【摘要】：目的:巖斜區(qū)由于位置深,周圍有許多重要的神經(jīng)血管結(jié)構(gòu),暴露困難,有“不可接近區(qū)”之稱。部分迷路切除巖骨尖入路是一種處理巖斜區(qū)病變的新型顱底入路,但由于開顱范圍大其創(chuàng)傷亦較大。本研究將該入路和鎖孔理念相結(jié)合,對其進行改良以減小創(chuàng)傷。 方法:研究分兩個階段進行,第一階段測量10例20側(cè)成人干顱骨標本各骨性結(jié)構(gòu)間的距離,第二階段對15例30側(cè)成人尸頭采用改良部分迷路切除巖骨尖入路及原入路暴露巖斜區(qū),測量骨窗大小及增加的視野和視角,并觀察有無巖骨內(nèi)重要結(jié)構(gòu)的損傷和巖斜區(qū)解剖結(jié)構(gòu)的暴露情況,對兩入路的數(shù)據(jù)進行統(tǒng)計學(xué)比較。 結(jié)果:在4cm×3cm大小的骨窗范圍內(nèi)可以完成所有的改良入路手術(shù)操作,巖淺大神經(jīng)溝到巖骨嵴的平均距離為12.8mm,Donaldson's線到巖骨嵴的平均距離為12.2mm,磨除部分迷路和巖骨尖后手術(shù)視野水平暴露平均增加14.2mm,垂直暴露平均增加12.5mm,手術(shù)水平視角平均增加58°,垂直視角平均增加46°。改良入路可充分暴露巖斜區(qū)各解剖結(jié)構(gòu),所有標本均未見損傷巖骨段頸內(nèi)動脈等重要結(jié)構(gòu),改良部分迷路切除巖骨尖入路與原入路的骨窗差異具有顯著性(P0.01),對巖斜區(qū)的暴露無統(tǒng)計學(xué)差異(P0.05)。 結(jié)論:巖骨磨除操作是改良部分迷路切除巖骨尖入路的關(guān)鍵技術(shù),Donaldson's線可以作為磨除巖骨的安全界限,改良入路較原入路創(chuàng)傷小,腦牽拉輕,不容易損傷頸靜脈球和面神經(jīng)顱外段等重要結(jié)構(gòu),有可能保留聽力,暴露同樣充分,是一種良好的處理巖斜區(qū)病變的手術(shù)入路。
[Abstract]:Objective: because of its deep position, there are many important neurovascular structures around the petroclival region, which are difficult to expose and are known as "inaccessible areas". Partial labyrinthectomy is a new approach for the treatment of petroclival lesions. In this study, the approach was combined with the keyhole concept to improve it to reduce trauma. Methods: the study was carried out in two stages. In the first stage, the distance between the bone structures of 10 adult and 20 adult skulls was measured. In the second stage, 30 adult cadavers were treated with modified partial labyrinthectomy via the petrous apex approach and the original approach to expose the diagonal area of the rock. The size of the bone window and the increased visual field and visual angle were measured. The data of the two approaches were compared statistically with or without the damage of the important structure in the petrosal bone and the exposure of the anatomic structure in the petroclival region. Results: all the modified approach procedures could be performed within the 4cm 脳 3cm size bone window. The average distance from the great petrosal sulcus to the petrous crest is 12.8mm from the Donaldsons line to the petrous crest, the average exposure to the surgical visual field after partial labyrinth and petrous apex is increased by 14.2mm, the vertical exposure is increased by 12.5mm, and the operative angle of view is average. The mean vertical angle of view increased by 46 擄with an increase of 58 擄. All the anatomical structures in the petroclival region could be fully exposed by the modified approach, and no important structures such as the internal carotid artery of the petrosal bone segment were found in all the specimens. There was significant difference between the modified partial labyrinthectomy and the original approach (P0.01), but there was no significant difference in the exposure to the petroclival region (P0.05). Conclusion: the petrous bone grinding is the key technique of modified partial labyrinthectomy of petrosal apex approach. Donaldsons line can be used as a safe limit for the removal of petrosal bone. The modified approach has less trauma and less brain retraction than the original approach. It is not easy to damage important structures such as jugular bulb and extracranial segment of facial nerve. It is possible to retain hearing and be exposed enough. It is a good surgical approach for the treatment of petroclival lesions.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2005
【分類號】：R651;R322

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相關(guān)期刊論文 前1條

1 張巖松,邵君飛,常義,惠國楨,劉宏毅;幕上下聯(lián)合經(jīng)部分迷路-巖尖入路的顯微解剖研究[J];中國微侵襲神經(jīng)外科雜志;2003年06期

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本文編號：2149619