本文關(guān)鍵詞： 側(cè)顱底 中顱窩 顯微解剖 虛擬現(xiàn)實(shí) 三維影像　出處：《北京大學(xué)》2008年博士論文　論文類型：學(xué)位論文

【摘要】： 目的: 顯微解剖結(jié)合虛擬現(xiàn)實(shí)三維立體影像,研究側(cè)顱底及相應(yīng)中顱窩區(qū)解剖結(jié)構(gòu)特點(diǎn)及其相互溝通路徑,指導(dǎo)臨床選擇手術(shù)入路。 方法: 15例(30側(cè))尸頭標(biāo)本,灌注紅藍(lán)膠及造影劑,采用額顳顴-耳前顳下-顳下窩入路,模擬手術(shù)逐層解剖;尸頭灌注前后行CT掃描,灌注前及解剖后行MRI掃描,將DICOM格式的掃描資料輸入Destroscope虛擬現(xiàn)實(shí)系統(tǒng)行三維重建;分別于顯微解剖及虛擬現(xiàn)實(shí)三維影像中,觀測重要解剖結(jié)構(gòu)及標(biāo)志,比較、分析兩者結(jié)果。 結(jié)果: 1、顯微解剖下描述顳淺動(dòng)脈及面神經(jīng),顳下窩的翼肌、上頜動(dòng)脈、下頜神經(jīng)、翼靜脈叢,咽旁間隙及翼腭窩的解剖結(jié)構(gòu)、相互關(guān)系及其與中顱窩溝通途經(jīng);測量相關(guān)數(shù)據(jù)。虛擬現(xiàn)實(shí)三維立體環(huán)境中測量側(cè)顱底及相應(yīng)中顱窩區(qū)相關(guān)數(shù)據(jù),與顯微解剖所測數(shù)據(jù)比較,無統(tǒng)計(jì)學(xué)差異。 2、提出翼肌上三角及翼肌下三角的概念,測量其邊長及面積,描述其內(nèi)穿行結(jié)構(gòu)。 3、提出一個(gè)新的骨性標(biāo)志點(diǎn):“O”點(diǎn),即顳蝶縫與顳下嵴的交點(diǎn)。于中顱窩底,它到眶上裂近端、圓孔、卵圓孔、棘孔的距離近似相等,平均23.22mm,即以上四點(diǎn)分布在以“O”點(diǎn)為圓心,以23.22mm為半徑的圓弧上,所構(gòu)成扇形的角度為66.07度,面積為310.71mm2。于顳下窩頂,測量其到各重要結(jié)構(gòu)的距離并描述其意義。 4、根據(jù)自然標(biāo)志,可以用1點(diǎn),2棘,3裂,4線,5孔,6區(qū)描述側(cè)顱底結(jié)構(gòu)。 結(jié)論: 1、本研究提出的“O“點(diǎn),即顳蝶縫與顳下嵴的交點(diǎn),是一個(gè)良好的骨性標(biāo)志,它到眶上裂近端、圓孔、卵圓孔、棘孔的距離近似相等,它們圍成的扇形區(qū)域是中顱窩、顳下窩腫瘤相互溝通的重要路徑,也是手術(shù)切除腫瘤的一個(gè)相對安全區(qū)域。 2、本研究提出的翼肌上三角和翼肌下三角,可作為肌性標(biāo)志,便于描述及定位上頜動(dòng)脈,頰神經(jīng)以及舌神經(jīng)、下牙槽神經(jīng),為術(shù)中定位提供解剖標(biāo)志。 3、本研究提出的結(jié)合三維影像將側(cè)顱底區(qū)的重要骨性結(jié)構(gòu)歸納為1點(diǎn),2棘,3裂,4線,5孔,6區(qū),便于描述和理解該區(qū)的復(fù)雜解剖關(guān)系,為手術(shù)提供解剖標(biāo)志。 4、額顳顴-耳前顳下-顳下窩入路能充分暴露并觀測側(cè)顱底及相應(yīng)中顱窩區(qū)顱內(nèi)外結(jié)構(gòu),適合顯微解剖研究,為設(shè)計(jì)手術(shù)入路提供解剖學(xué)依據(jù)。 5、虛擬現(xiàn)實(shí)三維影像所測數(shù)據(jù)與解剖所測數(shù)據(jù)吻合良好,真實(shí)可信。虛擬現(xiàn)實(shí)研究不僅是顯微解剖研究的有益補(bǔ)充,還有其不可替代的優(yōu)勢,可與顯微解剖相結(jié)合或單獨(dú)應(yīng)用以構(gòu)筑模型、觀測結(jié)構(gòu)、模擬解剖。
[Abstract]:Objective:. The microanatomy combined with virtual reality three-dimensional images was used to study the anatomical structure of lateral skull base and the corresponding middle cranial fossa and their communication paths to guide the clinical selection of surgical approaches. Methods:. 15 cadaveric head specimens were perfused with red and blue glue and contrast media, and were dissected by frontotemporal zygomaticozygomatic anterior subtemporal fossa approach, CT scan before and after perfusion, MRI scan before and after anatomic perfusion of cadaveric head. The scanning data in DICOM format are input into the Destroscope virtual reality system for 3D reconstruction, and the important anatomical structures and marks are observed in the microanatomy and virtual reality 3D images, and the results are compared and analyzed. Results:. 1. The anatomy of superficial temporal artery and facial nerve, pterygoid muscle of infratemporal fossa, maxillary artery, mandibular nerve, pterygovenous plexus, parapharyngeal space and pterygopalatine fossa were described under microanatomy. There was no statistical difference between the data of the lateral skull base and the corresponding middle cranial fossa in the virtual reality three-dimensional environment compared with the microanatomical data. 2. The concepts of upper triangle and inferior triangle of pterygoid are proposed, the length and area of the side are measured, and the internal structure is described. 3. A new bone marker, "O" point, is proposed, which is the intersection point between the temporal sphenoid suture and the subtemporal ridge. At the bottom of the middle cranial fossa, the distance between it and the superior orbital fissure, foramen, foramen ovale and foramen spinosus is approximately equal, with an average of 23.22mm, that is, the above four points are distributed in the center of the "O" point. On the arc with a radius of 23.22mm, the fan-shaped angle is 66.07 degrees and the area is 310.71mm2.The distance from the subtemporal fossa to each important structure is measured and its significance is described. 4. According to the natural markers, the lateral skull base structure can be described by 1 point, 2 spines, 3 clefts, 4 lines, 5 holes and 6 regions. Conclusion:. 1. The "O" point proposed in this study, that is, the intersection point between the temporal sphenoid suture and the subtemporal ridge, is a good bone marker. It is approximately equal in distance to the proximal end of the supraorbital fissure, foramen ovale, foramen ovale and foramen spinosus, and the fan-shaped region formed by them is the middle cranial fossa. The important path of communication between tumors in the infratemporal fossa is also a relatively safe area for surgical resection of tumors. 2. The superior and inferior pterygoid triangles can be used as muscle markers to describe and locate maxillary artery, buccal nerve, lingual nerve and inferior alveolar nerve. 3. The important bone structure of the lateral skull base area was classified into 1 point, 2 spines, 3 clefts, 4 lines, 5 holes and 6 areas, which was convenient to describe and understand the complex anatomical relationship in the area and to provide anatomic marks for the operation. 4. The frontotemporal zygomaticozygomatic anterior infratemporal fossa approach can fully expose and observe the intracranial and external structures of the lateral skull base and the corresponding middle cranial fossa, which is suitable for microanatomical study and provides anatomic basis for the design of the operative approach. 5. The data measured by virtual reality 3D images agree well with the data measured by anatomy. The study of virtual reality is not only a useful supplement to the study of microanatomy, but also an irreplaceable advantage. It can be combined with microanatomy or used alone to construct models, observe structures, and simulate anatomy.
【學(xué)位授予單位】：北京大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2008
【分類號】：R322

【參考文獻(xiàn)】

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