【摘要】： 目的:本文對(duì)經(jīng)典的面神經(jīng)隱窩入路人工耳蝸植入術(shù)、面神經(jīng)鼓室內(nèi)改道吻合術(shù)相關(guān)的解剖及比鄰結(jié)構(gòu)進(jìn)行了觀察、測(cè)量,為臨床上人工耳蝸植入術(shù)、面神經(jīng)改道吻合術(shù)及其他中耳相關(guān)手術(shù)提供解剖學(xué)資料。方法:20例(40側(cè))經(jīng)福爾馬林浸泡的國(guó)人成人頭顱濕標(biāo)本,在手術(shù)顯微鏡下經(jīng)面神經(jīng)隱窩入路模擬人工耳蝸植入術(shù),充分暴露相關(guān)的解剖結(jié)構(gòu),對(duì)人工耳蝸手術(shù)相關(guān)的結(jié)構(gòu)進(jìn)行觀察、測(cè)量;再充分解剖出顳骨內(nèi)面神經(jīng)各段,將面神經(jīng)在鼓室內(nèi)改道并測(cè)量。結(jié)果:外耳道上棘至砧骨短腳的平均距離為19.14±0.89mm,外耳道上棘至面神經(jīng)水平段與垂直段交點(diǎn)的平均距離為16.30±1.09mm,面神經(jīng)水平段與垂直段交點(diǎn)距乳突表面的平均距離為20.84±1.13mm,面神經(jīng)水平段與垂直段交點(diǎn)距鼓索神經(jīng)發(fā)出點(diǎn)平均距離為11.28±1.54mm,面神經(jīng)水平段與垂直段交點(diǎn)距外耳道后壁的平均距離為4.40±0.43mm,錐隆起至圓窗龕的平均距離為4.46±0.76mm,卵圓窗至圓窗龕的平均距離為3.74±0.37mm,砧鐙關(guān)節(jié)至圓窗龕的平均距離為3.80±0.63mm;鼓索神經(jīng)與面神經(jīng)垂直段的夾角平均為24.8±4.7°,水平半規(guī)管與面神經(jīng)水平段夾角平均為17.5±3.8°,砧骨長(zhǎng)腳與后拱柱夾角平均為46.0±7.1°,面神經(jīng)水平段平均長(zhǎng)11.60±0.80mm,面神經(jīng)垂直段平均長(zhǎng)15.30±1.32mm,面神經(jīng)水平段與垂直段的夾角平均為110.4±6.9°,面神經(jīng)改道后從莖乳孔到膝神經(jīng)節(jié)平均距離為22.06±1.40 mm,改道后可利用長(zhǎng)度延長(zhǎng)最短為4.00 mm,最長(zhǎng)為7.32mm。結(jié)論:外耳道上棘、砧骨短腳、水平半規(guī)管、錐隆起、匙突等標(biāo)志結(jié)構(gòu)位置恒定,尤其是水平半規(guī)管和錐隆起,為相關(guān)手術(shù)入路提供定位依據(jù);順利找到圓窗及圓窗龕是人工耳蝸手術(shù)的重要步驟,圓窗卵圓窗位置關(guān)系相對(duì)穩(wěn)定,圓窗龕與周圍結(jié)構(gòu)距離和角度在較小的范圍內(nèi)變化,可為人工耳蝸?lái)樌业綀A窗龕進(jìn)行鼓階鉆孔定位;了解顳內(nèi)段面神經(jīng)的走行在臨床中有重要意義,將面神經(jīng)在鼓室內(nèi)改道吻合,最長(zhǎng)可延長(zhǎng)7.32 mm,最短可延長(zhǎng)4.00 mm;顳骨內(nèi)解剖結(jié)構(gòu)復(fù)雜,手術(shù)者必須既要了解解剖知識(shí),又要有熟練的手術(shù)技巧,同時(shí)要結(jié)合術(shù)前的影像資料,因個(gè)體差異不同而變化。
[Abstract]:Objective: to observe the anatomic and adjacent structures of the classical facial nerve crypt approach cochlear implantation and the anastomosis of the intratympanic diversions of the facial nerve, and to measure the clinical application of cochlear implantation. Facial nerve anastomosis and other middle ear related operations provide anatomical data. Methods: 20 Chinese adult head wet specimens (40 sides) soaked in formalin were treated with simulated cochlear implantation via the facial nerve crypt under the operating microscope, and the related anatomical structures were fully exposed. The structures related to cochlear implants were observed and measured. The temporal facial nerve was fully dissected and the facial nerve was changed in the tympanum and measured. Results: the average distance between the superior spine of the external auditory canal and the short foot of the incus was 19.14 鹵0.89 mm, and the average distance between the superior spine of the external auditory canal and the horizontal segment of the facial nerve and the vertical segment was 16.30 鹵1.09 mm. The average distance between the horizontal and vertical segments of the facial nerve and the surface of the mastoid process was 20.84 鹵1.13 mm, and the average distance between the horizontal and vertical segments of the facial nerve was 11.28 鹵1.54 mm from the origin of the chorda tympani nerve, and the mean distance between the horizontal and vertical segments of the facial nerve was 11.28 鹵1.54 mm. The average distance between the horizontal and vertical segments of the facial nerve and the posterior wall of the external auditory canal was 4.40 鹵0.43 mm, the average distance between the conical eminence and the circle window niche was 4.46 鹵0.76 mm, and the average distance between the oval window and the circle window niche was 3.74 鹵0.37 mm. The average distance from the stirrup joint to the circle window niche was 3.80 鹵0.63 mm. The average angle of the vertical segment between the chorda tympani nerve and the facial nerve was 24.8 鹵4.7 擄, the angle between the horizontal semicircular canal and the horizontal segment of the facial nerve was 17.5 鹵3.8 擄, and the angle between the long foot of the incus and the posterior arch column was 46.0 鹵7.1 擄. The average length of the horizontal segment of the facial nerve was 11.60 鹵0.80 mm, the average length of the vertical segment of the facial nerve was 15.30 鹵1.32 mm, and the average angle between the horizontal segment and the vertical segment of the facial nerve was 110.4 鹵6.9 擄. The average distance from the stylomammary foramen to the genicular ganglion was 22.06 鹵1.40 mm, after the facial nerve was rerouted. The shortest possible length extension was 4.00 mm, and the longest was 7.32 mm. Conclusion: the location of the suprameval spine, the short foot of the incus, the horizontal semicircular canal, the conical eminence and the spasmatic process are constant, especially the horizontal semicircular canal and the conical eminence, which provide the basis for the location of the operative approach. The successful finding of round windows and niches is an important step in cochlear implant surgery. The position relationship of round window oval windows is relatively stable, and the distance and angle between the niches and the surrounding structures vary in a relatively small range. It can be used to locate the drill hole of the drum step for the cochlear implant to find the niches of the round window successfully. It is very important to understand the movement of the facial nerve in the medial temporal segment. The facial nerve can be anastomosed in the tympanic chamber. The longest extension is 7.32 mm, and the shortest is 4.00 mm;. The anatomical structure of temporal bone is complex, the operative must not only know the anatomy knowledge, but also have the skillful operation skill, at the same time, combine the image data before operation, and change according to the individual difference.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R764;R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 何利平,賀飛,李永新,趙嘯天;人工耳蝸植入相關(guān)的解剖學(xué)研究[J];耳鼻咽喉頭頸外科;2002年03期

2 王金平,劉清明,王岱君,鞠學(xué)紅,劉洪國(guó);人工耳蝸植入術(shù)的應(yīng)用解剖學(xué)研究[J];解剖學(xué)研究;2005年03期

3 王金平,鞠學(xué)紅,王岱君,鞠曉華,高培福;后鼓室手術(shù)入路的應(yīng)用解剖學(xué)研究[J];解剖科學(xué)進(jìn)展;2003年03期

4 韓思源,王玉新,郭永峰,趙磊;不同方法對(duì)周圍性面神經(jīng)損傷修復(fù)效果的比較[J];口腔頜面外科雜志;2001年S1期

5 張道行;人工耳蝸電極植入耳蝸入口的定位[J];臨床耳鼻咽喉科雜志;2000年05期

6 張道行,胡寶華,肖玉麗;110例人工耳蝸置入手術(shù)的回顧性分析[J];臨床耳鼻咽喉科雜志;2004年07期

7 劉寒波;馮永;陳登明;梅凌云;賀楚峰;蔡鑫章;;經(jīng)外耳道后上徑路人工耳蝸植入的手術(shù)入路和相關(guān)解剖關(guān)系研究[J];臨床耳鼻咽喉頭頸外科雜志;2007年10期

8 胡繼云，，張家雄;面神經(jīng)鼓室段區(qū)域的應(yīng)用解剖[J];上海醫(yī)學(xué);1995年12期

9 張家雄,胡繼云;鼓室成形術(shù)中鼓索神經(jīng)處理的探討[J];鐵道醫(yī)學(xué);2000年01期

10 徐金操;郭夢(mèng)和;張宏征;李永賀;;人工耳蝸植入術(shù)相關(guān)結(jié)構(gòu)的解剖測(cè)量[J];聽力學(xué)及言語(yǔ)疾病雜志;2006年03期

本文編號(hào)：2426179