基于解剖标本、术中软骨移植物和三维CT重建的中国人鼻中隔软骨测量

发布时间：2018-01-22 04:36

本文关键词： 鼻中隔软骨解剖三维重建人体测量学　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：研究目的:1.通过直接测量确定鼻中隔软骨的背侧长度和尾侧长度以及特定部位的厚度。使用软件测量鼻中隔软骨的面积,以及在保留10mmL型支架后可用于移植的软骨面积。通过CT扫描数据进行三维重建测量鼻侧软骨与鼻中隔软骨融合的长度以及与鼻中隔软骨的夹角,并对鼻中隔软骨的厚度进行分析。2.开发一种以头颅CT扫描数据为基础的三维重建和测量方法,将CT测量的适应证推广到包括鼻中隔偏曲患者在内的全部人群。3.将由CT扫描后获得的鼻中隔软骨三维重建测量结果与同一患者鼻中隔体外成形术中直接测量的结果比较,以检测CT三维重建测量方法的效果。4.比较本研究中测量所得到的中国人鼻中隔软骨面积与文献中报道的其他种族人群的鼻中隔软骨面积大小。研究方法:1.通过尸体解剖获得鼻中隔-鼻侧软骨复合体,直接测量后进行CT扫描和三维重建分析软骨的厚度。2 CT扫描获得头颅影像学数据,通过对骨性鼻中隔进行三维重建后与选定的矢状位影像叠加计算鼻中隔软骨面积,选择最优的重建方案。3.将鼻中隔体外成形术中获得的鼻中隔软骨进行测量,与术前CT三维重建测量的鼻中隔软骨面积进行比较,评价CT三维重建测量的可靠性。4.将术中测量的鼻中隔软骨面积与文献中报道的相关数据进行比较,分析中国人鼻中隔软骨大小与其他人种的差异。研究结果:1.解剖学测量结果显示,鼻中隔软骨总面积为612.4± 130.9mm2,可移植的鼻中隔软骨面积为253.5±75.06mm2,从厚度分布图像中可以看到鼻中隔软骨中央部厚度较厚,鼻中隔前角处较薄,L支架区域厚度也不均匀,总体上较中央区域薄。2.经鼻尖的矢状位重建后测量所得到的鼻中隔软骨面积大于经前鼻棘矢状位重建后测量的面积,两者的差别具有统计学意义(p0.05)。3.术中取出的软骨总面积为613.8±114.8mm2,保留10mmL型支架后可移植软骨的面积为255.0±70.19mm2。鼻中隔软骨的CT三维重建测量所得软骨总面积为668.8±130.5mm2,保留10mm L型支架后可移植软骨面积为282.7 ±76.86mm2。两种方法测量的结果比较,鼻中隔软骨总面积的差别有统计学意义(p0.05)。4.文献中报道的鼻中隔软骨总面积和可移植面积存在较大变异。本研究所测量结果与Jun Sik Kim报道的软骨总面积相当,差异无统计学意义(p=0.81),与其他研究之间均存在显著差异(p0.05)。而本研究测得可移植软骨的面积与文献中相关报道结果比较均存在显著差异(p0.05)。结论:1.在保留10mm L型支架后,可以切取用于移植的鼻中隔软骨的面积为253.5mm2,而背侧和尾侧长度都在15mm左右,这个大小的软骨不足以用于固定型的鼻中隔支撑移植物。鼻中隔软骨的厚度在分布上呈现中间和顶部厚,鼻中隔前角周围薄的规律,在L型支架的范围内是较薄的,术中应注意保留L型支架的适当宽度。2.通过将骨性鼻中隔三维影像与矢状位图像进行重叠可以准确的确定鼻中隔软骨的边界,适用于鼻中隔偏曲患者,使得鼻中隔软骨影像学测量的适用范围推广到的所有患者,大大提高术前测量和评估的准确性。将骨性鼻中隔与过鼻尖点的矢状面影像重叠后的测量结果更大,避免了因鼻中隔偏曲而导致的平面选择时的面积损失,是更加准确的测量方法。3.术前的三维CT扫描数据进行重建获得的鼻中隔软骨形态与手术中获得的鼻中隔软骨在形态上相符程度很高,CT重建测量的结果可以准确的估计手术中保留10mm L型支架后可移植的软骨大小。4.鼻中软骨的面积在不同人种间变异较大。中国人鼻中隔软骨较高加索人和印度人小,较多数韩国人的测量值也小,需要更多研究数据来确定更准确的解剖特征。
[Abstract]:Objective: 1. by direct measurement to determine the dorsal nasal septum cartilage length and caudal length and thickness. The use of specific parts of the software measurement of nasal septum cartilage area, and can be used in the area of cartilage transplantation in type 10mmL stent. Retained cartilage and cartilage of nasal septum and three-dimensional reconstruction of nasal fusion length by CT scan data and angle with the nasal septum cartilage, three-dimensional reconstruction and measurement methods to develop a head CT scan based on the data analysis of.2. and the nasal septum cartilage thickness measuring CT indication is extended to include patients with nasal septum deviation, all the people will get.3. by CT scan after nasal septum cartilage three-dimensional reconstruction measurement results with the same patients with nasal septum forming in vitro direct measurement of intraoperative results detected by CT three-dimensional reconstruction measurement method in this study compared the effect of.4. test The septal cartilage size of other ethnic groups reported by Chinese nasal septal cartilage area and in the literature. Methods: 1. through autopsy obtained nasal septum nasal cartilage complex, CT scanning and three-dimensional reconstruction of cartilage thickness.2 CT scan brain imaging data were measured by. 3D reconstruction of nasal septal cartilage and selected sagittal image superposition calculation of nasal septal cartilage area, select the optimal scheme of the.3. reconstruction of nasal septum in vitro forming cartilage of nasal septum surgery was measured, compared with the preoperative CT three-dimensional reconstruction of nasal septum cartilage area, compare the reported data of nasal the septal cartilage area and the literature evaluation reliability of.4. measured by CT three-dimensional reconstruction will be in operation in the measurement, analysis of differences between Chinese septal cartilage and size of other races. Results: 1. anatomic measurement showed that the total area of nasal septum cartilage was 612.4 + 130.9mm2, can be transplanted to the nasal septum cartilage area was 253.5 + 75.06mm2, the thickness distribution of the image can be seen in the central part of nasal septum cartilage thickness, anterior septal angle thin L stent region thickness is not uniform. Overall than the central region of the thin.2. sagittal reconstruction of nasal tip after measurement of nasal septum cartilage area is greater than by the anterior nasal spine sagittal reconstruction area, with significant difference (P0.05).3. from intraoperative cartilage total area was 613.8 + 114.8mm2, retention of 10mmL type support after transplantation of cartilage area was 255 + 70.19mm2. nasal septal cartilage CT three-dimensional reconstruction measurement of the total area of cartilage was 668.8 + 130.5mm2, 10mm type L stent can retain cartilage grafts for measuring area of 282.7 + 76.86mm2. the results of the two methods. Comparison was statistically significant difference between the total area of nasal septal cartilage (P0.05) had great variation in.4. reported in the literature and the total area of nasal septum cartilage transplantation area. This study measured results with the Jun Sik Kim reported a total area of cartilage, there was no statistically significant difference (p= 0.81), there were significant differences with other study (P0.05). This study can be measured in the literature area and cartilage grafts reported results there were significant differences (P0.05). Conclusion: 1. in the retention of 10mm L support, can be harvested for nasal septum soft bone graft area is 253.5mm2, and the dorsal and caudal length at around 15mm, the size of the cartilage is not enough to be used for nasal septum fixed support graft. The septal cartilage thickness distribution shows that the middle and top of thick, thin septum around the anterior horn of the law, in the range of L type bracket is thinner That should pay attention to the proper width of.2. retained L stent by osteoseptum 3D images and sagittal images can overlap nasal septal cartilage boundary is determined accurately in operation, suitable for patients with nasal septum deviation, all patients scope extended to the nasal septal cartilage imaging measurement, greatly improve the accuracy preoperative measurement and assessment. The measurement of sagittal imaging of the bony nasal septum and nasal tip overlap results after more, to avoid the loss caused by the plane area of nasal septum deviation of nasal septum cartilage was obtained with three-dimensional CT scan data measurement more accurate preoperative.3. reconstruction. The nasal septum cartilage morphology and surgery in highly consistent with each other in the form, the CT can be transplanted after reconstruction retained 10mm L support estimate accurate operation of cartilage in nasal.4. size In the area of cartilage in interracial variation. Chinese nasal septal cartilage than Caucasians and Indians, the majority of Koreans measurement value is small, more research is needed to determine the anatomical characteristics more accurately.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R622

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