面神经隐窝入路人工耳蜗植入术及面神经鼓室内改道吻合术的解剖学研究
发布时间：2019-02-18 20:35
【摘要】： 目的:本文对经典的面神经隐窝入路人工耳蜗植入术、面神经鼓室内改道吻合术相关的解剖及比邻结构进行了观察、测量,为临床上人工耳蜗植入术、面神经改道吻合术及其他中耳相关手术提供解剖学资料。方法:20例(40侧)经福尔马林浸泡的国人成人头颅湿标本,在手术显微镜下经面神经隐窝入路模拟人工耳蜗植入术,充分暴露相关的解剖结构,对人工耳蜗手术相关的结构进行观察、测量;再充分解剖出颞骨内面神经各段,将面神经在鼓室内改道并测量。结果:外耳道上棘至砧骨短脚的平均距离为19.14±0.89mm,外耳道上棘至面神经水平段与垂直段交点的平均距离为16.30±1.09mm,面神经水平段与垂直段交点距乳突表面的平均距离为20.84±1.13mm,面神经水平段与垂直段交点距鼓索神经发出点平均距离为11.28±1.54mm,面神经水平段与垂直段交点距外耳道后壁的平均距离为4.40±0.43mm,锥隆起至圆窗龛的平均距离为4.46±0.76mm,卵圆窗至圆窗龛的平均距离为3.74±0.37mm,砧镫关节至圆窗龛的平均距离为3.80±0.63mm;鼓索神经与面神经垂直段的夹角平均为24.8±4.7°,水平半规管与面神经水平段夹角平均为17.5±3.8°,砧骨长脚与后拱柱夹角平均为46.0±7.1°,面神经水平段平均长11.60±0.80mm,面神经垂直段平均长15.30±1.32mm,面神经水平段与垂直段的夹角平均为110.4±6.9°,面神经改道后从茎乳孔到膝神经节平均距离为22.06±1.40 mm,改道后可利用长度延长最短为4.00 mm,最长为7.32mm。结论:外耳道上棘、砧骨短脚、水平半规管、锥隆起、匙突等标志结构位置恒定,尤其是水平半规管和锥隆起,为相关手术入路提供定位依据;顺利找到圆窗及圆窗龛是人工耳蜗手术的重要步骤,圆窗卵圆窗位置关系相对稳定,圆窗龛与周围结构距离和角度在较小的范围内变化,可为人工耳蜗顺利找到圆窗龛进行鼓阶钻孔定位;了解颞内段面神经的走行在临床中有重要意义,将面神经在鼓室内改道吻合,最长可延长7.32 mm,最短可延长4.00 mm;颞骨内解剖结构复杂,手术者必须既要了解解剖知识,又要有熟练的手术技巧,同时要结合术前的影像资料,因个体差异不同而变化。
[Abstract]:Objective: to observe the anatomic and adjacent structures of the classical facial nerve crypt approach cochlear implantation and the anastomosis of the intratympanic diversions of the facial nerve, and to measure the clinical application of cochlear implantation. Facial nerve anastomosis and other middle ear related operations provide anatomical data. Methods: 20 Chinese adult head wet specimens (40 sides) soaked in formalin were treated with simulated cochlear implantation via the facial nerve crypt under the operating microscope, and the related anatomical structures were fully exposed. The structures related to cochlear implants were observed and measured. The temporal facial nerve was fully dissected and the facial nerve was changed in the tympanum and measured. Results: the average distance between the superior spine of the external auditory canal and the short foot of the incus was 19.14 卤0.89 mm, and the average distance between the superior spine of the external auditory canal and the horizontal segment of the facial nerve and the vertical segment was 16.30 卤1.09 mm. The average distance between the horizontal and vertical segments of the facial nerve and the surface of the mastoid process was 20.84 卤1.13 mm, and the average distance between the horizontal and vertical segments of the facial nerve was 11.28 卤1.54 mm from the origin of the chorda tympani nerve, and the mean distance between the horizontal and vertical segments of the facial nerve was 11.28 卤1.54 mm. The average distance between the horizontal and vertical segments of the facial nerve and the posterior wall of the external auditory canal was 4.40 卤0.43 mm, the average distance between the conical eminence and the circle window niche was 4.46 卤0.76 mm, and the average distance between the oval window and the circle window niche was 3.74 卤0.37 mm. The average distance from the stirrup joint to the circle window niche was 3.80 卤0.63 mm. The average angle of the vertical segment between the chorda tympani nerve and the facial nerve was 24.8 卤4.7 掳, the angle between the horizontal semicircular canal and the horizontal segment of the facial nerve was 17.5 卤3.8 掳, and the angle between the long foot of the incus and the posterior arch column was 46.0 卤7.1 掳. The average length of the horizontal segment of the facial nerve was 11.60 卤0.80 mm, the average length of the vertical segment of the facial nerve was 15.30 卤1.32 mm, and the average angle between the horizontal segment and the vertical segment of the facial nerve was 110.4 卤6.9 掳. The average distance from the stylomammary foramen to the genicular ganglion was 22.06 卤1.40 mm, after the facial nerve was rerouted. The shortest possible length extension was 4.00 mm, and the longest was 7.32 mm. Conclusion: the location of the suprameval spine, the short foot of the incus, the horizontal semicircular canal, the conical eminence and the spasmatic process are constant, especially the horizontal semicircular canal and the conical eminence, which provide the basis for the location of the operative approach. The successful finding of round windows and niches is an important step in cochlear implant surgery. The position relationship of round window oval windows is relatively stable, and the distance and angle between the niches and the surrounding structures vary in a relatively small range. It can be used to locate the drill hole of the drum step for the cochlear implant to find the niches of the round window successfully. It is very important to understand the movement of the facial nerve in the medial temporal segment. The facial nerve can be anastomosed in the tympanic chamber. The longest extension is 7.32 mm, and the shortest is 4.00 mm;. The anatomical structure of temporal bone is complex, the operative must not only know the anatomy knowledge, but also have the skillful operation skill, at the same time, combine the image data before operation, and change according to the individual difference.
【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】：R764;R322
本文编号：2426179
[Abstract]:Objective: to observe the anatomic and adjacent structures of the classical facial nerve crypt approach cochlear implantation and the anastomosis of the intratympanic diversions of the facial nerve, and to measure the clinical application of cochlear implantation. Facial nerve anastomosis and other middle ear related operations provide anatomical data. Methods: 20 Chinese adult head wet specimens (40 sides) soaked in formalin were treated with simulated cochlear implantation via the facial nerve crypt under the operating microscope, and the related anatomical structures were fully exposed. The structures related to cochlear implants were observed and measured. The temporal facial nerve was fully dissected and the facial nerve was changed in the tympanum and measured. Results: the average distance between the superior spine of the external auditory canal and the short foot of the incus was 19.14 卤0.89 mm, and the average distance between the superior spine of the external auditory canal and the horizontal segment of the facial nerve and the vertical segment was 16.30 卤1.09 mm. The average distance between the horizontal and vertical segments of the facial nerve and the surface of the mastoid process was 20.84 卤1.13 mm, and the average distance between the horizontal and vertical segments of the facial nerve was 11.28 卤1.54 mm from the origin of the chorda tympani nerve, and the mean distance between the horizontal and vertical segments of the facial nerve was 11.28 卤1.54 mm. The average distance between the horizontal and vertical segments of the facial nerve and the posterior wall of the external auditory canal was 4.40 卤0.43 mm, the average distance between the conical eminence and the circle window niche was 4.46 卤0.76 mm, and the average distance between the oval window and the circle window niche was 3.74 卤0.37 mm. The average distance from the stirrup joint to the circle window niche was 3.80 卤0.63 mm. The average angle of the vertical segment between the chorda tympani nerve and the facial nerve was 24.8 卤4.7 掳, the angle between the horizontal semicircular canal and the horizontal segment of the facial nerve was 17.5 卤3.8 掳, and the angle between the long foot of the incus and the posterior arch column was 46.0 卤7.1 掳. The average length of the horizontal segment of the facial nerve was 11.60 卤0.80 mm, the average length of the vertical segment of the facial nerve was 15.30 卤1.32 mm, and the average angle between the horizontal segment and the vertical segment of the facial nerve was 110.4 卤6.9 掳. The average distance from the stylomammary foramen to the genicular ganglion was 22.06 卤1.40 mm, after the facial nerve was rerouted. The shortest possible length extension was 4.00 mm, and the longest was 7.32 mm. Conclusion: the location of the suprameval spine, the short foot of the incus, the horizontal semicircular canal, the conical eminence and the spasmatic process are constant, especially the horizontal semicircular canal and the conical eminence, which provide the basis for the location of the operative approach. The successful finding of round windows and niches is an important step in cochlear implant surgery. The position relationship of round window oval windows is relatively stable, and the distance and angle between the niches and the surrounding structures vary in a relatively small range. It can be used to locate the drill hole of the drum step for the cochlear implant to find the niches of the round window successfully. It is very important to understand the movement of the facial nerve in the medial temporal segment. The facial nerve can be anastomosed in the tympanic chamber. The longest extension is 7.32 mm, and the shortest is 4.00 mm;. The anatomical structure of temporal bone is complex, the operative must not only know the anatomy knowledge, but also have the skillful operation skill, at the same time, combine the image data before operation, and change according to the individual difference.
【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】：R764;R322
【参考文献】
相关期刊论文 前10条
1 何利平,贺飞,李永新,赵啸天;人工耳蜗植入相关的解剖学研究[J];耳鼻咽喉头颈外科;2002年03期
2 王金平,刘清明,王岱君,鞠学红,刘洪国;人工耳蜗植入术的应用解剖学研究[J];解剖学研究;2005年03期
3 王金平,鞠学红,王岱君,鞠晓华,高培福;后鼓室手术入路的应用解剖学研究[J];解剖科学进展;2003年03期
4 韩思源,王玉新,郭永峰,赵磊;不同方法对周围性面神经损伤修复效果的比较[J];口腔颌面外科杂志;2001年S1期
5 张道行;人工耳蜗电极植入耳蜗入口的定位[J];临床耳鼻咽喉科杂志;2000年05期
6 张道行,胡宝华,肖玉丽;110例人工耳蜗置入手术的回顾性分析[J];临床耳鼻咽喉科杂志;2004年07期
7 刘寒波;冯永;陈登明;梅凌云;贺楚峰;蔡鑫章;;经外耳道后上径路人工耳蜗植入的手术入路和相关解剖关系研究[J];临床耳鼻咽喉头颈外科杂志;2007年10期
8 胡继云，，张家雄;面神经鼓室段区域的应用解剖[J];上海医学;1995年12期
9 张家雄,胡继云;鼓室成形术中鼓索神经处理的探讨[J];铁道医学;2000年01期
10 徐金操;郭梦和;张宏征;李永贺;;人工耳蜗植入术相关结构的解剖测量[J];听力学及言语疾病杂志;2006年03期
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