改良经岩骨侧方入路的解剖及临床研究

发布时间：2018-04-24 01:18

本文选题：经岩骨侧方入路 + 解剖　；参考：《吉林大学》2009年博士论文

【摘要】： 本研究的目的是:1、探寻岩斜坡区的解剖标识,并对空间结构进行量化。2、进一步研究岩斜坡区神经、血管及它们之间的相互关系。3、围绕着改善术区显露及减少术后并发症的发生这一宗旨,对现有的岩斜区手术入路进行分析、总结及改良,以期获得更佳的手术方案。通过尸头解剖及在尸头上模拟手术入路,寻找更合理的岩斜区手术入路。采用方法为对经10%福尔马林固定的成人尸头进行显微镜下解剖,进一步明确重要骨性结构的标志及位置;阐述颅底所有血管的走形、分布、与颅神经及脑干的关系,测量相关的距离;在尸头上模拟改良后的岩骨侧方入路。结果为1、提出外耳道上壁作为磨除岩骨的基本标志点,以此可对其他标志点进行判定。2、提出术中利用脑池交界区判断血管的位置。3、提出乙状窦前置的另外含义,不是乙状窦与外耳道之间的距离,不仅仅是对乙状窦与后半规管之间距离的简单描述,还应包含下列因素:乙状窦与后半规管壶腹部的距离;后半规管与岩尖的距离;乙状窦的长度;横窦-乙状窦交角的角度。4、利用不同脑池内血管穿支的分布规律,可更好的保护血管。5、应用三维螺旋CT对岩斜坡区的解剖结构进行预先定位,并找出规律,使手术预案更加合理。同时利用头部CTA所显示的肿瘤与血管的关系指导术中操作。6、提出了改良的经岩骨侧方入路,并提出了此入路需注意的问题。得出结论为1、外耳道上壁是重要标志点,它是两种幕上下双骨瓣开颅后十分明显的一个解剖标志,确切的讲是颧弓延长线与外耳道上壁的交点。2、在硬膜外操作可磨除三处骨质,岩尖及岩骨嵴、乙状窦前及枕骨髁前部。岩尖及岩骨嵴磨除的范围为前界至外展神经穿斜坡处的Dorello管,外侧界至颈内动脉岩骨水平段,后界至上半规管表面,内侧界至岩下窦;乙状窦前骨质磨除的范围是由乙状窦、颈静脉球、岩上窦、半规管及内听道所构成的不规则形区域中;枕骨髁磨除的范围是上至乙状窦第三处转折,前至舌下神经管内口,下至寰椎髁突,后方接近椎动脉压迹。3、磨除岩尖、岩骨嵴及乙状窦前的骨质,平行岩骨嵴切开小脑幕,轻抬颞叶,可使幕上观察斜坡的视角扩大,在颞叶抬起约22度角时即可清晰显示自鞍背至颈静脉孔的岩斜区中央部分;将枕骨髁前部磨除,在乙状窦下方切开硬膜并将乙状窦向前上方翻转,可使下斜坡的暴露更加充分,可在直视下观察远至对侧岩斜裂的下斜坡部分。4、双骨瓣可用颅骨固定钛钉确切复位固定。
[Abstract]:The purpose of this study is to explore the anatomical identification of the petroclival region, to quantify the spatial structure, and to further study the nerves in the petroclival region. According to the purpose of improving the exposure of the operation area and reducing the occurrence of postoperative complications, the existing approaches to the petroclival region were analyzed, summarized and improved in order to obtain a better operation plan. By dissection of cadaveric head and simulated operative approach on cadaveric head, a more rational approach to oblique rock region was found. Methods Anatomy of adult cadaveric head fixed with 10% formalin was carried out under microscope to further clarify the mark and position of important bone structure, to explain the shape and distribution of all blood vessels in the skull base, and the relationship with cranial nerve and brain stem. The relative distance was measured and the modified lateral approach of petrosal bone was simulated on the cadaveric head. The results were as follows: 1. The superior wall of the external auditory canal was proposed as the basic mark point for the removal of petrosal bone, which could be used to judge the other marker points. The location of the vessels was determined by using the cisternal junction area. The additional meaning of the sigmoid sinus anterior position was put forward. The distance between the sigmoid sinus and the external auditory canal is not only a simple description of the distance between the sigmoid sinus and the posterior semicircular canal, but also includes the following factors: the distance between the sigmoid sinus and the posterior semicircular canal ampulla, the distance between the posterior semicircular canal and the petrous apex; The length of sigmoid sinus, the angle of transverse sinusoid to sigmoid sinus, and the distribution of perforating branches in different cerebral cisterns can better protect blood vessels .5. the anatomical structure of petroclival region can be prepositioned by three-dimensional spiral CT, and the regularity can be found out. Make the operation plan more reasonable. At the same time, the relationship between tumor and blood vessel displayed by head CTA was used to guide the operation of .6. the modified lateral approach of petrosal bone was proposed, and the problems needing attention in the approach were put forward. In conclusion 1, the superior wall of the external auditory canal is an important marker, which is a very obvious anatomic marker after the craniotomy of the upper and lower tentorial double bone valves. The exact point is the intersection of the extension line of the zygomatic arch and the superior wall of the external auditory canal. Petrous apex and petrous crest, anterior sigmoid sinus and anterior occipital condyle. The range of petrous apex and petrous ridge grinding is from the anterior boundary to the Dorello canal through the Clivus of the abducens nerve, from the lateral boundary to the horizontal segment of the petrous bone of the internal carotid artery, from the posterior boundary to the surface of the semicircular canal, from the medial boundary to the inferior petrosal sinus, and from the sigmoid sinus to the anterior sigmoid sinus. In the irregular region of jugular bulb, superior petrosal sinus, semicircular canal and internal auditory canal, the condyle of occipital bone is removed from the third turn of the sigmoid sinus, from the anterior to the internal orifice of the hypoglossal canal, down to the atlas condyle, The posterior approach to vertebral artery indentation. 3, grinding the bony bone in the petrous apex, petrous crest and presigmoid sinus, parallel petrosal crest incision of the tentorium, gently lifting the temporal lobe, can enlarge the angle of view of the Clivus on the supratentorial. When the temporal lobe is raised at an angle of about 22 degrees, it is clearly shown from the back of the saddle to the central part of the oblique petrosal region of the foramen jugular; the anterior part of the condyle of the occipital bone is removed, the dura is cut below the sigmoid sinus and the sigmoid sinus is turned forward and the lower slope is exposed more fully. It can be observed as far as the lower slope of the contralateral diagonal fissure. The double bone flap can be fixed with titanium nail.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2009
【分类号】：R651;R322

【参考文献】