乙状窦后锁孔入路的解剖研究

发布时间：2018-03-29 15:44

本文选题：乙状窦后锁孔入路　切入点：模具硅胶　出处：《山西医科大学》2009年硕士论文

【摘要】： 【目的】脑干前外侧区域,部位深,周围解剖结构复杂,乙状窦后入路是切除该区域病变的主要入路之一。该课题应用锁孔入路的新理念,模拟乙状窦后锁孔入路,研究该入路的显微解剖和显微技巧,为临床应用提供理论指导和技术支持。【方法】(1)测量10具干性颅骨与乙状窦后锁孔入路相关的重要解剖标志间的距离。(2)对10具湿性成人尸头标本,采用手推恒压法用有色模具硅胶进行灌注。(3)模拟乙状窦后锁孔入路:侧卧位,头稍向健侧前屈,以乳突的内侧缘为最高点,枕骨鳞部基本处于水平位。以星点为起点向下的5cm垂直纵行切口。外侧边与上边刚显露横窦和乙状窦,大小为3.0×4.0 cm的椭圆形骨窗。切开硬膜,显微镜下进行显微解剖学观察。【结果(】1)乙状窦后锁孔入路,骨窗关键孔应位于星点下方1.0cm,距乙状窦沟后缘0.5cm。骨窗大小为直径3.0 cm左右,外侧边与上边刚显露横窦下缘和乙状窦后缘。(2)10具标本中,其中直径1mm动脉灌注成功10例全部成功;静脉灌注成功率较动脉低,直径1mm静脉灌注成功80%左右。随着血管变细,灌注成功率下降。(3)乙状窦后锁孔入路可以充分显露三叉神经和颈静脉孔之间的脑干侧方区域。【结论】(1)乙状窦后锁孔入路中,熟悉颅骨表面标志和颅内结构对应关系对骨窗关键孔及骨窗大小、位置有指导意义。(2)在头颈部的解剖研究中,用模具硅橡胶灌注头颈部血管标本是一种较好方法。(3)熟悉乙状窦后相关各解剖结构关系对手术操作过程中避免损伤重要结构有重要意义。,
[Abstract]:[objective] the anterolateral region of the brain stem is deep and the surrounding anatomical structure is complex. The posterior sigmoid approach is one of the main approaches for the resection of the lesions in this region. The new concept of keyhole approach is used to simulate the retrosigmoid keyhole approach. To study the microanatomy and microtechnique of the approach, to provide theoretical guidance and technical support for clinical application. [methods] the distance between the dry skull and the important anatomic markers associated with the retrosigmoid keyhole approach was measured in 10 cadavers from 10 wet adult cadavers. The method of hand push and constant pressure was used to make use of colored mould silica gel for perfusion. 3) simulating the retrosigmoid keyhole approach: lateral position, head slightly bent to the healthy side, with the medial edge of the mastoid process as the highest point. The scale of occipital bone was basically horizontal. The vertical longitudinal incision of 5cm with star point as the starting point was used. The lateral and upper sides had just exposed the transverse sinus and sigmoid sinus, and the size of the oval bone window was 3.0 脳 4.0 cm. The dura dural was cut open, and the microscopic anatomy was performed under the microscope. [results] in the retrosigmoid keyhole approach, the critical foramen of bone window should be located at 1.0 cm below the star point and 0.5 cm from the posterior margin of sigmoid sinus. The size of bone window was about 3.0 cm in diameter. The lateral and upper sides were just exposed to the inferior margin of transverse sinus and the posterior edge of sigmoid sinus. The success rate of venous perfusion was lower than that of artery, and the success rate of diameter 1mm was about 80%. The retrosigmoid keyhole approach can fully reveal the lateral region of the brain stem between the trigeminal nerve and the jugular foramen. [conclusion] in the retrosigmoid keyhole approach, familiarity with the relationship between the cranial surface markers and the intracranial structure has instructive significance for the size and location of the critical foramen and the bone window in the head and neck. It is a good method to infuse the vascular specimens of head and neck with mould silicone rubber. It is important to know the relationship between the related anatomical structures of the posterior sigmoid sinus and avoid the injury of the important structures during the operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R651;R322

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