面神经管的三维重建观测及临床意义

发布时间：2018-05-28 11:04

本文选题：面神经管 + CT　；参考：《新乡医学院》2015年硕士论文

【摘要】：背景面神经是最容易发生神经麻痹的脑神经之一,大多数面神经麻痹导致的面瘫均位于颞骨内,且与面神经管结构密切相关。导致面神经管的骨质改变的病变有外伤、先天性畸形、胆脂瘤以及肿瘤累及面神经管等,影像学资料是客观准确的诊断依据。螺旋CT具有强大的三维重建功能,如多平面重组(MPR)和曲面重组(CPR)等,特别是螺旋CT对骨性结构的良好显示能力,使面神经管结构在CT影像上能够清晰、完整地显示。目的利用螺旋CT图像后处理的多平面重组(MPR)和曲面重组(CPR)技术,观测面神经管及面神经的迷路段、前膝部、水平段、后膝部和垂直段的位置、形态、径线、角度,以及面神经管膝状窝的径线和面神经管垂直段与周围结构的距离,为面神经管病变的临床诊断提供形态学依据。材料与方法收集新乡医学院第三附属医院2013年1月至2014年12月期间,施行耳颞部多层螺旋CT扫描的成年检查者影像200例,无耳部、颞骨、颅底部畸形和经临床检查均无面神经瘫痪者,其中男性100例,女性100例,年龄21-60岁；经影像检查和手术证实分别确诊为面神经管骨折、中耳胆脂瘤和面神经瘤的影像资料各20例,年龄23-57岁。将被检查者的原始影像数据输入CT三维重建工作站,使用ADW 4.2重建软件的多平面重组(MPR)和曲面重组(CPR)技术,分别沿面神经管进行图像后处理,显示出面神经管各段结构的全程。使用三维重建工作站内的测量软件,测量面神经管各结构的径线和角度等。采用SPSS13.0软件对所得数据进行统计学处理,采用均数±标准差(x±s)表示。结果1.面神经管的多平面重组(MPR)斜轴位影像可以清晰显示面神经管的迷路段、前膝部和水平段的起始部,斜矢状位影像可以清晰显示面神经管的水平段、后膝部和垂直段。多平面重组(MPR)影像的左右侧、男女性和影像与标本之间均无显著性差异(P0.05),迷路段、水平段、垂直段的长度和宽度以及前膝部、后膝部的角度分别为(3.66±0.39) mm、(11.50±1.06) mm、(13.68±1.05) mm 和 (0.89±0.14) mm、(1.10±0.11) mm. (1.10±0.14) mm, (71.88±7.98)°、 (110.10±6.13)°。2.面神经管的曲面重组(CPR)横轴位、冠状位、矢状位影像均可以清晰显示面神经管的全程。横轴位的迷路段宽度和后膝部角度与冠状位、矢状位之间存在显著性差异(P0.05),横轴位、冠状位、矢状位的前膝部角度之间均存在显著性差异(P0.05),横轴位、冠状位的水平段宽度和垂直段宽度与矢状位之间均存在显著性差异(P0.05)。3.多平面重组(MPR)与曲面重组(CPR)影像的面神经管的迷路段长度、迷路段宽度、垂直段长度、垂直段宽度均无显著性差异(P0.05),前膝部角度、水平段长度、水平段宽度、后膝部角度均存在显著性差异(P0.05)。4.多平面重组(MPR)面神经管膝状窝径线长度的A线、B线、C线、D线、E线的正常组与骨折组之间均存在显著性差异(P0.05),正常组径线分别为(2.88±0.32)mm、(3.29±0.27)mm、(1.63±0.18)mm、(1.67±0.18)mm、(3.26±0.29) mm,骨折组的径线均明显大于正常组。5.面神经管垂直段分别至男、女性的外耳道后壁、外耳门后缘、乙状窦沟前壁、面隐窝的距离之间均存在显著性差异(P0.05),男、女性分别为(3.07±0.86) mm、(12.07±2.94) mm、(8.35±2.23) mm、(1.89±0.35) mm 和 (2.86±0.61) mm、 (10.49±2.65) mm、(7.68±2.03) mm、(1.74±0.36) mm。结论1.面神经管的多平面重组(MPR)、曲面重组(CPR)CT影像可以直观显示面神经管,对判断面神经管发育异常、骨折和肿瘤侵犯面神经管等提供了重要的影像解剖学资料。2.面神经管膝状窝的多平面重组(MPR)径线测量,为膝状窝扩大可作为膝状窝骨折的诊断指标提供了客观依据。3.面神经管垂直段与周围结构距离的测量,确定了面神经管在颞骨内的位置,为面神经病变减压手术等提供了定位面神经管的方法。
[Abstract]:The background facial nerve is one of the most prone nerve palsy. Facial paralysis caused by most facial paralysis is located in the temporal bone and is closely related to the structure of the facial nerve canal. The lesions of the facial nerve canal include trauma, congenital malformation, cholesteatoma, and swelling of the facial nerve canal. The imaging data are objective. The diagnostic basis. Spiral CT has powerful three-dimensional reconstruction functions, such as multiplane recombination (MPR) and surface recombination (CPR), especially the good display ability of spiral CT to bone structure, so that the facial nerve tube structure can be clearly and completely displayed on the CT image. Objective to use the post-processing of multiplanar recombination (MPR) and surface recombination with spiral CT images. (CPR) technology, observation of the labyrinth segment of the facial nerve canal and facial nerve, the position of the anterior knee, the horizontal segment, the posterior knee and the vertical segment, the shape, the diameter line, the angle, the distance between the facial nerve canal geniculate fossa and the distance between the vertical segment of the facial nerve canal and the surrounding structure, and provide the morphological basis for the clinical diagnosis of the facial nerve canal lesions. Materials and methods collect Xinxiang From January 2013 to December 2014 of the Third Affiliated Hospital of Medical College, 200 adult examiners were performed with multi spiral CT scanning of the auricular temporal region. There was no facial nerve paralysis in the ear, the temporal bone, the skull base deformity and the clinical examination, of which 100 cases were male, 100 cases were female, and the age was 21-60 years old. The image data of nerve canal fracture, middle ear cholesteatoma and facial neuroma were 20 cases, aged 23-57 years. The original image data of the examiners were entered into the CT 3D reconstruction workstation. The multiplane recombination (MPR) and surface recombination (CPR) technique of the ADW 4.2 reconstruction software were used to post the image post-processing along the facial nerve tube, showing the nodes of each segment of the facial nerve tube. The measurement software in the three-dimensional reconstruction workstation was used to measure the diameters and angles of each structure of the facial nerve tube. The data were processed with SPSS13.0 software, and the mean number + standard deviation (x + s) was used. The results of the multi plane recombinant (MPR) oblique axis image of the 1. facial nerve tube could clearly show the labyrinth of the facial nerve tube. Segment, the beginning of the anterior and horizontal segments, the oblique sagittal image can clearly display the horizontal segment of the facial nerve canal, the posterior and vertical segments. The left and right sides of the multiplane recombinant (MPR) image have no significant difference (P0.05), the labyrinth segment, the flat segment, the length and width of the vertical segment, the anterior genu and the posterior knee. The angles were (3.66 + 0.39) mm, (11.50 + 1.06) mm, (13.68 + 1.05) mm and (0.89 + 0.14) mm, (1.10 + 0.11) mm. (1.10 + 0.14), (71.88 + 0.14) mm, (71.88 + 11.50) degrees, the transverse axis of the curved surface of the facial nerve canal (CPR), and the coronal and sagittal images could clearly show the whole course of the facial nerve canal. The width of the transverse section of the labyrinth segment and the posterior segment of the transverse axis There was significant difference between the angle of the knee and the coronal position and the sagittal position (P0.05). There were significant differences (P0.05) between the transverse axis, the coronal position and the anterior knee of the sagittal position. The horizontal segment width and the vertical segment width were significantly different between the sagittal and the sagittal positions (P0.05).3. multiplane recombination (MPR) and the surface recombination (CP). R) the length of the labyrinth segment of the facial nerve canal, the width of the labyrinth segment, the length of the vertical segment and the width of the vertical segment had no significant difference (P0.05). The anterior knee angle, the horizontal segment length, the horizontal segment width, the posterior knee angle had significant difference (P0.05) the A line of the length of the geniculate nests of the MPR facial nerve canal, the B line, C line, D line, E line. There were significant differences between the normal group and the fracture group (P0.05). The normal group diameter line was (2.88 + 0.32) mm, (3.29 + 0.27) mm, (1.63 + 0.18) mm, (1.67 + 0.18) mm, (3.26 + 0.29) mm, and the fracture group was significantly larger than that of the normal group.5. facial nerve canal vertical segment, respectively, the posterior wall of the external auditory canal, the posterior edge of the external ear and the anterior wall of the sigmoid sinus. There were significant differences in the distance between the facial recess (P0.05), men and women were (3.07 + 0.86) mm, (12.07 + 2.94) mm, (8.35 + 2.23) mm, (1.89 + 0.35) mm and (2.86 + 0.61) mm, (10.49 + 2.65) mm, (7.68 + 2.03) mm, multiplanar reorganization of neural tube (MPR), and surface recombination (CPR) CT images can be displayed intuitively The facial nerve canal provides important imaging anatomical data for judging the abnormal development of the facial nerve canal, fracture and tumor invasion of the facial nerve canal, and so on. The multiplanar reorganization (MPR) measurement of the.2. facial nerve canal geniculate fossa can be used to provide an objective basis for the diagnosis of the fracture of the geniculate fossa, which provides an objective basis for the vertical and peripheral structures of the.3. facial nerve canal. The measurement of distance determines the location of the facial nerve canal in the temporal bone, and provides a method for locating facial nerve canal for decompression operation of facial nerve diseases.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.3

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