鼻中隔偏曲、OMC解剖变异与慢性鼻窦炎关系的临床研究
发布时间：2019-04-21 11:00
【摘要】：目的 采用多层螺旋薄层扫描技术,结合冠状位、轴状位、矢状位图像观察鼻窦炎组患者、正常对照组的鼻中隔及窦口鼻道复合体(ostiomeatal complex,OMC)的解剖结构变异情况,探讨鼻中隔偏曲、OMC解剖变异与慢性鼻窦炎(chronic rhinosinusitis, CRS)发病之间的关系。 材料和方法 1.选择2009年7月至2011年7月间在我院确诊为CRS的患者100例及正常对照组(非鼻窦炎组)100例的临床资料,且两组均排除鼻中隔呈“S”型偏曲的患者。■ 2.应用鼻窦冠状位、轴状位、矢状位CT扫描及鼻内窥镜检查对鼻窦炎组及正常对照组的鼻中隔偏曲位置、方向、程度及OMC解剖结构变异情况进行统计学分析,并分析其与CRS之间的关系。 结果 1.鼻中隔偏曲位置、偏曲程度在鼻窦炎组与正常组之间差异有统计学意义(P0.05),鼻中隔高位偏曲、重度偏曲与鼻窦炎的发生关系密切。 2.额窦炎、前组筛窦炎在鼻中隔高位偏曲和低位偏曲中差异有统计学意义(P0.05),鼻中隔高位偏曲更易诱发额窦炎、前组筛窦炎的发生。 3.鼻中隔偏曲患者两侧鼻窦炎的发病率无统计学意义(P0.05),即鼻中隔偏曲两侧鼻窦炎的发病率无显著性差异。 4.对于鼻中隔高位偏曲,同侧或对侧OMC解剖结构变异在鼻窦炎组和对照组中的发生率均有显著性差异(P0.05)；对于鼻中隔低位偏曲对侧OMC区域发生解剖变异的发生率在两组间的分布有显著性差异(P0.05),而低位偏曲同侧无显著性差异(P0.05)。鼻中隔偏曲特别是鼻中隔高位偏曲两侧OMC解剖变异存在差异性,鼻中隔偏曲的对侧更易发生OMC解剖变异,与CRS的发生有相关性。 5.窦口鼻道复合体中的解剖学变异：中甲气化、钩突偏曲、钩突肥大、鼻丘气房和Haller气房在鼻窦炎患者组与正常对照组中有统计学差异(P0.05)；而中甲反向偏曲、钩突气化、筛泡过度气化在鼻窦炎患者组与正常对照组之间无统计学差异(P0.05),窦口鼻道复合体解剖变异中中甲气化、钩突偏曲、钩突肥大、鼻丘气房和Haller气房与CRS的发生关系密切。 结论 1.结合冠状位、轴状位、矢状位三个方位的图像,能够对疾病的部位、性质、解剖变异、范围、程度以及手术中可能出现的各种并发症做出正确的评估,尤其能清晰显示对窦口鼻道复合体的解剖变异情况,并能够选择合理的术式指导功能性鼻内镜手术的顺利进行。 2.鼻中隔偏曲特别是鼻中隔高位偏曲、窦口鼻道复合体(OMC)的解剖变异在慢性鼻窦炎的发病中起着重要作用,所以对于慢性鼻窦炎的治疗是需要综合性考虑的,在治疗鼻窦炎黏膜炎症的同时一定要注意解除鼻中隔偏曲及窦口鼻道复合体等局部解剖变异。
[Abstract]:Objective to observe the anatomic variation of nasal septum and sinus orifice nasal meatus complex (ostiomeatal complex,OMC) in sinusitis group and normal control group by multi-slice spiral thin-layer scanning combined with coronal axial and sagittal images. To explore the relationship between nasal septum deviation, OMC anatomical variation and the pathogenesis of chronic sinusitis (chronic rhinosinusitis, CRS). Materials and methods 1. From July 2009 to July 2011, the clinical data of 100 patients with CRS diagnosed in our hospital and 100 normal controls (non-sinusitis group) were selected, and the patients with "S" deviation of nasal septum were excluded from both groups. The sinus coronal, axial, sagittal CT scan and nasal endoscopy were used to analyze the deviation of nasal septum in sinusitis group and normal control group. The deviation of nasal septum, direction, degree and anatomic structure variation of OMC in sinusitis group and normal control group were analyzed statistically. The relationship between them and CRS was analyzed. Outcome 1. The deviation of nasal septum was significantly different between sinusitis group and normal group (P0.05). The high deviation of nasal septum and severe deviation of nasal septum were closely related to the occurrence of sinusitis. 2. Frontal sinusitis, anterior group ethmoid sinusitis in the nasal septum high deviation and low deviation has statistical significance (P0.05), nasal septum high deviation is more prone to induce frontal sinusitis, the anterior group ethmoid sinusitis occurrence. 3. There was no significant difference in the incidence of bilateral sinusitis in patients with nasal septum deviation (P0.05), that is, there was no significant difference in the incidence of bilateral nasal sinusitis in patients with nasal septum deviation. 4. For the high deviation of nasal septum, the incidence of OMC anatomical structural variation in sinusitis group and control group was significantly different (P0.05). The incidence of anatomical variation in the contralateral OMC region of the nasal septum was significantly different between the two groups (P0.05), but there was no significant difference in the low deviation of the nasal septum on the ipsilateral side (P0.05). There were differences in OMC anatomical variation on both sides of nasal septum deviation, especially in high nasal septum deviation. The contralateral side of nasal septum deviation was more prone to OMC anatomical variation, which was correlated with the occurrence of CRS. 5. Anatomical variation in sinus-orifice-nasomeatus complex: middle turbinate gasification, uncinate process deviation, uncinate process hypertrophy, nasal colliculus air chamber and Haller air chamber in sinusitis patients group and normal control group had statistical difference (P0.05); However, there was no significant difference between the nasal sinusitis group and the normal control group in the reverse deviation of the middle nail, the gasification of the hook process and the over gasification of the ethmoid vesicle between the patients with sinusitis and the normal control group (P0.05). The nasal colliculus chamber and Haller chamber were closely related to the occurrence of CRS. Conclusion 1. Combined with coronal, axial and sagittal images, it is possible to correctly assess the location, nature, anatomical variation, scope, extent, and possible complications of the disease. In particular, it can clearly show the anatomic variation of the sinus-orifice-nasal complex, and can guide the successful operation of functional endoscopic sinus surgery by choosing a reasonable operative method. 2. The deviation of nasal septum, especially the high deviation of nasal septum, and the anatomical variation of (OMC) play an important role in the pathogenesis of chronic sinusitis, so the treatment of chronic sinusitis needs to be considered comprehensively. In the treatment of sinusitis mucosa inflammation, attention must be paid to relieve the deviation of nasal septum and sinus nasal meatus complex and other local anatomical variations.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.41
本文编号：2462136
[Abstract]:Objective to observe the anatomic variation of nasal septum and sinus orifice nasal meatus complex (ostiomeatal complex,OMC) in sinusitis group and normal control group by multi-slice spiral thin-layer scanning combined with coronal axial and sagittal images. To explore the relationship between nasal septum deviation, OMC anatomical variation and the pathogenesis of chronic sinusitis (chronic rhinosinusitis, CRS). Materials and methods 1. From July 2009 to July 2011, the clinical data of 100 patients with CRS diagnosed in our hospital and 100 normal controls (non-sinusitis group) were selected, and the patients with "S" deviation of nasal septum were excluded from both groups. The sinus coronal, axial, sagittal CT scan and nasal endoscopy were used to analyze the deviation of nasal septum in sinusitis group and normal control group. The deviation of nasal septum, direction, degree and anatomic structure variation of OMC in sinusitis group and normal control group were analyzed statistically. The relationship between them and CRS was analyzed. Outcome 1. The deviation of nasal septum was significantly different between sinusitis group and normal group (P0.05). The high deviation of nasal septum and severe deviation of nasal septum were closely related to the occurrence of sinusitis. 2. Frontal sinusitis, anterior group ethmoid sinusitis in the nasal septum high deviation and low deviation has statistical significance (P0.05), nasal septum high deviation is more prone to induce frontal sinusitis, the anterior group ethmoid sinusitis occurrence. 3. There was no significant difference in the incidence of bilateral sinusitis in patients with nasal septum deviation (P0.05), that is, there was no significant difference in the incidence of bilateral nasal sinusitis in patients with nasal septum deviation. 4. For the high deviation of nasal septum, the incidence of OMC anatomical structural variation in sinusitis group and control group was significantly different (P0.05). The incidence of anatomical variation in the contralateral OMC region of the nasal septum was significantly different between the two groups (P0.05), but there was no significant difference in the low deviation of the nasal septum on the ipsilateral side (P0.05). There were differences in OMC anatomical variation on both sides of nasal septum deviation, especially in high nasal septum deviation. The contralateral side of nasal septum deviation was more prone to OMC anatomical variation, which was correlated with the occurrence of CRS. 5. Anatomical variation in sinus-orifice-nasomeatus complex: middle turbinate gasification, uncinate process deviation, uncinate process hypertrophy, nasal colliculus air chamber and Haller air chamber in sinusitis patients group and normal control group had statistical difference (P0.05); However, there was no significant difference between the nasal sinusitis group and the normal control group in the reverse deviation of the middle nail, the gasification of the hook process and the over gasification of the ethmoid vesicle between the patients with sinusitis and the normal control group (P0.05). The nasal colliculus chamber and Haller chamber were closely related to the occurrence of CRS. Conclusion 1. Combined with coronal, axial and sagittal images, it is possible to correctly assess the location, nature, anatomical variation, scope, extent, and possible complications of the disease. In particular, it can clearly show the anatomic variation of the sinus-orifice-nasal complex, and can guide the successful operation of functional endoscopic sinus surgery by choosing a reasonable operative method. 2. The deviation of nasal septum, especially the high deviation of nasal septum, and the anatomical variation of (OMC) play an important role in the pathogenesis of chronic sinusitis, so the treatment of chronic sinusitis needs to be considered comprehensively. In the treatment of sinusitis mucosa inflammation, attention must be paid to relieve the deviation of nasal septum and sinus nasal meatus complex and other local anatomical variations.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.41
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