carotid canal and other important structures, the relationship between the distance and structure were observed and measured; 10% formalin fixed 10 adult cadaveric heads (20 sides), arteriovenous were perfused with color latex, in the high level of brain stem quadrigeminal cut off, remove the cerebral hemisphere and the retention the brainstem, cerebellum and complete removal of the tentorium, middle fossa dura, identify the foramen spinosum, trigeminal nerve, greater superficial petrosal nerve, arcuate eminence, hiatus of facial nerve canal, petrous ridge, superior petrosal sinus structures. Grinding petrous bone bone exposed surface of petrous carotid, geniculate ganglion, ear The worm, the relationship between the position of observation and measurement of the surrounding rock bone structure; 10% formalin fixed cadaveric heads were perfused with color latex 6 with 12 side, simulation of anterior transpetrosal approach operation in 6~25 times of surgery under the microscope, the surgical approach of the whole operation and observation of anatomy, and to observe the exposure range the operation field. To measure the structure with vernier caliper and compasses, taking the average of three measurements respectively, the statistical analysis on the measurement data, and the simulating operation experiences were summarized.

【学位授予单位】：江西医学院
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R322

【相似文献】