锥上间隙的三维重建和手术观察
发布时间：2018-11-12 17:53
【摘要】：目的： 通过颞骨高分辨率CT(HRCT)图像观察、手术中观察及三维重建阐明锥上间隙的位置、发生率、形态学特点,以期有助于慢性中耳炎患者面神经的术中定位和识别。 方法： 收集300例慢性中耳炎患者术前颞骨HRCT图像,对锥上间隙进行术中观察和HRCT图像观察,确定锥上间隙的出现率和位置；对锥上间隙及其周围解剖结构进行三维重建,确定锥上间隙与面神经的关系。收集同期无明确耳部疾病行颞骨HRCT检查的门诊病人的颞骨HRCT图像资料160例作为对照组,对锥上间隙进行HRCT图像观察。 结果： 手术组,在68.3%(205例)病人的术中观察到了锥上间隙,锥上间隙通常是后鼓室面隐窝骨壁上面神经锥曲段表面唯一的一个气房或者如果周围有小气房存在的话也是该区域气房中最大的一个,其位置在：面神经管锥曲段外侧,后鼓环内侧,砧骨窝和鼓窦入口下方,鼓索嵴上方。锥上间隙的形态大致可分为：类圆形(11.7%,35例)、弯杆状(52.7%,158例)和不规则形(4%,12例)。对照组,锥上间隙的观察率为76%(122例),与手术组差异无统计学意义(p0.05)。颞骨HRCT对锥上间隙诊断的灵敏度和特异度分别为：79.0%和88.4%。 结论： 锥上间隙是否出现及形态如何都不是确定的,但锥上间隙和面神经管锥曲段的位置关系是相对确定的,因此,锥上间隙可以作为中耳术中面神经管锥曲段定位的一个新的解剖标志。颞骨HRCT图像对于锥上间隙的诊断价值是有限的,尤其当该间隙不典型时。
[Abstract]:Objective: to investigate the location, incidence and morphological features of the superior cone space by observing and reconstructing the temporal bone with high resolution CT (HRCT) images, so as to help the location and recognition of the facial nerve in the patients with chronic otitis media. Methods: HRCT images of temporal bone were collected from 300 patients with chronic otitis media before operation. Intraoperative and HRCT images were observed to determine the occurrence rate and location of the supraconical space. The three dimensional reconstruction of the superior cone space and its surrounding anatomical structure was carried out to determine the relationship between the superior cone space and the facial nerve. The data of HRCT images of temporal bone of outpatients who had no definite HRCT examination of temporal bone in the same period were collected as control group. The HRCT images of the superior cone space were observed. Results: in the operation group, the supraconical space was observed in 68.3% (205 cases) of patients. The space above the cone is usually the only gas chamber on the surface of the conical segment of the facial nerve on the posterior tympanic surface of the recess, or, if there are any small chambers around it, the largest of the gas chambers in the region, which is located on the outside of the conical segment of the facial nerve tube. The medial posterior tympanic ring, incus fossa and inferior entrance of the tympanic sinus, above the crest of the tympanic cord. The shape of the supraconical space can be roughly divided into three types: round shape (11.710%), curved rod shape (52.7%) and irregular shape (4 cases). In the control group, the observation rate of the superior cone space was 76% (122 cases), and there was no significant difference between the operation group and the operation group (p0.05). The sensitivity and specificity of HRCT in the diagnosis of supraconical space were 79.0% and 88.4%, respectively. Conclusion: the appearance and shape of the superior cone space are uncertain, but the position relationship between the superior cone space and the conical segment of the facial canal is relatively certain. The superior cone space can be used as a new anatomic marker for the location of the conical segment of the facial nerve canal during middle ear operation. HRCT images of temporal bone are of limited value in the diagnosis of supraconical space, especially when the space is not typical.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R764.21
[Abstract]:Objective: to investigate the location, incidence and morphological features of the superior cone space by observing and reconstructing the temporal bone with high resolution CT (HRCT) images, so as to help the location and recognition of the facial nerve in the patients with chronic otitis media. Methods: HRCT images of temporal bone were collected from 300 patients with chronic otitis media before operation. Intraoperative and HRCT images were observed to determine the occurrence rate and location of the supraconical space. The three dimensional reconstruction of the superior cone space and its surrounding anatomical structure was carried out to determine the relationship between the superior cone space and the facial nerve. The data of HRCT images of temporal bone of outpatients who had no definite HRCT examination of temporal bone in the same period were collected as control group. The HRCT images of the superior cone space were observed. Results: in the operation group, the supraconical space was observed in 68.3% (205 cases) of patients. The space above the cone is usually the only gas chamber on the surface of the conical segment of the facial nerve on the posterior tympanic surface of the recess, or, if there are any small chambers around it, the largest of the gas chambers in the region, which is located on the outside of the conical segment of the facial nerve tube. The medial posterior tympanic ring, incus fossa and inferior entrance of the tympanic sinus, above the crest of the tympanic cord. The shape of the supraconical space can be roughly divided into three types: round shape (11.710%), curved rod shape (52.7%) and irregular shape (4 cases). In the control group, the observation rate of the superior cone space was 76% (122 cases), and there was no significant difference between the operation group and the operation group (p0.05). The sensitivity and specificity of HRCT in the diagnosis of supraconical space were 79.0% and 88.4%, respectively. Conclusion: the appearance and shape of the superior cone space are uncertain, but the position relationship between the superior cone space and the conical segment of the facial canal is relatively certain. The superior cone space can be used as a new anatomic marker for the location of the conical segment of the facial nerve canal during middle ear operation. HRCT images of temporal bone are of limited value in the diagnosis of supraconical space, especially when the space is not typical.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R764.21
【参考文献】
相关期刊论文 前3条
1 陈兵;;术中面神经定位及医源性面瘫的预防[J];中国眼耳鼻喉科杂志;2009年05期
2 迟放鲁;王t，
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