横窦与颈内静脉或颈外静脉搭桥的相关研究
发布时间：2018-09-08 20:52
【摘要】：目的:1.描述双侧横窦的走形和引流规律,测量和定位双侧横窦的位置,计算横窦沟的深度和厚度,总结如何利用体表标志来准确定位横窦的位置,测量双侧颈内静脉和颈外静脉在颈总动脉末端处的横截面积。2.探讨进行横窦—颈内静脉/颈外静脉搭桥来治疗横窦、乙状窦及颈静脉孔区等部位的病变。对象和方法:在门诊病人中选取100例我国成人CTA的全部影像资料,用计算机重建出骨窗与血管的图像,建立以后正中线连线为Y轴,以枕外隆凸最高点为原点,以Y的垂线为X轴的直角坐标系,测量横窦在-40mm~40mm区间内每间隔5mm处的坐标系数据,将右侧横窦沟上缘的点依次命名为点1a、1b、1c、1d、1e、1f、1g、1h,将右侧横窦沟下缘的点依次命名为2a、2b、2c、2d、2e、2f、2g、2h;左侧分别为-1a、-1b、-1c、-1d、-1e、-1f、-1g、-1h和-2a、-2b、-2c、-2d、-2e、-2f、-2g、-2h。并记录各个孔中点的坐标,从而系统化地分析横窦的解剖位置。并测量出双侧横窦沟在这一区间内的深度和其距离颅骨表面的最近距离即厚度。对比枕内粗隆与枕外隆凸的位置关系、测量出枕内粗隆与枕外隆凸平面之间的距离。在选取的影像资料中,分别在双侧颈总动脉末端的层面上测量出胸锁乳突肌内侧的颈内静脉横截面积以及胸锁乳突肌表面的颈外静脉横截面积。对20例成人湿性头颅标本模拟后颅窝的开颅手术并暴露出横窦的位置,为准确验证横窦的走形和定位提供解剖学依据。结果:国人横窦呈右侧优势者占56%,其中绝对优势者占8%,相对优势者占28%,稍优势者占20%;国人横窦呈左侧优势者占20%,其中绝对优势者占4%,相对优势者占4%,稍优势者占1.2%。而左右两侧差别不大的病例占24%。通过研究横窦沟的走形我们发现,左侧的横窦位置要比右侧横窦低,而且左侧横窦走形时的弯曲程度比右侧要小。右侧横窦沟各坐标点在Y轴上的平均值分别是:1a:28.18±2.13,1b:25.34±2.19,1c:20.29±1.76,1d:17.94±1.69,1e:16.98±1.21,1f:16.66±1.03,1g:14.97±2.08,1h:12.98±2.12;2a:15.74±2.24,2b:11.24±2.1,2c:9.46±1.20,2d:7.34±2.57,2e:7.12±2.28,2f:7.09±1.13,2g:4.26±1.60,2h:3.28±1.41;左侧横窦沟各坐标点在Y轴上的平均值分别是:-1a:19.91±1.41,-1b:17.45±2.14,-1c:15.42±2.12,-1d:15.07±2.2,-1e:14.61±1.71,-1f:14.35±2.01,-1g:12.92±1.91,-1h:12.2±2.01;-2a:10.87±2.11,-2b:8.47±1.67,-2c:7.38±1.81,-2d:7.23±3.03,-2e:6.93±1.65,-2f:5.47±2.13,-2g:4.57±1.89,-2h:4.50±2.11。右侧颈内静脉的横截面积平均值为125.44±23.18mm2,其中以右侧为优势侧的患者中横截面积平均值为159.32±20.31 mm2,以左侧为优势侧的患者其横截面积平均值为64.92±21.02 mm2。左侧颈内静脉横截面积的平均值为113.26±19.25mm2,其中以左侧为优势侧的患者横截面积平均值为138.79±28.99mm2,以右侧为优势侧的患者其横截面积平均值为74.98±12.18 mm2。右侧颈外静脉的平均横截面积为47.34±6.23mm2,左侧颈外静脉的平均横截面积为42.22±5.86mm2,两者之间无明显差异。在所有病例中,右侧颈外静脉横截面积较大者占45%,左侧颈外静脉横截面积较大者占51%,右侧颈外静脉在颈总动脉末端层面的胸锁乳突肌表面处缺如者占3%,左侧缺如者占1%。枕外隆凸与枕内粗隆相比,枕内粗隆较枕外隆凸高者占76%,这些病例中枕内粗隆比枕外隆凸平均高9.03±2.11mm;枕内粗隆较枕外隆凸低者占13%,平均比枕外隆凸低8.03±1.86mm;两者处于同一水平面者占11%。横窦沟在距离中线40mm内最大深度的平均值为2.89±0.79mm,而横窦沟最深处至颅骨外表面的厚度平均值为8.24±1.31mm。结论:1.术前了解横窦的位置和走形,有助于提高在神经外科手术过程的安全性;2.术前了解颈内静脉和颈外静脉的横截面积有助于术前设计手术方案;3.对于横窦、乙状窦以及颈内静脉上段等部位的病变,在不能经常规治疗或常规治疗困难时,可以考虑行横窦—颈内静脉/颈外静脉的搭桥来治疗;4.进行横窦—颈内静脉/颈外静脉的搭桥治疗是相对安全、有效、简捷的。
[Abstract]:Objective: 1. To describe the shape and drainage of bilateral transverse sinuses, measure and locate the position of bilateral transverse sinuses, calculate the depth and thickness of transverse sinus sulcus, summarize how to locate the position of transverse sinuses accurately by body surface markers, and measure the cross-sectional area of bilateral internal jugular veins and external jugular veins at the end of the common carotid artery. Objectives and Methods: 100 Chinese adults were selected from the outpatient clinic to reconstruct the image of bone window and blood vessel, and then the median line was established as the Y axis, the highest point of occipital eminence was the origin, and the vertical line of Y was the X axis. In the rectangular coordinate system, the coordinate coefficients of the transverse sinus are measured at 5 mm intervals between - 40mm and 40 mm. The points on the upper edgeof the right transverse sinus groove are named points 1a, 1b, 1c, 1d, 1d, 1e, 1f, 1f, 1g, 1h, 1h, and the points on the lower edgeof the right transverse sinus groove are named 2a, 2b, 2b, 2c, 2d, 2e, 2e, 2f, 2g, 2h; on the left side are - 1a, - 1b, - 1c, - 1c, - 1d, - 1e, - 1f, - 1f, - 1g, - 1g, - 1g, - 1h, - 1g, - 1h, -2e, -2 F, - 2g, - 2h. and the coordinates of the central points of each hole were recorded to systematically analyze the anatomical position of the transverse sinus. The depth of the bilateral transverse sinus groove in this region and the nearest distance from the skull surface were measured. The distance between the intraoccipital tuberosity and the occipital protuberance was measured by comparing the position of the intraoccipital tuberosity and the occipital protuberance. The cross-sectional area of the internal jugular vein in the medial sternocleidomastoid muscle and the external jugular vein on the surface of the sternocleidomastoid muscle were measured at the bilateral end of the common carotid artery, respectively. Results: 56% of the Chinese had right superiority, 8% had absolute superiority, 28% had relative superiority, 20% had slight superiority, 20% had left superiority, 4% had absolute superiority, 4% had relative superiority and 1.2% had slight superiority. By studying the shape of the transverse sinus sulcus, we found that the position of the left transverse sinus was lower than that of the right transverse sinus, and the curvature of the left transverse sinus was smaller than that of the right. .97卤2.08,1h:12.98卤2.12;2a:15.74卤2.24,2b:11.24卤2.1,2c:9.46卤1.20,2d:7.34卤2.57,2e:7.12卤2.28,2f:7.09卤1.13,2g:4.26卤1.60,2h:3.28卤1.41;宸︿晶妯娌熷悇鍧愭爣鐐瑰湪Y杞翠笂鐨勫钩鍧囧，
本文编号：2231662
[Abstract]:Objective: 1. To describe the shape and drainage of bilateral transverse sinuses, measure and locate the position of bilateral transverse sinuses, calculate the depth and thickness of transverse sinus sulcus, summarize how to locate the position of transverse sinuses accurately by body surface markers, and measure the cross-sectional area of bilateral internal jugular veins and external jugular veins at the end of the common carotid artery. Objectives and Methods: 100 Chinese adults were selected from the outpatient clinic to reconstruct the image of bone window and blood vessel, and then the median line was established as the Y axis, the highest point of occipital eminence was the origin, and the vertical line of Y was the X axis. In the rectangular coordinate system, the coordinate coefficients of the transverse sinus are measured at 5 mm intervals between - 40mm and 40 mm. The points on the upper edgeof the right transverse sinus groove are named points 1a, 1b, 1c, 1d, 1d, 1e, 1f, 1f, 1g, 1h, 1h, and the points on the lower edgeof the right transverse sinus groove are named 2a, 2b, 2b, 2c, 2d, 2e, 2e, 2f, 2g, 2h; on the left side are - 1a, - 1b, - 1c, - 1c, - 1d, - 1e, - 1f, - 1f, - 1g, - 1g, - 1g, - 1h, - 1g, - 1h, -2e, -2 F, - 2g, - 2h. and the coordinates of the central points of each hole were recorded to systematically analyze the anatomical position of the transverse sinus. The depth of the bilateral transverse sinus groove in this region and the nearest distance from the skull surface were measured. The distance between the intraoccipital tuberosity and the occipital protuberance was measured by comparing the position of the intraoccipital tuberosity and the occipital protuberance. The cross-sectional area of the internal jugular vein in the medial sternocleidomastoid muscle and the external jugular vein on the surface of the sternocleidomastoid muscle were measured at the bilateral end of the common carotid artery, respectively. Results: 56% of the Chinese had right superiority, 8% had absolute superiority, 28% had relative superiority, 20% had slight superiority, 20% had left superiority, 4% had absolute superiority, 4% had relative superiority and 1.2% had slight superiority. By studying the shape of the transverse sinus sulcus, we found that the position of the left transverse sinus was lower than that of the right transverse sinus, and the curvature of the left transverse sinus was smaller than that of the right. .97卤2.08,1h:12.98卤2.12;2a:15.74卤2.24,2b:11.24卤2.1,2c:9.46卤1.20,2d:7.34卤2.57,2e:7.12卤2.28,2f:7.09卤1.13,2g:4.26卤1.60,2h:3.28卤1.41;宸︿晶妯娌熷悇鍧愭爣鐐瑰湪Y杞翠笂鐨勫钩鍧囧，
本文编号：2231662
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