【摘要】： 目的 前床突是前、中顱窩的分界點(diǎn),又是視神經(jīng)、頸內(nèi)動(dòng)脈外側(cè)的保護(hù)標(biāo)志,因此,前床突有著重要的解剖意義。其位置重要,對(duì)于該區(qū)域的病變,需要考慮如何通過磨除前床突獲得手術(shù)操作空間是近幾年來研究的熱點(diǎn)和難點(diǎn)。為取得國人此方面的資料,為臨床眶上裂及海綿竇區(qū)域病變的顯微外科手術(shù)入路提供解剖學(xué)參數(shù)依據(jù),本研究通過顯微鏡下對(duì)尸體頭顱的解剖、測(cè)量,明確前床突與周圍結(jié)構(gòu)的解剖關(guān)系,并對(duì)高度個(gè)體化的骨性結(jié)構(gòu)、神經(jīng)、血管、硬膜等的解剖關(guān)系進(jìn)行分析統(tǒng)計(jì),我設(shè)計(jì)了此項(xiàng)研究。 方法 應(yīng)用福爾馬林充分固定的國人成人尸頭濕標(biāo)本10例20側(cè),無法確切地判定年齡和性別,為更準(zhǔn)確地區(qū)分動(dòng)靜脈,維持血管正常粗細(xì)和提高拍攝質(zhì)量,所有頭顱濕標(biāo)本均在動(dòng)脈系統(tǒng)灌注混有紅色染料的乳膠,靜脈系統(tǒng)灌注混有藍(lán)色染料的乳膠。漂白的國人成人顱骨干標(biāo)本10例20側(cè),供骨性結(jié)構(gòu)的觀察和測(cè)量。選擇前外側(cè)方手術(shù)最有代表性的額顳開顱翼點(diǎn)入路進(jìn)行詳細(xì)研究,在手術(shù)顯微鏡下,模擬手術(shù)入路逐層解剖,對(duì)解剖結(jié)構(gòu)進(jìn)行精確測(cè)量和拍攝,所得數(shù)據(jù)均經(jīng)spss軟件處理,以平均數(shù)測(cè)量值范圍的形式表現(xiàn)。 結(jié)果 1、APC前外下方為眶上裂,前外與蝶骨小翼連接,前內(nèi)與視神經(jīng)管頂部后緣及視柱相連結(jié),內(nèi)側(cè)有頸內(nèi)動(dòng)脈通過,外下側(cè)有海綿竇。狀如錐形,其長(zhǎng)、寬、厚分別為9.80±1.22(7.52-12.48)mm,12.57±2.41(8.67-17.25)mm,5.74±1.39(3.10-9.97)�？赏ㄟ^硬膜內(nèi)外聯(lián)合法磨除,注意其下緣緊貼著海綿竇外側(cè)壁內(nèi)的顱神經(jīng)。 2、在前床突切除前后,左右兩側(cè)結(jié)合起來測(cè)量的平均值±標(biāo)準(zhǔn)差分別如下。視神經(jīng)長(zhǎng)度:9.56±1.85mm和21.37±2.94mm;頸內(nèi)動(dòng)脈長(zhǎng)度:9.97±2.06mm和13.82±2.53mm;視神經(jīng)頸內(nèi)動(dòng)脈三角(OCT)寬度:3.67±1.10mm和12.54±2.37mm;OCT長(zhǎng)度:9.66±2.39mm和22.09±23.32mm。 3、床突間隙是磨除前床突后人為形成的一錐形腔隙,尖端指向后方,毗鄰組織與前床突存在時(shí)大致相同。其空間大小與前床突及周圍組織結(jié)構(gòu)的構(gòu)成、范圍和邊緣的大小有很大的關(guān)系,其中全頸內(nèi)動(dòng)脈(ICA)型最大,并可影響經(jīng)該處的顯微手術(shù)操作。其內(nèi)長(zhǎng)8.12±2.54(4.20-14.23)mm,內(nèi)下長(zhǎng)11.54±3.21(4.11-16.52)mm,寬5.32±1.24(2.23-7.52)mm,頂部深2.33±0.84(0.52-4.50)mm,根部深8.22±2.51(5.32-16.23)mm。 4、視柱是分隔視神經(jīng)管與眶上裂的柱狀結(jié)構(gòu)。 5、測(cè)量神經(jīng)管上、下壁長(zhǎng)度分別為8.20±1.23(6.06-10.28)mm,5.95±2.96(1.42-12.62)mm,距顱口內(nèi)、外緣間距分別為12.64±2.62(8.00-17.16)mm,23.71±3.55(17.14-29.30)mm。 6、眶上裂被鍵環(huán)分為外、中、下三個(gè)區(qū),經(jīng)其穿行的顱神經(jīng)及血管毗鄰位置及區(qū)域較恒定,所有穿行于海綿竇的神經(jīng)和眼靜脈均經(jīng)眶上裂入眶,其中動(dòng)眼神經(jīng)下支最粗,淚腺神經(jīng)最細(xì)。 7、頸內(nèi)動(dòng)脈床突段位于遠(yuǎn)、近側(cè)硬腦膜環(huán)之間,外觀呈楔形,前方與視柱、內(nèi)側(cè)與蝶骨頸動(dòng)脈溝前部、上外側(cè)與前床突相毗鄰。ICA床突段的遠(yuǎn)環(huán)和近環(huán)都不完整,ICA床突段內(nèi)側(cè)血管壁與骨膜之間存在床突靜脈叢間隙,頸內(nèi)動(dòng)脈床突段應(yīng)該是海綿竇內(nèi)結(jié)構(gòu)。 結(jié)論 1、床突周圍區(qū)域的狹小空間,匯集了顱底最重要、最復(fù)雜和最密集的血管、顱神經(jīng)和其它的組織結(jié)構(gòu),密切聯(lián)系,難以分離。 2、磨除前床突后形成的床突間隙,增加了手術(shù)操作空間;在視神經(jīng)和OCT長(zhǎng)度方面增加了兩倍的顯露,同時(shí)在OCT寬度方面增加了3～4倍,提高了視神經(jīng)、ICA的顯露,擴(kuò)大了OCT,在顯微外科方面有幾個(gè)重要的優(yōu)點(diǎn),包括:(1)早期定位、顯露視神經(jīng)和ICA;(2)視神經(jīng)和ICA的活動(dòng)和減壓能預(yù)防術(shù)中的神經(jīng)血管損傷;(3)改善了到達(dá)困難位置的手術(shù)入路,這對(duì)更加完全切除腫瘤帶來方便。 3、頸內(nèi)動(dòng)脈床突段多數(shù)情況下應(yīng)屬于海綿竇內(nèi)結(jié)構(gòu),術(shù)中要暴露頸內(nèi)動(dòng)脈床突段等結(jié)構(gòu)必須磨除前床突。 4、經(jīng)顱手術(shù)入路治療眶尖區(qū)病變時(shí),應(yīng)根據(jù)病變部位及侵襲范圍選擇內(nèi)側(cè)、中央或外側(cè)入路,以獲得最大暴露和最少損傷。 5、視神經(jīng)管減壓時(shí),應(yīng)切實(shí)開放視神經(jīng)管及視神經(jīng)鞘的中、前段。
[Abstract]:objective
The anterior bed process is the demarcation point of the anterior and middle cranial fossa, and it is a protective sign of the optic nerve and the lateral of the internal carotid artery. Therefore, the anterior bed process has an important anatomical significance. Its position is important. It is a hot and difficult point to consider how to get the operation space by grinding the anterior bed process for the lesions in this area. The data provided the anatomical basis for the microsurgical approach to the clinical orbital fissure and the cavernous sinus regional lesion. The anatomical relationship between the anterior bed process and the surrounding structure was determined by the anatomy of the corpse head under the microscope, and the anatomical relationships of the highly individualized bone structure, nerve, blood vessel, and dura were divided into the anatomical relationships of the highly individualized bone, nerve, blood vessel and dura. Statistics, I designed this study.
Method
10 cases of adult cadaver head wet specimens of formalin were fully fixed in 20 sides. They were unable to determine the age and sex, to divide the veins in the more accurate area, to maintain the normal blood vessel and to improve the quality of the shooting. All the wet specimens of the head were filled with latex with red dye in the arterial system, and the blue dye was mixed with the venous system. Latex. Bleached Chinese adult cranial diaphysis specimens of 10 cases, 20 sides, for observation and measurement of bone structure. Select the most representative frontal and temporal craniofacial pterional approach for the anterior lateral lateral operation. Under the operation microscope, the surgical approach is anatomically dissected and the anatomical structure is measured and taken accurately. The data are all through SPSS software. Processing, in the form of an average range of measured values.
Result
1, APC anterior and inferior in the upper part of the orbital fissure, anterior and sphenoid wing, anterior to the posterior of the optic canal and the optic column, the internal carotid artery through the internal carotid artery, and the cavernous sinus on the outer side. The length, width and thickness are 9.80 + 1.22 (7.52-12.48) mm, 12.57 + 2.41 (8.67-17.25) mm and 5.74 + 1.39 (3.10-9.97). After grinding, the lower edge of the cavernous sinus should be kept close to the cranial nerves.
2, before and after anterior resection, the average standard deviation of the measured values of the left and right sides was as follows. The optic nerve length was 9.56 + 1.85mm and 21.37 + 2.94mm; the length of the internal carotid artery was 9.97 + 2.06mm and 13.82 + 2.53mm; the width of the internal carotid triangle (OCT) of the optic nerve: 3.67 + 1.10mm and 12.54 + 2.37mm; OCT length: 9.66 + 2.39mm and 22.09 + 23.32mm.
3, the bed gap is a conical cavity formed by grinding the anterior bed process. The tip points to the rear, and the adjacent tissue is roughly the same as that of the anterior bed process. The space size is closely related to the structure of the front and surrounding tissue, the size of the range and the size of the edge, of which the total internal carotid artery (ICA) type is the largest and can affect the microscopical microscopy. The operation was 8.12 + 2.54 (4.20-14.23) mm, 11.54 + 3.21 (4.11-16.52) mm, 5.32 + 1.24 (2.23-7.52) mm, 2.33 + 0.84 (0.52-4.50) mm at the top, and 8.22 + 2.51 (5.32-16.23) mm. in the root.
4, the optic column is a columnar structure separating the optic canal from the supraorbital fissure.
5, on the nerve canal, the length of the lower wall was 8.20 + 1.23 (6.06-10.28) mm, 5.95 + 2.96 (1.42-12.62) mm, and the distance from the cranial mouth was 12.64 + 2.62 (8.00-17.16) mm, 23.71 + 3.55 (17.14-29.30) mm., respectively.
6, the orbital fissure is divided into the outer, middle and lower three areas. The cranial nerve and the adjacent area of the blood vessels are relatively constant. All the nerves and the eye veins that go through the cavernous sinus are split into the orbit through the orbit, of which the lower oculomotor nerve is the thickest and the lacrimal gland is the finest.
7, the segment of the internal carotid artery was located between the distal and proximal dural rings with a wedge-shaped appearance, the front and the optic column, the medial and the anterior part of the sphenoid carotid artery, the distal and proximal rings of the.ICA bed adjacent to the superior lateral and anterior protrusion, and the interspace between the medial vascular walls of the ICA bed and the periosteum, and the internal carotid artery bed process should be The internal structure of the cavernous sinus.
conclusion
1, the narrow space around the area around the bed, the most important, most complex and densest vessels of the skull base, the cranial nerves and other tissue structures, closely linked and difficult to separate.
2, the clearance of the bed process which was formed after the anterior bed process increased the operation space, increased the exposure of the optic nerve and the length of the OCT by two times, and increased the width of the OCT by 3~4 times, increased the exposure of the optic nerve, ICA, expanded the OCT, and had several important advantages in the microsurgery, including: (1) early localization and exposure of the optic nerve. ICA; (2) the activity and decompression of the optic nerve and ICA can prevent the neurovascular injury in the operation; (3) the surgical approach to the difficult position is improved, which is convenient for the more complete resection of the tumor.
3, most of the internal carotid artery segment should belong to the structure of the cavernous sinus. During the operation, we must expose the structure of the internal carotid artery, and so on.
4, the medial, central or lateral approach should be chosen according to the lesion location and the range of invasion to obtain the maximum exposure and minimal damage when the craniotomy approach is used to treat the orbital apex lesions.
5, when the optic canal is decompressed, the middle and anterior segment of optic canal and optic nerve sheath should be opened.
【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R322

【相似文獻(xiàn)】

相關(guān)會(huì)議論文 前10條

1 劉軍;劉樹偉;衡雪源;費(fèi)昶;韋有義;劉煥亭;張忠和;;床突間隙的顯微和斷層解剖研究[A];中國解剖學(xué)會(huì)2011年年會(huì)論文文摘匯編[C];2011年

2 劉小丘;趙建農(nóng);;前床突和周圍結(jié)構(gòu)的顯微解剖及其臨床意義(綜述)[A];海南省第二屆腫瘤學(xué)術(shù)會(huì)議論文集[C];2005年

3 章文斌;劉翔;趙鵬來;張玉海;鄒元杰;劉宏毅;;翼點(diǎn)硬膜外入路切除前床突腦膜瘤[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

4 盧亦成;;前床突腦膜瘤的顯微外科手術(shù)治療[A];中國醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)首屆全國代表大會(huì)論文匯編[C];2005年

5 劉偉;楊廷艦;張賀;;經(jīng)翼點(diǎn)入路顯微切除前床突腦膜瘤[A];中國醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第二屆全國代表大會(huì)論文匯編[C];2007年

6 劉軍;劉樹偉;費(fèi)昶;衡雪源;韋有義;張忠和;張建;于建軍;;鞍區(qū)的冠狀斷層面解剖與三維重建[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

7 于加省;雷霆;陳勁草;何躍;陳堅(jiān);李齡;;頸內(nèi)動(dòng)脈床突旁動(dòng)脈瘤的血管內(nèi)治療[A];中國醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第四屆全國代表大會(huì)論文匯編[C];2009年

8 孫正輝;許百男;武琛;姜金利;周定標(biāo);余新光;李保民;;個(gè)性化手術(shù)治療海綿竇和床突旁大型和巨大型動(dòng)脈瘤(附75例報(bào)告)[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

9 祝向東;龔江標(biāo);傅偉明;沈宏;黃欣;朱永堅(jiān);李立;;翼點(diǎn)入路視神經(jīng)管減壓術(shù)治療外傷性視神經(jīng)損傷[A];2006年浙江省神經(jīng)外科學(xué)術(shù)會(huì)議論文匯編[C];2006年

10 郭付有;宋來君;保建基;孫紅衛(wèi);魏新亭;;96例顱底腦膜瘤顯微手術(shù)的臨床研究[A];中國醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第二屆全國代表大會(huì)論文匯編[C];2007年

相關(guān)重要報(bào)紙文章 前3條

1 陳漢橋;發(fā)現(xiàn)一個(gè)“間隙” 突破一個(gè)“禁區(qū)”[N];中國醫(yī)藥報(bào);2003年

2 曹勇 華濤 孫輝;顱腦腫瘤治療三大進(jìn)展[N];健康報(bào);2006年

3 王振嶺 印素萍 任素麗;我國神經(jīng)介入治療邁上新的臺(tái)階[N];中國醫(yī)藥報(bào);2003年

相關(guān)博士學(xué)位論文 前9條

1 邵君飛;神經(jīng)導(dǎo)航下經(jīng)硬膜間腔巖尖入路顯微外科解剖學(xué)研究[D];蘇州大學(xué);2003年

2 陶存山;前外側(cè)顱底手術(shù)硬腦膜外人路相關(guān)的顯微解剖研究[D];第二軍醫(yī)大學(xué);2003年

3 胡凡;天幕裂孔區(qū)顯微解剖及手術(shù)入路研究[D];復(fù)旦大學(xué);2003年

4 簡(jiǎn)志宏;顱底內(nèi)外溝通區(qū)的顯微外科解剖[D];中南大學(xué);2011年

5 竇以河;海綿竇顯微解剖與海綿竇海綿狀血管瘤的顯微手術(shù)治療[D];山東大學(xué);2008年

6 石小峰;鎖孔與微創(chuàng)手術(shù)入路的解剖學(xué)和臨床研究[D];南方醫(yī)科大學(xué);2007年

7 陸云濤;經(jīng)蝶海綿竇內(nèi)側(cè)壁相關(guān)解剖和手術(shù)學(xué)研究[D];第一軍醫(yī)大學(xué);2007年

8 張榮偉;擴(kuò)大經(jīng)蝶入路治療海綿竇侵襲性垂體腺瘤的研究[D];第三軍醫(yī)大學(xué);2007年

9 羅俊生;顱底中央部前方手術(shù)入路的顯微解剖學(xué)研究[D];中國醫(yī)科大學(xué);2004年

相關(guān)碩士學(xué)位論文 前10條

1 涂斌鋒;前床突及床突間隙的應(yīng)用解剖學(xué)研究[D];南昌大學(xué);2012年

2 馬全鋒;經(jīng)眶顴入路對(duì)前床突—眶尖區(qū)的顯微解剖學(xué)研究[D];天津醫(yī)科大學(xué);2010年

3 董浩;前床突及相關(guān)區(qū)域顯微解剖研究[D];山東大學(xué);2005年

4 李志鵬;前床突和周圍結(jié)構(gòu)的顯微解剖研究[D];中國醫(yī)科大學(xué);2009年

5 韓獎(jiǎng)勵(lì);CT成像模擬眶上鎖孔入路磨除前床突前后頸內(nèi)動(dòng)脈床突上段的顯露[D];中南大學(xué);2010年

6 尹嘉;床突間隙與周圍結(jié)構(gòu)的顯微解剖學(xué)研究及臨床應(yīng)用[D];第二軍醫(yī)大學(xué);2001年

7 劉錦峰;海綿竇的應(yīng)用解剖學(xué)研究[D];汕頭大學(xué);2007年

8 梁建濤;前床突旁區(qū)及海綿竇外側(cè)壁的顯微解剖研究[D];山西醫(yī)科大學(xué);2003年

9 張小軍;蝶巖斜區(qū)的顯微外科解剖學(xué)研究[D];南京醫(yī)科大學(xué);2010年

10 譚秋豐;頭顱CT片個(gè)人識(shí)別研究[D];四川大學(xué);2007年

，

本文編號(hào)：2148754