【摘要】：研究背景:隨著顯微神經(jīng)外科的提高和神經(jīng)影像技術(shù)的發(fā)展,當(dāng)代神經(jīng)外科由傳統(tǒng)開顱方式向以病灶為中心的個體化微創(chuàng)手術(shù)入路發(fā)展,而微創(chuàng)手術(shù)的基礎(chǔ)是術(shù)前對病灶的精確定位。近年來,由于立體定向技術(shù)的功能神經(jīng)外科、微創(chuàng)神經(jīng)外科以及放射神經(jīng)外科的快速發(fā)展,計算機(jī)輔助的腦、神經(jīng)影像學(xué)引導(dǎo)下立體定向和介入放射技術(shù)為大腦皮層病變的微侵襲治療提供了現(xiàn)實途徑。中央前回是分裂于大腦半球兩側(cè),從半球間裂處,即后內(nèi)上方走向前外下方的額葉腦回,止于外側(cè)窩池上方,位于中央前溝與中央溝之間。中央前回是屬于額葉的腦回,研究發(fā)現(xiàn)它在橫斷面上與額上回、額中回、額下回廣泛相連,而與中央后回在靠近外側(cè)窩池處相連。中央前回的一部分向后反折,突入中央溝內(nèi),形成一個明顯的結(jié)區(qū)。中央溝、中央后回在此部位也向后稍有移位。而在大腦半球其他部位,雖然腦回存在彎曲和反折,但都不如在這個區(qū)域反折的幅度大,形成獨特的半個花結(jié)形狀。中央溝的一個小側(cè)枝進(jìn)入反折的腦回中,使結(jié)中間有一個小裂隙,呈ω形,也可不很明顯。在矢狀面上呈“典型的構(gòu)型”,表現(xiàn)出一個清晰的島形區(qū),稱之為“構(gòu)型征”,或者呈“刺刀形”、“階梯狀”或“彎彎曲曲形”。中央前回這個特定區(qū)域涉及一部分特定腦部功能,又可作為中央前回的定位標(biāo)志,具有非常重要的臨床價值。本研究對中央前回手運動區(qū)分型進(jìn)行補(bǔ)充,將之更細(xì)分為七種形態(tài)。在基于連合間徑的笛卡爾三維坐標(biāo)系中測量中央前回的立體定位數(shù)據(jù)集,求得其在坐標(biāo)系中的平面回歸方程;構(gòu)建基于斷層影像的中央前回在整腦中的三維可視化模型,為研究中前回區(qū)域的臨床影像學(xué)、立體定向外科、介入放射及微創(chuàng)神經(jīng)外科等提供量化影像解剖學(xué)資料。第一部分大腦中央前回手運動區(qū)的MRI形態(tài)學(xué)研究目的:通過研究以AC-PC線為掃描基線的活體薄層MR圖像,定位及分析手運動區(qū)域的形態(tài)學(xué)規(guī)律。方法:選取48名右手利健康成人志愿者頭顱進(jìn)行薄層MRI掃描,獲得48名志愿者96個大腦半球的mri橫斷位、矢狀位及冠狀位圖像,對手運動區(qū)進(jìn)行識別、定位,并觀察分析其形態(tài)學(xué)規(guī)律。結(jié)果:手運動區(qū)域分7種類型:倒Ω,ω,ω內(nèi)不對稱,ω外不對稱,曲線,三葉草,波浪型。對男女、男性和女性左右側(cè)大腦半球各型進(jìn)行秩和檢驗發(fā)現(xiàn)差異均無有統(tǒng)計學(xué)意義(p0.05)。對男女倒Ω型的高和寬進(jìn)行統(tǒng)計學(xué)分析,男女性倒Ω型的高度無統(tǒng)計學(xué)差異(p0.05),而男女性基底寬有統(tǒng)計學(xué)差異,即男性基底寬大于女性(p0.05)。結(jié)論:完善中央前回手運動區(qū)在橫斷面的形態(tài)學(xué)分類,為臨床及實驗研究識別中央前回提供便利條件。第二部分大腦中央前回立體定位數(shù)據(jù)集的構(gòu)建及回歸分析1.中央前回前壁和后壁最內(nèi)、外側(cè)緣的立體定位數(shù)據(jù)集的構(gòu)建目的:求得中央前回前壁和后壁最內(nèi)、外側(cè)緣在笛卡爾三維坐標(biāo)系中的立體定位數(shù)據(jù)集方法:男女各20例健康成人志愿者顱腦,以大腦間徑(ac-pc線)為掃描基線(冠狀面為垂直于ac-pc線),行橫斷層2mm、矢狀面2mm和冠狀面2mmt1mr掃描。在微型計算機(jī)上將掃描數(shù)據(jù)以dicom3.0格式導(dǎo)入efilm3.4工作站。將顱腦橫斷層面mri數(shù)據(jù)經(jīng)格式轉(zhuǎn)化導(dǎo)入photoshop軟件,以連合間經(jīng)中點為原點,使連合間徑與y軸重疊建立笛卡爾三維坐標(biāo)系,測量每個層面上中央前回前壁和后壁最內(nèi)、外側(cè)點,讀取、記錄各取樣點的x、y坐標(biāo)值,z值為所在層面距離零層面的數(shù)目與層距的乘積。結(jié)果:得到正常成年男女中央前回前壁和后壁最內(nèi)、外側(cè)點在大腦中的三維空間立體定位數(shù)據(jù)集。結(jié)論:男女中央前回前壁和后壁最內(nèi)、外側(cè)點立體定位數(shù)據(jù)集的構(gòu)建為立體定向神經(jīng)外科、介入放射治療及微創(chuàng)神經(jīng)外科等有較大的臨床應(yīng)用價值;同時為神經(jīng)生理功能、人類學(xué)等方面的研究提供形態(tài)學(xué)基礎(chǔ)。2.中央前回前壁和后壁最內(nèi)、外側(cè)點的投影圖及擬合曲線方程分析目的:計算中央前回前壁和后壁最內(nèi)、外側(cè)點在冠狀面上的投影圖及在冠狀面、橫斷面上的擬合曲線方程。方法:將上述大腦中央前回前壁和后壁最內(nèi)、外側(cè)點的大腦空間坐標(biāo)系的坐標(biāo)值(X,Y,Z),利用excel求其在冠狀面上的投影圖,并利用SPSS17.0軟件求解其在冠狀面、橫斷面上的擬合曲線方程。結(jié)果:中央前回前壁和后壁最內(nèi)、外側(cè)點在冠狀面上的投影圖能夠反映中央前回的形態(tài)特征,求出了中央前回前壁和后壁最內(nèi)、外側(cè)點在冠狀面及橫斷面投影方向上的擬合曲線方程。結(jié)論:中央前回前壁和后壁,最內(nèi)側(cè)點相關(guān)系數(shù)較高,最外側(cè)點相關(guān)系數(shù)較低,中央前回后壁較前壁相關(guān)系數(shù)較高,即中央前回中下內(nèi)側(cè)部分分布有顯著匯聚趨勢,即在大腦內(nèi)側(cè)面近大腦中部穩(wěn)定性較高,外側(cè)面大腦結(jié)構(gòu)變異較高,這在腦的人類學(xué)、發(fā)育學(xué)、體質(zhì)測量學(xué)等方面具有一定的科學(xué)意義。第三部分大腦中央前回的三維重建及可視化目的:重建中央前回的三維可視化模型,為微創(chuàng)神經(jīng)外科手術(shù)、介入放射治療及影像解剖學(xué)教學(xué)提供可視化模型。方法:在微型計算機(jī)上,將1例正常成人(無神經(jīng)、精神病史及家族史)顱腦橫斷面2mm薄層MRI掃描數(shù)據(jù)以Dicom3.0格式導(dǎo)入3D-Doctor軟件,人工分割中央前回、中央后回、側(cè)腦室及大腦表面,分別以不同顏色標(biāo)識,以復(fù)雜面重建方法對上訴三者同時進(jìn)行三維重建。結(jié)果:成功重建了中央前回在整腦中的三維可視化模型,從不角度展現(xiàn)了中央前回在活體腦中的形態(tài)、位置及毗鄰關(guān)系。結(jié)論:應(yīng)用活體MRI數(shù)據(jù)建立中央前回的三維模型,可以從不角度觀察中央前回三維形態(tài)、空間位置及其與重要結(jié)構(gòu)的毗鄰關(guān)系,并可以在模型上進(jìn)行三維解剖學(xué)的測量,這在立體定向神經(jīng)外科、介入放射治療、影像解剖學(xué)教學(xué)等方面有應(yīng)用價值
[Abstract]:BACKGROUND: With the development of microneurosurgery and neuroimaging technology, contemporary neurosurgery has evolved from traditional craniotomy to individual minimally invasive approach centered on lesions. The basis of minimally invasive surgery is preoperative precise localization of lesions. In recent years, due to stereotactic functional neurosurgery, minimally invasive spirit has emerged. With the rapid development of surgery and radioneurosurgery, computer-assisted brain, neuroimaging-guided stereotactic and interventional radiology have provided a practical approach for minimally invasive treatment of cerebral cortical lesions. The anterior central gyrus belongs to the frontal gyrus. It is extensively connected with the superior frontal gyrus, the middle frontal gyrus and the inferior frontal gyrus, but with the posterior central gyrus near the lateral fossa cistern. In other parts of the cerebral hemisphere, although the gyrus is curved and reflexed, the extent of reflexion is not as large as in this area, forming a unique half-nodule shape. A small lateral branch of the central sulcus enters the reflexed gyrus, causing a small fissure in the middle of the nodule. The shape of the anterior central gyrus, which involves a specific part of the brain function and serves as a marker for the location of the anterior central gyrus, shows a distinct "typical configuration" on the sagittal plane, which is called "configuration" or "bayonet-shaped", "ladder-shaped" or "curved". This study supplements the central anterior return motion classification and further subdivides it into seven shapes. In Cartesian three-dimensional coordinate system based on the connecting diameters, the data sets of the central anterior return are measured to obtain the plane regression equation in the coordinate system, and the pre-central return is integrated based on the sectional images. The three-dimensional visualization model in the brain provides quantitative image anatomical data for the study of clinical imaging, stereotactic surgery, interventional radiology and minimally invasive neurosurgery in the anterior gyrus. Part I: MRI morphological study of the anterior central gyrus motor area. Methods: 48 right-handed healthy adult volunteers were scanned with thin-slice MRI, and 96 cerebral hemispheres of 48 volunteers were obtained in transverse, sagittal and coronal MRI images. The hand motion areas were identified, located and observed. Types: inverted_, _, _internal asymmetry, _external asymmetry, curves, clover, wave type. No significant difference was found in the left and right hemispheres of men and women, men and women by rank sum test (p0.05). Statistical analysis of the height and width of inverted_between men and women showed no significant difference in the height of inverted_between men and women (p0.05). Conclusion: Perfecting the morphological classification of the anterior central gyrus provides convenient conditions for clinical and experimental studies to identify the anterior central gyrus. Part II Construction and regression analysis of stereotaxic data sets of the anterior central gyrus. Objective: To construct a stereotaxic data set of the innermost and lateral margins of the posterior wall and anterior wall of the anterior and posterior gyrus of the central anterior gyrus. Methods: Twenty healthy adult volunteers, male and female, were scanned with the AC-PC line as the baseline (the coronal plane was perpendicular to the AC-PC line), and transverse sectional section 2 was performed. Mm, sagittal 2mm and coronal 2mmt 1MR scans. Scanning data are imported into efilm 3.4 workstation in DICOM 3.0 format on microcomputer. Transverse cranial tomographic MRI data are transformed into Photoshop software. The origin is the midpoint of the junction, and the diameter of the junction overlaps with the Y Y Y Y Y Y Y Y Y Y Y Y Y axis to establish a Cartesian 3-D coordinate system for measuring the middle of each plane. Results: Three-dimensional spatial data sets of the anterior and posterior walls of the central gyrus were obtained in normal adult men and women. The data set of stereotactic location of the anterior and posterior wall and the lateral points is of great clinical value for stereotactic neurosurgery, interventional radiotherapy and minimally invasive neurosurgery. It also provides morphological basis for the study of neurophysiological function and anthropology. 2. Projection and fitting of anterior and posterior wall of the central anterior gyrus Objective: To calculate the projection of the anterior and posterior walls of the central anterior gyrus and the fitting curve equation of the lateral points on the coronal plane and the coronal plane and cross section. Results: The projection maps of the anterior and posterior walls of the central anterior gyrus and the lateral points on the coronal plane can reflect the morphological characteristics of the anterior and posterior walls of the central anterior gyrus, and the projection directions of the anterior and posterior walls of the central anterior gyrus are obtained. CONCLUSION: The correlation coefficients of the anterior and posterior walls of the anterior and posterior gyrus are higher, the correlation coefficients of the laterolateral points are lower, and the correlation coefficients of the anterior and posterior walls of the central gyrus are higher than those of the anterior wall. The third part is the three-dimensional reconstruction and visualization of the anterior central gyrus. The purpose is to reconstruct the three-dimensional visualization model of the anterior central gyrus and provide a visualization model for minimally invasive neurosurgery, interventional radiotherapy and imaging anatomy teaching. On a microcomputer, the 2mm thin-slice MRI data of a normal adult (without neurological, psychiatric and family history) were imported into the 3D-Doctor software in Dicom 3.0 format. The anterior central gyrus, posterior central gyrus, lateral ventricle and brain surface were artificially segmented and marked with different colors, and the appellate was reconstructed simultaneously by complex surface reconstruction method. Results: Three-dimensional visualization model of anterior central gyrus was successfully reconstructed, and the morphology, location and adjacent relationship of anterior central gyrus in vivo were displayed from different angles. The adjacent relationship of the structure and the measurement of three-dimensional anatomy on the model can be used in stereotactic neurosurgery, interventional radiotherapy, image anatomy teaching and so on.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 欒麗菊,劉豐春;中央前、后回在矢狀斷面上的定位[J];中國臨床解剖學(xué)雜志;2004年02期

，

本文編號：2201204