颅骨气化及其相关结构的临床解剖学研究

发布时间：2018-04-12 13:19

本文选题：鼻旁窦 + 乳突小房　；参考：《江苏大学》2010年硕士论文

【摘要】： 目的:测量及比较炎症组与对照组的上颌窦、蝶窦和乳突小房的体积;观察蝶窦内的颈内动脉、视神经隆凸的出现率,分析颈内动脉隆凸的出现率与蝶窦体积的关系。在此基础上,探讨鼻窦炎、中耳炎与颅骨气化的关系;鼻旁窦与乳突小房之间的气化关系;探讨蝶窦体积与颈内动脉隆凸出现的规律;及其经蝶窦入路时,提出手术中如何保护视神经和颈内动脉的原则。方法:1.收集鼻窦炎、中耳炎病人分别为30和15例,正常对照组350人。采用GE公司的Hispeed 64排128层螺旋CT扫描,扫描图像经重建后的层厚为1 mm。 2.首先是一般观察蝶窦内颈内动脉隆凸、视神经隆凸所出现的比例。用Mimicsl2.0三维医学图像处理软件,半自动的方法逐层勾画出上颌窦、蝶窦和乳突小房,由软件自动完成上述结构的三维重建模型和体积。结果:1.鼻旁窦体积的测量鼻窦炎组的上颌窦体积为7.01±2.86cm~3蝶窦体积为4.80±1.20 cm~3;对照组的上颌窦体积为30.17±13.54cm~3;蝶窦体积为17.79±6.93 cm~3;中耳炎组的乳突小房的体积为7.48±3.43 cm~3,对照组乳突小房的体积为13.09±6.31 cm~3;鼻窦炎与对照组的上颌窦和蝶窦体积相比较无统计学差异;中耳炎与对照组乳突小房体积之间相比较有显著性差异。将上述对照组的上颌窦、蝶窦及其乳突小房的体积进行分析,其没有明显的相关性。 2.蝶窦气化程度与蝶窦内隆凸关系的研究,蝶窦内没有出现颈内动脉隆凸的占总数70.75%;蝶窦腔内出现一侧隆凸的占总数8.49%;;蝶窦腔内出现两侧隆凸的占总数20.74%;两种情况相加,蝶窦内有颈内动脉隆凸占总数的29.23%。根据上述调查结果,将受试者分为无颈内动脉隆凸组、单侧颈内动脉隆凸组、双侧颈内动脉隆凸组,从每组中随机选择30例,测量蝶窦的体积,分析隆凸与蝶窦体积之间的关系。无颈内动脉隆凸组的体积为11.16±16.00(8.57～14.67)cm3;单侧颈内动脉隆凸组14.20±1.80(11.76～20.86)cm3;双侧颈内动脉隆凸组25.03±2.21(18.37～31.24)cm3。 3.视神经行走过程与临床应用要点主要分为两种类型,一是气化程度不高的蝶窦,未见蝶窦内有视神经管凸,但视神经与其紧密相邻;气化程度非常良好的蝶窦,有14%视神经管向蝶窦内形成隆凸,行走于蝶窦的外侧壁,甚至裸露在管腔内。在进行经蝶窦入路时,特别注意不要伤及与其相邻的视神经,否则会造成很严重的后果。 4.颈内动脉行走过程气化明显的颈内动脉突入到蝶窦内形成隆凸,有的形成半侧管腔的突入,有的是整个管腔的突入,其血管与蝶窦之间隔一层很薄的骨质,有时似乎没有骨质血管直接裸露在蝶窦内;没有形成隆凸的,之间的骨质相对较厚。结论:1.鼻旁窦体积的测量鼻窦炎的发病率与鼻旁窦的气化无关;中耳炎的发病率与乳突小房气化程度相关,气化程度越低,中耳炎的发病率越高。 2.蝶窦气化程度与颈内动脉隆凸的出现率是直接相关的,体积越大,颈内动脉隆凸的出现率就高。可以根据蝶窦的气化程度确定手术方案。 3.蝶窦气化程度与视神经管隆凸也是直接相关的,视神经管隆凸的出现均伴随蝶窦气化程度良好和颈内动脉隆凸的出现,视神经有时直接裸露在蝶窦内,有时为一段的视神经位于在蝶窦的侧壁,根据视神经管隆凸出现的规律,可确定手术的指导方案。
[Abstract]:Objective: to measure and compare the inflammatory group and the control group of the maxillary sinus, sphenoid sinus and mastoid volume; observation of internal carotid artery in sphenoid sinus, optic nerve protuberance rate, analysis of internal carotid artery carina of the relationship between the occurrence rate of sphenoid sinus volume. On this basis, to explore the relationship between sinusitis, otitis media and the relationship between skull gasification; gasification of paranasal sinus and mastoid; of sphenoid sinus and internal carotid artery volume carina the law; and the transsphenoidal approach, put forward how to protect the optic nerve and internal carotid artery surgery principle.
Methods: 1.. We collected 30 cases of sinusitis and 15 cases of otitis media, and 350 cases of the normal control group. The Hispeed 64 row 128 slice spiral CT scan of GE company was used to scan the images. The thickness of the reconstructed images was 1 mm..
2. is the first general observation of internal carotid artery in sphenoid sinus carina, optic nerve protuberance arising ratio. Using Mimicsl2.0 three-dimensional medical image processing software, semi-automatic method layer outline of maxillary sinus, sphenoid sinus and mastoid cells, automatically complete the three-dimensional modeling of the structure type and volume by the software.
Results: 1. paranasal sinusitis group measured volume of maxillary sinus volume was 7.01 + 2.86cm~3 + 1.20 sphenoid sinus volume is 4.80 cm~3; the control group of the maxillary sinus volume was 30.17 + 13.54cm~3; sphenoid volume was 17.79 + 6.93 cm~3; otitis media group of mastoid volume is 7.48 + 3.43 cm~3, control group of mastoid volume is 13.09 + 6.31 cm~3; and the control group of maxillary sinusitis and sphenoid sinus volume compared with no significant difference; there is a significant difference between the control group and otitis media between the mastoid volume. The control group of the maxillary sinus, sphenoid sinus and mastoid volume analysis no, the obvious correlation.
Study on the 2. degree of sphenoid sinus and sphenoid sinus palatinus relationship, no internal carotid artery carina in 70.75% of the total number of sphenoid sinus; sphenoid sinus cavity side carina accounted for 8.49%;; sphenoid sinus cavity appears on both sides of the carina accounted for 20.74%; two cases of sphenoid sinus in addition, internal carotid artery carina of the total 29.23%. according to the survey results, the subjects were divided into internal carotid artery carina group, unilateral internal carotid artery carina group, bilateral internal carotid artery carina group, 30 cases were randomly selected from each group, measured the volumes of sphenoid sinus, sphenoid sinus and carina analysis of the relationship between the volume. No internal carotid artery carina group volume is 11.16 + 16 (8.57 ~ 14.67) cm3; unilateral internal carotid artery carina group 14.20 + 1.80 (11.76 ~ 20.86) cm3; bilateral internal carotid artery carina group 25.03 + 2.21 (18.37 ~ 31.24) cm3.
3. optic nerve during walking and clinical application points are divided into two types, one is not high degree of pneumatization of sphenoid sinus, sphenoid sinus had no optic canal convex, but the optic nerve closely; very good degree of pneumatization of sphenoid sinus, 14% optic canal to the sphenoid sinus formed in the carina. Walking on the lateral wall of sphenoid sinus, even exposed in the lumen. In transsphenoidal approach, with particular attention to the adjacent optic nerve and not, otherwise it will cause serious consequences.
4. internal carotid artery during walking into the internal carotid artery was gasified in the sphenoid sinus formation of carina, some form of half side into the lumen, some entire lumen into the septum, a thin layer of bone between the vessel and the sphenoid sinus, sometimes seem to have bone vessels exposed in the sphenoid sinus; no carina and between the bone is relatively thick.
Conclusion: 1. the incidence of sinusitis is not related to the volume of paranasal sinus. The incidence of otitis media is related to the degree of mastoidectomy. The lower the degree of gasification, the higher the incidence of otitis media.
2., the degree of sphenoid sinus gasification is directly related to the occurrence rate of internal carotid artery protuberance. The larger the volume, the higher the incidence of internal carotid artery protuberance. We can determine the operative plan according to the degree of gasification of the sphenoid sinus.
3. degree of sphenoid sinus and optic canal carina is directly related to the optic nerve tube carina were accompanied by a good degree of sphenoid sinus and internal carotid artery carina of the optic nerve, sometimes exposed in the sphenoid sinus, optic nerve is sometimes located on a side wall of the sphenoid sinus, according to the optic canal carina appeared regularity, can determine the guidance scheme for surgery.

【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

【参考文献】