成人侧颅底临床解剖学研究

发布时间：2018-03-04 06:42

本文选题：侧颅底　切入点：解剖　出处：《安徽医科大学》2008年硕士论文　论文类型：学位论文

【摘要】： 目的:侧颅底肿瘤位置深在,毗邻重要的颅神经和动、静脉,传统的开颅手术和颌面进路手术,不但并发症和死亡率高,手术进路也常损坏面容。加之手术暴露困难,难以彻底切除病变,术后复发率高,因此侧颅底曾被认为是手术禁区。近年来随着医学影像学、耳显微医学、麻醉医学、重症监护医学的发展,侧颅底外科的诊疗技术也有了长足的发展。本研究通过对20具(40侧)黄种成人尸头侧颅底区域重要解剖标志进行观察与测量,得出相关实验结果,用于指导临床:侧颅底手术前设计最合理的手术路径;侧颅底手术中尽可能充分暴露手术野,避免损伤重要血管、神经,防止长时间和过度牵拉脑组织;同时也可增加内镜颅底手术的安全性及减少颅底导航技术的配准误差。方法:本组实验标本中男性12具,女性8具(性别、年龄由解剖教研室提供),按1—40的顺序进行编号。从外科手术的角度出发,按编号顺序对侧颅底区域进行解剖,行实验项目的观察与测量。解剖方法:尸头固定于解剖架上,颧根与顶骨最高点连线的中、上1/3处平行于眶-耳平面钢锯锯除颅骨,进行颅底内面观察与测量。切除下颌骨及其周围附着肌肉,进行颅底外面观察与测量。电钻行扩大乳突轮廓化上至中颅窝硬脑膜,暴露窦脑膜角,暴露上、外、后三组骨半规管;乙状窦全程显露至颈静脉球;自颅内段至颞骨外段全程显露面神经,行面神经改道及面神经的主动前移;颈部解剖颈内动脉至颈内动脉管外口,电钻磨除骨质显现岩骨段颈内动脉,颅内暴露颈内动脉至前床突段上部。结果:本研究结果包括三项内容:1、以骨性颈静脉孔静脉部、骨性颈静脉孔神经部、颧弓后根、茎突根部及星点为解剖基点,观察测量与侧颅底重要结构的解剖关系、解剖距离及解剖角度。2、测量迷路三角(窦脑膜角、颈静脉球、鼓窦入口),迷路后三角(窦脑膜角、颈静脉球、后半规管),乳突表面三角(星点、乳突尖、颧根)解剖面积。3、测量颞骨内面神经各段的长度;测量面神经垂直段改道及水平段、垂直段联合改道后延长的可利用面神经长度;行面神经长路径(从茎乳孔至膝状神经节)和短路径(从茎乳孔至外膝部)主动前移,在茎乳孔处面神经前移10mm的共同前提下,分别测量不同径路颈静脉球上缘、外膝部面神经前移的最大距离和角度。采用SPSS10.0统计软件计算各测量数据,计量资料以均数±标准差((?)±s)表示。结论: 1.从外科手术的角度出发,以临床手术医师的视野,行成人侧颅底解剖学研究,能让研究结果更有征对性,进而能为临床提供更有力的参考。 2.颈静脉球变异大,而骨性颈静脉孔静脉部变异小,本研究采用骨性颈静脉孔静脉部作为解剖基点测量其与体表骨性标志的距离,结果更准确,术者了解此结果可减小侧颅底术中损伤颈静脉球的可能性。以骨性颈静脉孔神经部为解剖基点所得到的解剖数据可为术中更好地保护后组颅神经提供参考。 3.以茎突根部、颧弓根、星点为解剖基点所得到的解剖数据可降低临床侧颅底手术中损伤护重要血管、神经的风险;增加内镜颅底手术的安全性;减少颅底导航技术的配准误差。 4.迷路三角、迷路后三角、乳突表面三角面积的测定为临床侧颅底手术方案的设计、手术径路的选择提供参考。 5.颞骨内面神经改道可延长神经的可利用长度,减少面神经端端吻合时的张力。面神经主动前移可为术者提供更广阔的手术视野。茎乳孔处面神经前移应和神经周围的纤维鞘一同进行,防止损伤茎乳动脉。
[Abstract]:Objective: lateral skull base tumors located in deep, adjacent to the important cranial nerve and vein, traditional craniotomy and maxillofacial surgery approach, not only the high morbidity and mortality, surgical approach is often damaged. In addition to face difficult surgical exposure, it is impossible to completely remove lesions, recurrence rate is high, so the lateral skull base was considered is the operation area. In recent years with medical imaging, ear micro medicine, anesthesiology, the development of critical care medicine, diagnosis and treatment of lateral skull base surgery technology has made great progress. This study based on 20 (40 sides) adult cadaveric head yellow lateral skull base region important anatomic landmarks were observed and measured, draw relevant the experimental results are used to guide clinical design before surgery of lateral skull base surgery: the most reasonable path; lateral skull base surgery in fully exposed surgical field as far as possible, avoid injury of important blood vessels, nerves, prevent the long time and excessive brain retraction At the same time, it can also increase the safety of endoscopic skull base surgery and reduce registration error of skull base navigation.
Methods: the experimental group were male 12, female 8 (gender, age from Department of Anatomy), 1 - 40 of the number in the sequence. Starting from a surgical point, according to the regional anatomy of the lateral skull base number order, observation and measurement for experiment. Methods: cadaveric head anatomy fixed on the anatomical shelf, zygomatic root and parietal connections in the highest point, 1/3 parallel to the orbital plane in ear steel saw skull, surface observation and measurement of skull base. Resection of the mandible and its attached muscles were observed and measured. The skull base was expanding drill mastoidectomy to middle cranial fossa dura exposure, exposure, meningeal sinus angle, after three groups of semicircular canals; sigmoid sinus to show the whole jugular bulb; since the intracranial segment of extratemporal segment to show the whole facial nerve, to advance the initiative of facial nerve and facial nerve rerouting; neck anatomy of internal carotid artery to internal carotid artery In the outer mouth, the electric drill grind away the bone segment of the internal carotid artery and expose the internal carotid artery to the upper part of the front of the anterior bed.
Results: the results of this study include three contents: 1, in the vein of the bony jugular foramen, jugular foramen nerve, the dorsal root of the zygomatic arch, anatomy of styloid process and star point, to observe the relationship between anatomical measurement and lateral skull base structure, anatomy and anatomical distance measuring.2 angle, the labyrinthine triangle (sinus meningeal angle, jugular bulb, tympanic antrum entrance), retrolabyrinthine triangle (sinus dural angle, jugular bulb, posterior semicircular canal), mastoid surface triangle (star, mastoid tip, zygomatic root) anatomical area of.3, measuring the intratemporal facial nerve segment length measurement; facial nerve vertical section and horizontal section of diversion the vertical section of diversion, combined with prolonged use of facial nerve length; facial nerve (long path from the stylomastoid foramen to the geniculate ganglion) and short path (from the stylomastoid foramen to the knee) initiative forward, in the stylomastoid foramen at facial nerve forward 10mm, were measured in different path of neck the ball on the edge of the vein, The maximum distance and angle of the anterior movement of the facial nerve in the external genu were calculated by the SPSS10.0 statistical software, and the measurement data were expressed in a mean number of standard deviations ((?) + s).
Conclusion:
1., from the perspective of surgical operation, the lateral skull base anatomical study of adults can be made more satisfactory by clinical operation doctors' vision, which can provide more powerful references for clinical research.
2. jugular bulb variation, and the variation of the vein of the jugular foramina is small, this study adopts the jugular Kong Jingmai Department of anatomy as a basic point to measure the surface and the bony landmarks of the distance, the more accurate results of the understanding of this result can reduce the possibility of damage to the jugular bulb during the operation. The lateral skull base bony jugular foramen the nerve part of anatomical data for anatomy points obtained during operation to better protect cranial nerves and provide reference.
3. the anatomical data obtained from the base of the styloid process, the zygomatic arch and the star point can reduce the risk of injury and protection of important vessels and nerves in clinical lateral skull base surgery, increase the safety of endoscopic skull base surgery, and reduce the registration error of the skull base navigation technology.
The 4. labyrinth triangle, the posterior triangle of the labyrinth, and the trigonometric area of the mastoid surface are the design of the clinical lateral skull base operation scheme, and the choice of the surgical path is a reference.
5. intratemporal facial nerve rerouting can prolong the nerve can be used to reduce the length of facial nerve anastomosis of the facial nerve tension. The initiative forward can provide a broader vision for the surgical operation. The fibrous sheath around the stylomastoid foramen at the facial nerve and nerve should forward together, to prevent damage to the stylomastoid artery.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322

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