侧颅底及相应中颅窝区显微解剖和虚拟现实三维影像研究

发布时间：2018-02-08 22:43

本文关键词： 侧颅底中颅窝显微解剖虚拟现实三维影像　出处：《北京大学》2008年博士论文　论文类型：学位论文

【摘要】： 目的: 显微解剖结合虚拟现实三维立体影像,研究侧颅底及相应中颅窝区解剖结构特点及其相互沟通路径,指导临床选择手术入路。方法: 15例(30侧)尸头标本,灌注红蓝胶及造影剂,采用额颞颧-耳前颞下-颞下窝入路,模拟手术逐层解剖;尸头灌注前后行CT扫描,灌注前及解剖后行MRI扫描,将DICOM格式的扫描资料输入Destroscope虚拟现实系统行三维重建;分别于显微解剖及虚拟现实三维影像中,观测重要解剖结构及标志,比较、分析两者结果。结果: 1、显微解剖下描述颞浅动脉及面神经,颞下窝的翼肌、上颌动脉、下颌神经、翼静脉丛,咽旁间隙及翼腭窝的解剖结构、相互关系及其与中颅窝沟通途经;测量相关数据。虚拟现实三维立体环境中测量侧颅底及相应中颅窝区相关数据,与显微解剖所测数据比较,无统计学差异。 2、提出翼肌上三角及翼肌下三角的概念,测量其边长及面积,描述其内穿行结构。 3、提出一个新的骨性标志点:“O”点,即颞蝶缝与颞下嵴的交点。于中颅窝底,它到眶上裂近端、圆孔、卵圆孔、棘孔的距离近似相等,平均23.22mm,即以上四点分布在以“O”点为圆心,以23.22mm为半径的圆弧上,所构成扇形的角度为66.07度,面积为310.71mm2。于颞下窝顶,测量其到各重要结构的距离并描述其意义。 4、根据自然标志,可以用1点,2棘,3裂,4线,5孔,6区描述侧颅底结构。结论: 1、本研究提出的“O“点,即颞蝶缝与颞下嵴的交点,是一个良好的骨性标志,它到眶上裂近端、圆孔、卵圆孔、棘孔的距离近似相等,它们围成的扇形区域是中颅窝、颞下窝肿瘤相互沟通的重要路径,也是手术切除肿瘤的一个相对安全区域。 2、本研究提出的翼肌上三角和翼肌下三角,可作为肌性标志,便于描述及定位上颌动脉,颊神经以及舌神经、下牙槽神经,为术中定位提供解剖标志。 3、本研究提出的结合三维影像将侧颅底区的重要骨性结构归纳为1点,2棘,3裂,4线,5孔,6区,便于描述和理解该区的复杂解剖关系,为手术提供解剖标志。 4、额颞颧-耳前颞下-颞下窝入路能充分暴露并观测侧颅底及相应中颅窝区颅内外结构,适合显微解剖研究,为设计手术入路提供解剖学依据。 5、虚拟现实三维影像所测数据与解剖所测数据吻合良好,真实可信。虚拟现实研究不仅是显微解剖研究的有益补充,还有其不可替代的优势,可与显微解剖相结合或单独应用以构筑模型、观测结构、模拟解剖。
[Abstract]:Objective:. The microanatomy combined with virtual reality three-dimensional images was used to study the anatomical structure of lateral skull base and the corresponding middle cranial fossa and their communication paths to guide the clinical selection of surgical approaches. Methods:. 15 cadaveric head specimens were perfused with red and blue glue and contrast media, and were dissected by frontotemporal zygomaticozygomatic anterior subtemporal fossa approach, CT scan before and after perfusion, MRI scan before and after anatomic perfusion of cadaveric head. The scanning data in DICOM format are input into the Destroscope virtual reality system for 3D reconstruction, and the important anatomical structures and marks are observed in the microanatomy and virtual reality 3D images, and the results are compared and analyzed. Results:. 1. The anatomy of superficial temporal artery and facial nerve, pterygoid muscle of infratemporal fossa, maxillary artery, mandibular nerve, pterygovenous plexus, parapharyngeal space and pterygopalatine fossa were described under microanatomy. There was no statistical difference between the data of the lateral skull base and the corresponding middle cranial fossa in the virtual reality three-dimensional environment compared with the microanatomical data. 2. The concepts of upper triangle and inferior triangle of pterygoid are proposed, the length and area of the side are measured, and the internal structure is described. 3. A new bone marker, "O" point, is proposed, which is the intersection point between the temporal sphenoid suture and the subtemporal ridge. At the bottom of the middle cranial fossa, the distance between it and the superior orbital fissure, foramen, foramen ovale and foramen spinosus is approximately equal, with an average of 23.22mm, that is, the above four points are distributed in the center of the "O" point. On the arc with a radius of 23.22mm, the fan-shaped angle is 66.07 degrees and the area is 310.71mm2.The distance from the subtemporal fossa to each important structure is measured and its significance is described. 4. According to the natural markers, the lateral skull base structure can be described by 1 point, 2 spines, 3 clefts, 4 lines, 5 holes and 6 regions. Conclusion:. 1. The "O" point proposed in this study, that is, the intersection point between the temporal sphenoid suture and the subtemporal ridge, is a good bone marker. It is approximately equal in distance to the proximal end of the supraorbital fissure, foramen ovale, foramen ovale and foramen spinosus, and the fan-shaped region formed by them is the middle cranial fossa. The important path of communication between tumors in the infratemporal fossa is also a relatively safe area for surgical resection of tumors. 2. The superior and inferior pterygoid triangles can be used as muscle markers to describe and locate maxillary artery, buccal nerve, lingual nerve and inferior alveolar nerve. 3. The important bone structure of the lateral skull base area was classified into 1 point, 2 spines, 3 clefts, 4 lines, 5 holes and 6 areas, which was convenient to describe and understand the complex anatomical relationship in the area and to provide anatomic marks for the operation. 4. The frontotemporal zygomaticozygomatic anterior infratemporal fossa approach can fully expose and observe the intracranial and external structures of the lateral skull base and the corresponding middle cranial fossa, which is suitable for microanatomical study and provides anatomic basis for the design of the operative approach. 5. The data measured by virtual reality 3D images agree well with the data measured by anatomy. The study of virtual reality is not only a useful supplement to the study of microanatomy, but also an irreplaceable advantage. It can be combined with microanatomy or used alone to construct models, observe structures, and simulate anatomy.
【学位授予单位】：北京大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R322

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