经面神经隐窝入路人工耳蜗植入术相关解剖学研究
发布时间：2018-08-07 08:26
【摘要】：目的：通过对人工耳蜗植入术相关的面神经隐窝及后鼓室解剖结构进行观察测量,为人工耳蜗植入手术中避免面神经、鼓索神经等损伤及准确定位鼓阶开窗口提供理论参考。 材料：取经福尔马林浸泡的国人颞骨湿标本10例20侧,其中女性7例(14耳),男性3例(6耳),均为成人标本,均无中耳畸形及疾病(研究中证实)。标本来自南方医科大学解剖学教研室与珠江医院神经外科教研室。测量工具：自制仿镫骨测量器、制图用带长针头分规、电子游标卡尺(精确度0.01mm)、Leica耳科手术显微镜、耳科手术电钻、耳科显微手术器械。 方法： 1.实验步骤：耳后切口,剥离软组织和骨膜,暴露乳突。行乳突轮廓化,保留外耳道后壁,暴露砧骨短脚,磨出面神经垂直段(磨去骨管)和鼓索神经,保留后拱柱。在面神经垂直段与鼓索神经之间切开面神经隐窝,进入后鼓室,显露砧镫关节、锥隆起、镫骨肌腱、圆窗龛、圆窗等结构。再磨去后拱柱,摘除砧骨,显露面神经水平段(磨去骨管)和匙状突；磨低圆窗龛,充分暴露圆窗膜,自下缘掀起圆窗膜后定位鼓阶入口,并于圆窗膜前钻开鼓阶。彻底磨出耳蜗底回,暴露骨螺旋板,在耳蜗底回上方磨开耳蜗第二回。在各步骤中对实验前拟定的测量指标进行测量。 2.主要观察指标：外耳道后上棘与砧骨短脚之间的距离,鼓索神经发出点与茎乳孔之间的距离,砧骨短脚与鼓索神经发出点之间的距离,而神经隐窝最宽处与砧骨短脚之间的距离,面神经隐窝最宽处与鼓索神经发出点之间的距离,面神经隐窝最大宽度,面神经隐窝宽度(镫骨头水平),面神经隐窝宽度(圆窗水平),锥隆起与圆窗膜前缘之间的距离,镫骨头与圆窗膜下缘之间的距离,砧骨短脚与圆窗龛之间的距离,镫骨头与圆窗龛之间的距离,面神经垂直段与圆窗龛之间的距离,鼓阶入口与卵圆窗最近距离之间的距离,匙状突与圆窗龛之间的距离,镫骨头与耳蜗第二回切开点之间的距离,锥隆起与耳蜗第二回切开点之间的距离。 3.测量点的选择：外耳道后上棘以尖端为测量点；砧骨短脚以砧骨短脚尖端为测量点；茎乳孔以乳突腔茎乳孔内口为测量点；圆窗龛以圆窗龛上唇下缘为测量点；面神经垂直段以面神经垂直段前边缘为测量点；锥隆起以锥隆起骨性尖端为测量点；圆窗膜前缘以圆窗膜前缘垂直切线为测量点；圆窗膜下缘以圆窗膜下缘垂直切线为测量点；面神经隐窝宽度指所指平面面神经至鼓索神经的最短距离；匙状突以匙状突下缘为测量点；鼓阶入口以基底膜起点下缘为测量点；卵圆窗以卵圆窗最下缘为测量点；耳蜗第二回切开点以第二回基底膜起点下缘为测量点。面神经垂直段至圆窗龛(后唇前缘)之间距离指两者间最小直线距离。 4.统计学处理：所有测量数据取3次测量值的平均值,所得平均值用SPSS13.0软件做统计学处理,结果以均数±标准差表示,并列出测量范围。 结果： 1.面神经垂直段并非成一条直线垂直下行,而是先向后外有一拱形的弧度,然后内下至茎乳孔出颞骨,从而形成了面神经垂直段弧度最大位置。总的走向是由前内侧逐渐移向后外侧,行程中前后方向呈“C”形弯曲。面神经垂直段弧度最大位置约在砧骨短脚下6.28mm处。 2.有1侧面神经水平段骨管的缺如；2侧面神经垂直段前移影响圆窗龛的暴露；2侧鼓索神经由茎乳孔发出；1侧鼓索神经多支的变异：1侧圆窗龛的变异。 3.外耳道后上棘至砧骨短脚之间的距离为(12.44±1.58)mm(8.35～14.46mm)；鼓索神经发出点至茎乳孔之间的距离为(2.67±1.50)mm(0～5.22mm)；砧骨短脚至鼓索神经发出点之间的距离为(15.22±2.67)mm(10.35～20.24mm)；面神经隐窝最宽处至砧骨短脚之间距离为(6.28±1.27)mm(4.23～8.88mm)；面神经隐窝最宽处至鼓索神经发出点之间距离为(9.81±2.16)mm(5.55～13.76mm)；面神经隐窝最大宽度为(2.73±0.64)mm(1.61～4.01mm)；镫骨头水平面神经隐窝宽度为(2.48±0.68)mm(1.42～3.70mm)；圆窗水平的面神经隐窝宽度为(2.24±0.61)mm(1.28～3.33mm)；锥隆起至圆窗膜前缘之间的距离为(2.22±0.70)mm(1.46～4.16mm)；镫骨头至圆窗膜下缘之间的距离为(2.16±0.48)mm(1.24～2.88mm)；砧骨短脚至圆窗龛之间的距离为(5.91±0.84)mm(4.49～8.02mm)；镫骨头至圆窗龛之间的距离为(2.11±0.58)mm(3.31～3.79mm)；面神经垂直段至圆窗龛之间的距离为(6.70±0.61)mm(5.02～7.78mm)；鼓阶入口与卵圆窗最近距离为(2.12±0.56)mm(1.24～3.43mm)；匙状突至圆窗龛之间的距离为(3.79±0.56)mm(3.07～5.23mm)；镫骨头至耳蜗第二回切开点之间距离为(2.25±0.43)mm(1.35～2.93mm)；锥隆起至耳蜗第二回转切开点之间距离为(2.28±0.62)mm(1.54～4.09mm)。 结论：在经面神经隐窝入路人工耳蜗植入术中,面神经隐窝切开、鼓阶入口的定位是手术的关键,关系到手术的成功与否。面神经的损伤是人工耳蜗植入术中比较严重的并发症之一。本研究认为面神经垂直段弧度最大位置处的面神经隐窝前后距离最大,切开面神经隐窝时损伤面神经及鼓索神经的几率最小,是切开并充分开放面神经隐窝起始位置。镫骨头、锥隆起是后鼓室比较容易找到并相对比较恒定的解剖标志,当术中圆窗龛暴露不良或不能暴露及耳蜗底转骨化等情况时,可参考镫骨头、锥隆起来定位鼓阶入口。本研究的相关数据为经面神经隐窝入路人工耳蜗植入手术中避免面神经、鼓索神经等重要结构损伤及准确定位鼓阶入口提供理论参考。
[Abstract]:Objective: To observe and measure the anatomical structure of the facial nerve recess and the posterior tympanic cavity related to the cochlear implantation, and provide a theoretical reference for avoiding the facial nerve, tympani nerve and so on in the cochlear implantation.
Materials: 20 sides of the Chinese temporal bone wet specimens soaked by formalin, including 7 women (14 ears), 3 males (6 ears), were all adult specimens, all had no middle ear malformation and disease (confirmed in the study). The specimens were from the Department of anatomy teaching and research in Southern Medical University and Department of Neurosurgery, Zhujiang Hospital. Measurement tools: homemade stapes measuring apparatus, Drawing with a long needle gauge, electronic vernier caliper (accuracy 0.01 mm), Leica otology surgery microscope, otology surgery electric drill, otology microsurgical instruments.
Method:
1. the experimental procedure: after the ear incision, the soft tissue and periosteum were stripped and the mastoid was exposed. The posterior wall of the external auditory canal was retained, the posterior wall of the external auditory canal was retained, the anvil short foot was exposed, the vertical segment of the facial nerve (the bone canal) and the tympanum nerve were worn, and the posterior arch was retained. The facial nerve recess was cut in the vertical segment of the facial nerve and the tympani nerve, and the posterior tympanic cavity was entered and the incus stapes joint was exposed. Conical protruding, stapes tendon, round window niche, round window and so on. Then grinding the post arch column, removing the anvil, exposing the horizontal segment of the facial nerve (grinding the bone tube) and the spoon process; grinding the low round window niche, exposing the circular window film fully, setting the drum step after the round window film, and drilled the drum order before the round window membrane. Cochlear second times above the base of the cochlear. The measurement indexes before the experiment were measured in each step.
2. main indicators: the distance between the posterior upper spine and the short foot of the anvil, the distance between the emit point of the tympani and the orifice of the stem, the distance between the short foot of the anvil and the point of the tympani nerve, the distance between the widest part of the nerve recess and the short foot of the anvil, the distance between the widest part of the facial nerve recess and the point of the tympani nerve, and the facial deity The width of the recess, the width of the facial nerve recess (the level of the stapes), the width of the facial nerve recess (the level of the round window), the distance between the cones and the front of the round window membrane, the distance between the stapes and the lower edge of the round window membrane, the distance between the short feet of the incus and the niches of the round window, the distance between the stapes and the niches of the round window, the vertical segment of the facial nerve and the niches of the round window. Distance, the distance between the entrance of the drum and the nearest distance of the oval window, the distance between the spoon and the round window niche, the distance between the second incised points of the stapes and the cochlea, and the distance between the conical protruding and the second back incised point of the cochlea.
3. the selection of the measuring point: the tip of the posterior upper spine of the external auditory canal was measured at the point of the tip; the short foot of the anvil was measured at the tip of the short foot of the anvil; the stem lacteal hole was measured with the orifice of the mammary hole in the mastoid cavity; the round window niche was measured at the lower edge of the upper lip of the round window niche; the vertical segment of the facial nerve was measured at the front edge of the vertical segment of the facial nerve; the conical uplift was a conical bone. The front edge of the circular window membrane is measured by the vertical tangent line of the front edge of the circular window membrane; the lower edge of the circular window membrane is measured by the vertical tangent line of the lower edge of the circular window membrane; the width of the facial nerve recess refers to the shortest distance from the plane facial nerve to the drum nerve; the spoon process is the measuring point with the spoonful edge of the lower edge; the drum step entrance is under the base film starting point under the basement membrane. The margin is the measuring point; the oval window is measured at the bottom of the oval window, and the second point of the cochlea is measured at the lower edge of the base membrane of the second basilar membrane. The distance between the vertical section of the facial nerve to the round window niche (the posterior lip of the rear lip) refers to the minimum linear distance between the two.
4. statistical treatment: the average value of all measured data was taken for 3 times. The average value was processed by SPSS13.0 software. The results were expressed with the average number of standard deviation, and the range of measurement was listed.
Result:
The vertical section of the 1. facial nerve is not a straight line vertical downward, but an arched arc from the back to the outside, and then from the inside to the Stemal hole out of the temporal bone, thus forming the maximum position of the vertical segment of the facial nerve. The general direction is gradually shifted from the front to the lateral side, and the front and back side of the stroke is curved "C". The vertical segment of the facial nerve is the most curved. The large position is about 6.28mm at the foot of the anvil.
2. there were 1 sides of the nerve horizontal segment of the bone canal; the 2 sides of the vertical segment of the nerve affected the exposure of the niches of the round window; the 2 side of the tympanic nerve was emitted from the stem of the mammary gland; the variation of the multiple branches of the 1 side of the tympanic nerve: the variation of the 1 round window niches.
3. the distance between the posterior upper spine and the short foot of the anvil was (12.44 + 1.58) mm (8.35 ~ 14.46mm), the distance between the emit point of the cord to the stem mammary hole was (2.67 + 1.50) mm (0 to 5.22mm), the distance between the short foot of the incus and the point of the tympanus nerve was (15.22 + 2.67) mm (10.35 ~ 20.24mm), and the width of the facial nerve recess to the short foot of the anvil The distance was (6.28 + 1.27) mm (4.23 ~ 8.88mm), the width of the facial nerve recess was (9.81 + 2.16) mm (5.55 ~ 13.76mm), the maximum width of the facial nerve recess was (2.73 + 0.64) mm (1.61 to 4.01mm), the width of the saphenous fossa of the stapes' horizontal plane was (2.48 + 0.68) mm (1.42 ~ 3.70mm), and the level of the circular window was the level of the facial nerve. The width of the recess is (2.24 + 0.61) mm (1.28 ~ 3.33mm), the distance between the pyramid and the front of the circular window membrane is (2.22 + 0.70) mm (1.46 ~ 4.16mm); the distance between the stapes and the lower edge of the round window membrane is (2.16 + 0.48) mm (1.24 to 2.88mm); the distance between the short foot to the round window niche is (5.91 + 0.84) mm (4.49 ~ 8.02mm), and the stapes bone to the round window niche is the distance between the incus short feet to the round window niche. The distance between them was (2.11 + 0.58) mm (3.31 ~ 3.79mm), the distance between the vertical segment of the facial nerve and the round window niche was (6.70 + 0.61) mm (5.02 ~ 7.78mm), the nearest distance between the drum step entrance and the oval window was (2.12 + 0.56) mm (1.24 to 3.43mm), the distance between the spoon process and the round window niche was (3.79 + 0.56) mm (3.07 ~ 5.23mm), and the stapes bone to the cochlea second back cut. The distance between the opening points was (2.25 +0.43) mm (1.35-2.93 mm) and the distance between the cone protuberance and the second turning of the cochlea was (2.28 +0.62) mm (1.54-4.09 mm).
Conclusion: during the implantation of the cochlear implant with facial nerve recess, the location of the facial nerve recess is the key to the operation, which is related to the success of the operation. The injury of the facial nerve is one of the most serious complications in the cochlear implantation. The maximum probability of injury to the facial nerve and the tympane nerve in the incision of the facial nerve recess was the most likely to open and open the starting position of the facial nerve recess. The stapes bone, the conical bulge is the posterior tympanum which is relatively easy to find and relatively constant, when the recess of the round window is unexposed or unexposed and the cochlear ossification is not exposed. In the case of the case, the stapes bone can be referred to the cones to locate the drum step entrance. The relevant data of this study can provide theoretical reference for avoiding the important structural damage of the facial nerve, the tympani nerve, and the accurate location of the drum entrance during the cochlear implant surgery of the facial recess approach.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R764
本文编号：2169458
[Abstract]:Objective: To observe and measure the anatomical structure of the facial nerve recess and the posterior tympanic cavity related to the cochlear implantation, and provide a theoretical reference for avoiding the facial nerve, tympani nerve and so on in the cochlear implantation.
Materials: 20 sides of the Chinese temporal bone wet specimens soaked by formalin, including 7 women (14 ears), 3 males (6 ears), were all adult specimens, all had no middle ear malformation and disease (confirmed in the study). The specimens were from the Department of anatomy teaching and research in Southern Medical University and Department of Neurosurgery, Zhujiang Hospital. Measurement tools: homemade stapes measuring apparatus, Drawing with a long needle gauge, electronic vernier caliper (accuracy 0.01 mm), Leica otology surgery microscope, otology surgery electric drill, otology microsurgical instruments.
Method:
1. the experimental procedure: after the ear incision, the soft tissue and periosteum were stripped and the mastoid was exposed. The posterior wall of the external auditory canal was retained, the posterior wall of the external auditory canal was retained, the anvil short foot was exposed, the vertical segment of the facial nerve (the bone canal) and the tympanum nerve were worn, and the posterior arch was retained. The facial nerve recess was cut in the vertical segment of the facial nerve and the tympani nerve, and the posterior tympanic cavity was entered and the incus stapes joint was exposed. Conical protruding, stapes tendon, round window niche, round window and so on. Then grinding the post arch column, removing the anvil, exposing the horizontal segment of the facial nerve (grinding the bone tube) and the spoon process; grinding the low round window niche, exposing the circular window film fully, setting the drum step after the round window film, and drilled the drum order before the round window membrane. Cochlear second times above the base of the cochlear. The measurement indexes before the experiment were measured in each step.
2. main indicators: the distance between the posterior upper spine and the short foot of the anvil, the distance between the emit point of the tympani and the orifice of the stem, the distance between the short foot of the anvil and the point of the tympani nerve, the distance between the widest part of the nerve recess and the short foot of the anvil, the distance between the widest part of the facial nerve recess and the point of the tympani nerve, and the facial deity The width of the recess, the width of the facial nerve recess (the level of the stapes), the width of the facial nerve recess (the level of the round window), the distance between the cones and the front of the round window membrane, the distance between the stapes and the lower edge of the round window membrane, the distance between the short feet of the incus and the niches of the round window, the distance between the stapes and the niches of the round window, the vertical segment of the facial nerve and the niches of the round window. Distance, the distance between the entrance of the drum and the nearest distance of the oval window, the distance between the spoon and the round window niche, the distance between the second incised points of the stapes and the cochlea, and the distance between the conical protruding and the second back incised point of the cochlea.
3. the selection of the measuring point: the tip of the posterior upper spine of the external auditory canal was measured at the point of the tip; the short foot of the anvil was measured at the tip of the short foot of the anvil; the stem lacteal hole was measured with the orifice of the mammary hole in the mastoid cavity; the round window niche was measured at the lower edge of the upper lip of the round window niche; the vertical segment of the facial nerve was measured at the front edge of the vertical segment of the facial nerve; the conical uplift was a conical bone. The front edge of the circular window membrane is measured by the vertical tangent line of the front edge of the circular window membrane; the lower edge of the circular window membrane is measured by the vertical tangent line of the lower edge of the circular window membrane; the width of the facial nerve recess refers to the shortest distance from the plane facial nerve to the drum nerve; the spoon process is the measuring point with the spoonful edge of the lower edge; the drum step entrance is under the base film starting point under the basement membrane. The margin is the measuring point; the oval window is measured at the bottom of the oval window, and the second point of the cochlea is measured at the lower edge of the base membrane of the second basilar membrane. The distance between the vertical section of the facial nerve to the round window niche (the posterior lip of the rear lip) refers to the minimum linear distance between the two.
4. statistical treatment: the average value of all measured data was taken for 3 times. The average value was processed by SPSS13.0 software. The results were expressed with the average number of standard deviation, and the range of measurement was listed.
Result:
The vertical section of the 1. facial nerve is not a straight line vertical downward, but an arched arc from the back to the outside, and then from the inside to the Stemal hole out of the temporal bone, thus forming the maximum position of the vertical segment of the facial nerve. The general direction is gradually shifted from the front to the lateral side, and the front and back side of the stroke is curved "C". The vertical segment of the facial nerve is the most curved. The large position is about 6.28mm at the foot of the anvil.
2. there were 1 sides of the nerve horizontal segment of the bone canal; the 2 sides of the vertical segment of the nerve affected the exposure of the niches of the round window; the 2 side of the tympanic nerve was emitted from the stem of the mammary gland; the variation of the multiple branches of the 1 side of the tympanic nerve: the variation of the 1 round window niches.
3. the distance between the posterior upper spine and the short foot of the anvil was (12.44 + 1.58) mm (8.35 ~ 14.46mm), the distance between the emit point of the cord to the stem mammary hole was (2.67 + 1.50) mm (0 to 5.22mm), the distance between the short foot of the incus and the point of the tympanus nerve was (15.22 + 2.67) mm (10.35 ~ 20.24mm), and the width of the facial nerve recess to the short foot of the anvil The distance was (6.28 + 1.27) mm (4.23 ~ 8.88mm), the width of the facial nerve recess was (9.81 + 2.16) mm (5.55 ~ 13.76mm), the maximum width of the facial nerve recess was (2.73 + 0.64) mm (1.61 to 4.01mm), the width of the saphenous fossa of the stapes' horizontal plane was (2.48 + 0.68) mm (1.42 ~ 3.70mm), and the level of the circular window was the level of the facial nerve. The width of the recess is (2.24 + 0.61) mm (1.28 ~ 3.33mm), the distance between the pyramid and the front of the circular window membrane is (2.22 + 0.70) mm (1.46 ~ 4.16mm); the distance between the stapes and the lower edge of the round window membrane is (2.16 + 0.48) mm (1.24 to 2.88mm); the distance between the short foot to the round window niche is (5.91 + 0.84) mm (4.49 ~ 8.02mm), and the stapes bone to the round window niche is the distance between the incus short feet to the round window niche. The distance between them was (2.11 + 0.58) mm (3.31 ~ 3.79mm), the distance between the vertical segment of the facial nerve and the round window niche was (6.70 + 0.61) mm (5.02 ~ 7.78mm), the nearest distance between the drum step entrance and the oval window was (2.12 + 0.56) mm (1.24 to 3.43mm), the distance between the spoon process and the round window niche was (3.79 + 0.56) mm (3.07 ~ 5.23mm), and the stapes bone to the cochlea second back cut. The distance between the opening points was (2.25 +0.43) mm (1.35-2.93 mm) and the distance between the cone protuberance and the second turning of the cochlea was (2.28 +0.62) mm (1.54-4.09 mm).
Conclusion: during the implantation of the cochlear implant with facial nerve recess, the location of the facial nerve recess is the key to the operation, which is related to the success of the operation. The injury of the facial nerve is one of the most serious complications in the cochlear implantation. The maximum probability of injury to the facial nerve and the tympane nerve in the incision of the facial nerve recess was the most likely to open and open the starting position of the facial nerve recess. The stapes bone, the conical bulge is the posterior tympanum which is relatively easy to find and relatively constant, when the recess of the round window is unexposed or unexposed and the cochlear ossification is not exposed. In the case of the case, the stapes bone can be referred to the cones to locate the drum step entrance. The relevant data of this study can provide theoretical reference for avoiding the important structural damage of the facial nerve, the tympani nerve, and the accurate location of the drum entrance during the cochlear implant surgery of the facial recess approach.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R764
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