本文選題：應(yīng)用研究　切入點：乙狀竇后入路　出處：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：【目的】采用數(shù)字化可視人（首例中國女性）的數(shù)據(jù)集，對顳骨及其相鄰結(jié)構(gòu)的空間位置關(guān)系進行斷面解剖學(xué)研究，并對顳骨及相鄰結(jié)構(gòu)進行計算機三維重建和虛擬現(xiàn)實顯示；在此基礎(chǔ)上再將現(xiàn)代影像技術(shù)與神經(jīng)導(dǎo)航儀相結(jié)合應(yīng)用于改良的乙狀竇后-內(nèi)耳道上入路（Retrosigmoidal suprameatal approach，RSSMA）來進行量化研究內(nèi)耳道上結(jié)節(jié)和巖尖的擴大磨除的范圍以及其安全性、有效性和實用性。 【材料】數(shù)字化可視人（中國首例女性）數(shù)據(jù)集中的頭部連續(xù)薄層斷面圖像, Adobe photoshop CS3、Amira和Maya軟件；10%甲醛固定好的成人尸頭標(biāo)本15例（雙側(cè)共計30組數(shù)據(jù)）、64排螺旋CT（0.625mm層厚）、Mimics V10.0軟件、神經(jīng)導(dǎo)航儀等。 【方法】該研究中，我們采用數(shù)字化可視人（中國首例女性）的數(shù)據(jù)集（該斷層層厚較薄，重建圖像更逼真，數(shù)據(jù)更精確），對顳骨及PICA進行斷面解剖學(xué)觀察，提取相關(guān)斷面圖像信息，分別應(yīng)用Adobephotoshop CS3、Amira和Maya軟件，對顳骨及PICA進行計算機三維重建和虛擬現(xiàn)實顯示。在神經(jīng)導(dǎo)航儀的精確引導(dǎo)下模擬該手術(shù)入路，并進行逐層顯微解剖定位，從后向前對內(nèi)耳道上結(jié)節(jié)和巖尖的骨質(zhì)進行安全磨除，以提高骨質(zhì)磨除的安全性，并采用CT測量的方法來觀察和測量內(nèi)耳道上結(jié)節(jié)和巖尖的磨除范圍以及三叉神經(jīng)等結(jié)構(gòu)的顯露范圍；并借助Mimics V10.0軟件來三維重建內(nèi)耳及顳骨，以此來估算巖骨骨質(zhì)磨除相對比較安全的范圍。 【結(jié)果】通過3個正交切面中典型的二維層面（如外半規(guī)管層面、前庭窗層面、咽鼓管層面），對其主要結(jié)構(gòu)的斷面形態(tài)及毗鄰關(guān)系進行描述。重建三維模型可清楚地顯示顳骨內(nèi)部結(jié)構(gòu)和PICA的形態(tài)和空間位置關(guān)系，同時尚可任意角度旋轉(zhuǎn)、切割、組合和整體顯示相關(guān)結(jié)構(gòu)。PICA水平段與PICA彎曲部和內(nèi)耳道內(nèi)側(cè)緣連線的夾角平均值為67.5度。通過本次實驗研究，在改良的RSSMA中，內(nèi)耳道上結(jié)節(jié)前-后、中線-側(cè)方的骨質(zhì)可以全部磨除；巖尖的上-下（可磨除8.22mm骨質(zhì)）、前-后、中線-側(cè)方的骨質(zhì)可以部分磨除；其中三叉神經(jīng)在磨除后可增加顯露9.26±1.25mm；內(nèi)耳道前后壁夾角可擴大33.06±5.75度的手術(shù)視野；可顯露上斜坡的范圍約93.08±7.50mm2，中顱窩底約148.76±8.21mm2。 【結(jié)論】采用三維重建技術(shù)重建的顳骨及PICA結(jié)構(gòu)清晰，其構(gòu)建模型可較為準(zhǔn)確地揭示顳骨內(nèi)部結(jié)構(gòu)及與PICA的毗鄰關(guān)系，，為解剖學(xué)習(xí)和臨床應(yīng)用提供更為直觀便捷的參考;在現(xiàn)代醫(yī)學(xué)影像技術(shù)與神經(jīng)導(dǎo)航儀相結(jié)合的條件下進行改良的RSSMA較傳統(tǒng)入路更簡便、安全、實用、微創(chuàng),改良的RSSMA是巖斜區(qū)腫瘤手術(shù)治療的較佳選擇。
[Abstract]:[objective] to study the sectional anatomy of temporal bone and its adjacent structures by using the data set of digitized visual human (the first Chinese female), and to reconstruct the temporal bone and adjacent structures by computer and virtual reality. On this basis, a modified retrosigmoidal suprameatal approach was applied to the modified retrosigmoidal suprameatal approach (RSSMAA), which was combined with a neural navigator to quantify the extent and safety of the enlarged removal of nodules and petrous apex in the inner ear canal. Effectiveness and practicability. [materials] continuous thin-layer sectional images of the head in a digital visual human (the first female case in China), 15 adult cadaveric head specimens fixed with 10% formaldehyde with Adobe photoshop CS3Amira and Maya software (30 groups of bilateral data) were collected by Mimics V10.0 software. A neural navigator, etc. [methods] in this study, we used the data set of digitized visible human (the first female in China) (the slice thickness is thinner, the reconstructed image is more realistic, the data is more accurate), and the sectional anatomy of temporal bone and PICA were observed. The relevant sectional image information was extracted, and the temporal bone and PICA were reconstructed by computer and virtual reality display using Adobephotoshop CS3Amira and Maya software respectively. The surgical approach was simulated under the accurate guidance of the neural navigator, and the microanatomical localization was carried out layer by layer. To improve the safety of bone removal, the tubercle and petrous apex of the inner auditory canal were removed from the posterior front. The removal range of tubercle and petrosal apex on the inner ear canal and the exposure range of trigeminal nerve structure were observed and measured by CT, and the inner ear and temporal bone were reconstructed by Mimics V10.0 software. This is used to estimate the relatively safe range of bone removal from petrosal bone. [results] the typical two-dimensional plane in three orthogonal sections (such as external semicircular canal, vestibular window, etc.). In the eustachian tube, the cross-section and adjacent relationship of its main structure are described. The reconstructed three-dimensional model can clearly display the internal structure of the temporal bone and the relationship between the shape and spatial position of PICA, and can rotate and cut at any angle with fashion. The average angle between the horizontal segment of PICA and the PICA curve and the medial edge of the inner auditory meatus was 67.5 degrees. In this experimental study, in the modified RSSMA, the superior tubercle of the inner ear canal was pre- and post-nodule. The midline-lateral bone can be completely removed, the upper-lower (8.22mm) bone can be removed, the midline-lateral bone can be partially removed. The angle of anterior and posterior wall of the internal auditory canal could be enlarged by 33.06 鹵5.75 degrees, and the range of upper slope was 93.08 鹵7.50 mm 2, and the bottom of middle cranial fossa was 148.76 鹵8.21 mm 2. The trigeminal nerve could be exposed 9.26 鹵1.25 mm after grinding, and the angle between anterior and posterior wall of the internal auditory canal could be enlarged by 33.06 鹵5.75 degrees. [conclusion] the structure of temporal bone and PICA reconstructed by 3D reconstruction is clear, and the model can accurately reveal the internal structure of temporal bone and its adjacent relationship with PICA, and provide a more direct and convenient reference for anatomical study and clinical application. Under the condition of the combination of modern medical imaging technology and neural navigator, the modified RSSMA is more convenient, safe, practical and minimally invasive than the traditional approach. The modified RSSMA is a better choice for the surgical treatment of tumors in the petroclival region.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R322

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