颅颈交界区影像解剖学研究

发布时间：2018-05-03 21:00

本文选题：颅颈交界区 + 解剖　；参考：《天津医科大学》2007年硕士论文

【摘要】： 第一部分颅颈交界区大体和断层解剖学研究目的:了解颅颈交界区重要结构及其毗邻,深入研究颅颈交界区重要结构的断层解剖,为该区域影像学研究提供解剖学依据。资料和方法:本研究采用经福尔马林固定的正常成人头颅标本12例(天津医科大学解剖教研室提供),男9例,女3例,年龄47—73岁,平均年龄67.8岁。其中3例用于进行颅颈交界区大体解剖观察,3例制成5.0mm厚的冰冻切片,6例制成0.5mm厚的薄层切片。观察颅颈交界区重要结构的形态及其毗邻关系。结果:颅颈交界区位于枕骨、乳突、颞骨岩部、寰枢椎椎体等骨性结构所围成的间隙内,一些重要的支撑韧带(翼状韧带、十字韧带、齿突尖韧带、寰枕前、后膜、覆膜)和神经、血管等结构穿行其中。该区域韧带结构从后向前依次为:寰枕后膜、覆膜、十字韧带(包括上下纵束、横韧带)、翼状韧带、齿突尖韧带及寰枕前膜,其中覆膜、十字韧带上纵束、齿突尖韧带在枕骨基底部粘连紧密,不易分离。椎动脉与第1、2颈神经关系密切。结论:大体解剖及断层切片能较好地显示颅颈交界区韧带、神经、血管等重要结构及其毗邻,为深入进行颅颈交界区影像学研究提供了解剖学依据。第二部分颅颈交界区CT和MRI影像解剖学研究目的:研究正常颅颈交界区重要结构的CT和MRI表现,优化该区域重要结构的影像学检查方法,为该区域的临床诊断提供有价值的影像解剖学基础。资料和方法:在2006年10月至2007年5月期间,于我院行头颈部平扫及增强CT检查中,随机选取51例正常者,其中男31例,女20例,年龄34—60岁,平均年龄49.4岁,行螺旋CT横断面扫描,冠状面、矢状面重组,增强扫描采用经肘静脉注射非离子型碘对比剂100ml(350mg I/ml),流速4.0ml/s。选取无头颈部外伤、不适的健康志愿者51例,其中男30例,女21例,年龄20—39岁,平均年龄27.3岁,采用MRI多脉冲序列行横断面、冠状面、矢状面扫描。结合大体和断面解剖,分析颅颈交界区各断面重要结构的CT和MRI表现。比较MRI各脉冲序列对颅颈交界区主要韧带(寰枕后膜—硬膜复合体、覆膜—硬膜复合体、横韧带、翼状韧带、寰枕前膜)的显示效果。测量该区域重要结构的影像解剖参数。结果:CT和MRI能较好地显示颅颈交界区重要结构及其毗邻。寰枕后膜—硬膜复合体、覆膜—硬膜复合体、横韧带及翼状韧带均能在CT和MRI上清晰显示,显示率为100%(51/51);齿突尖韧带只可在正中矢状面识别,在CT上的显示率为29.4%(15/51),在MRI上的显示率为43.1%(22/51);寰枕前膜在MRI上的显示率为100%(51/51),但在CT上难以识别。两名医师分别分析MRI各脉冲序列对颅颈交界区主要韧带的显示情况,研究结果表明质子密度加权像显示该区域主要韧带的效果最佳。比较CT和MRI测量值,结果显示基底角、寰枕关节角、枕齿间距、齿状突位置及左右侧寰齿间隙差在CT和MRI上的差异无统计学意义(P＞0.05)。结论:CT和MRI能较好地显示颅颈交界区重要结构及其毗邻。质子密度加权像能清晰显示颅颈交界区主要韧带,可作为该区域韧带结构的理想MRI成像序列,恰当的成像层面有利于韧带的显示。该区域重要结构的影像学测量将有助于疾病的诊断。
[Abstract]:Part one: gross and sectional anatomy of craniofacial junction
Objective: to understand the important structures and adjacent areas of the craniofacial junction, and to study the anatomy of the important structures in the craniofacial junction area, and to provide an anatomical basis for the study of the region.
Materials and methods: in this study, 12 cases of normal adult head specimens (Medical University Of Tianjin anatomy teaching and Research Department) fixed by formalin were used, 9 men and 3 women, aged 47 to 73 years old, with an average age of 67.8 years. 3 cases were used for gross anatomical observation in the craniofacial junction, 3 cases of 5.0mm thick frozen section, and 6 cases of thick thin slice of 0.5mm. The morphology and adjacent relationship of the important structures in the craniofacial junction were observed.
Results: the craniocalderm junction is located in the interoccipital bone, mastoid, petrous and atlantoaxial vertebral structures. Some important supporting ligaments (pteroid ligaments, cruciate ligaments, odontoid ligaments, anterior atlantooccipital, posterior membrane), and nerves and vessels are worn. The ligament structure from the posterior to the posterior membrane of the atlantooccipital, overlying the posterior membrane of the atlantooccipital, overlying the posterior membrane of the occipital. The membrane, cruciate ligament (including upper and lower longitudinal fascicles, transverse ligaments), pterygoid ligaments, apex ligaments and occipital anterior membrane, including the membrane, the longitudinal fasciculus on the cruciate ligament, and the apex of the odontoid in the basal part of the occipital bone, is not easy to separate. The vertebral artery is closely related to the 1,2 cervical nerve.
Conclusion: the gross anatomy and fault section can well display the important structures and adjacent structures of the ligaments, nerves and vessels in the craniofacial junction, and provide an anatomical basis for the in-depth study of the imaging study of the craniofacial junction.
The second part: imaging anatomy of CT and MRI in craniofacial junction area
Objective: To study the CT and MRI manifestations of the important structure of the normal craniocede junction area, and to optimize the imaging examination methods for the important structure of the region, and provide a valuable imaging anatomical basis for the clinical diagnosis of the region.
Data and methods: during October 2006 to May 2007, 51 normal subjects were selected randomly in the head and neck scan and enhanced CT examination in our hospital, including 31 males and 20 females, aged 34 to 60 years old, with an average age of 49.4 years, spiral CT cross-sectional scan, coronary and sagittal reconstruction, and enhanced scan using non ionic iodine contrast injection via the elbow vein. 100ml (350mg I/ml), flow velocity 4.0ml/s. selected 51 healthy volunteers without head and neck trauma and discomfort, including 30 male and 21 female, age 20 to 39 years old, with an average age of 27.3 years old, using MRI multi pulse sequence to cross section, coronal surface and sagittal plane scan. Combined with gross and dissecting anatomy, the CT and MRI tables of the important structures of the sections of the craniofacial junction were analyzed, and the CT and MRI tables were analyzed. To compare the effects of the MRI pulse sequence on the main ligaments of the craniocecular junction (atlantooccipital posterior membrane complex, the laminar epidural complex, the transverse ligament, the winged ligament, the occipital anterior membrane), and to measure the image anatomy parameters of the important structure of the region.
Results: CT and MRI could well display the important structure and adjacent area of the craniocecular junction. The posterior occipital membrane - epidural complex, the membrane - epidural complex, the transverse ligament and the pterygoid ligament were clearly displayed on CT and MRI, and the display rate was 100% (51/51); the apical ligament of the odontoid can only be identified in the median sagittal plane, and the display rate on CT was 15/51, in MRI. The rate of display was 43.1% (22/51), and the occipital anterior membrane showed 100% (51/51) on MRI, but it was difficult to identify on CT. Two physicians analyzed the display of the main ligaments in the craniocal junction with the MRI pulse sequence. The results showed that the proton density weighted image showed the best effect in the main ligaments of the region. Comparison of the CT and MRI measurements, The results showed that there was no significant difference in CT and MRI between basal angle, atlantooccipital joint angle, occipital tooth spacing, dentate position and left and right atlanto odontoid space difference (P > 0.05).
Conclusion: CT and MRI can well display the important structure and adjacent area of the craniofacial junction. The proton density weighted image can clearly display the main ligaments in the craniofacial junction, which can be used as an ideal MRI imaging sequence for the structure of the ligamentum, and the appropriate imaging level is beneficial to the display of the ligaments. Diagnosis.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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