本文關(guān)鍵詞： 鼻中隔軟骨 解剖 三維重建 人體測量學(xué)　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

【摘要】：研究目的:1.通過直接測量確定鼻中隔軟骨的背側(cè)長度和尾側(cè)長度以及特定部位的厚度。使用軟件測量鼻中隔軟骨的面積,以及在保留10mmL型支架后可用于移植的軟骨面積。通過CT掃描數(shù)據(jù)進(jìn)行三維重建測量鼻側(cè)軟骨與鼻中隔軟骨融合的長度以及與鼻中隔軟骨的夾角,并對鼻中隔軟骨的厚度進(jìn)行分析。2.開發(fā)一種以頭顱CT掃描數(shù)據(jù)為基礎(chǔ)的三維重建和測量方法,將CT測量的適應(yīng)證推廣到包括鼻中隔偏曲患者在內(nèi)的全部人群。3.將由CT掃描后獲得的鼻中隔軟骨三維重建測量結(jié)果與同一患者鼻中隔體外成形術(shù)中直接測量的結(jié)果比較,以檢測CT三維重建測量方法的效果。4.比較本研究中測量所得到的中國人鼻中隔軟骨面積與文獻(xiàn)中報道的其他種族人群的鼻中隔軟骨面積大小。研究方法:1.通過尸體解剖獲得鼻中隔-鼻側(cè)軟骨復(fù)合體,直接測量后進(jìn)行CT掃描和三維重建分析軟骨的厚度。2 CT掃描獲得頭顱影像學(xué)數(shù)據(jù),通過對骨性鼻中隔進(jìn)行三維重建后與選定的矢狀位影像疊加計算鼻中隔軟骨面積,選擇最優(yōu)的重建方案。3.將鼻中隔體外成形術(shù)中獲得的鼻中隔軟骨進(jìn)行測量,與術(shù)前CT三維重建測量的鼻中隔軟骨面積進(jìn)行比較,評價CT三維重建測量的可靠性。4.將術(shù)中測量的鼻中隔軟骨面積與文獻(xiàn)中報道的相關(guān)數(shù)據(jù)進(jìn)行比較,分析中國人鼻中隔軟骨大小與其他人種的差異。研究結(jié)果:1.解剖學(xué)測量結(jié)果顯示,鼻中隔軟骨總面積為612.4± 130.9mm2,可移植的鼻中隔軟骨面積為253.5±75.06mm2,從厚度分布圖像中可以看到鼻中隔軟骨中央部厚度較厚,鼻中隔前角處較薄,L支架區(qū)域厚度也不均勻,總體上較中央?yún)^(qū)域薄。2.經(jīng)鼻尖的矢狀位重建后測量所得到的鼻中隔軟骨面積大于經(jīng)前鼻棘矢狀位重建后測量的面積,兩者的差別具有統(tǒng)計學(xué)意義(p0.05)。3.術(shù)中取出的軟骨總面積為613.8±114.8mm2,保留10mmL型支架后可移植軟骨的面積為255.0±70.19mm2。鼻中隔軟骨的CT三維重建測量所得軟骨總面積為668.8±130.5mm2,保留10mm L型支架后可移植軟骨面積為282.7 ±76.86mm2。兩種方法測量的結(jié)果比較,鼻中隔軟骨總面積的差別有統(tǒng)計學(xué)意義(p0.05)。4.文獻(xiàn)中報道的鼻中隔軟骨總面積和可移植面積存在較大變異。本研究所測量結(jié)果與Jun Sik Kim報道的軟骨總面積相當(dāng),差異無統(tǒng)計學(xué)意義(p=0.81),與其他研究之間均存在顯著差異(p0.05)。而本研究測得可移植軟骨的面積與文獻(xiàn)中相關(guān)報道結(jié)果比較均存在顯著差異(p0.05)。結(jié)論:1.在保留10mm L型支架后,可以切取用于移植的鼻中隔軟骨的面積為253.5mm2,而背側(cè)和尾側(cè)長度都在15mm左右,這個大小的軟骨不足以用于固定型的鼻中隔支撐移植物。鼻中隔軟骨的厚度在分布上呈現(xiàn)中間和頂部厚,鼻中隔前角周圍薄的規(guī)律,在L型支架的范圍內(nèi)是較薄的,術(shù)中應(yīng)注意保留L型支架的適當(dāng)寬度。2.通過將骨性鼻中隔三維影像與矢狀位圖像進(jìn)行重疊可以準(zhǔn)確的確定鼻中隔軟骨的邊界,適用于鼻中隔偏曲患者,使得鼻中隔軟骨影像學(xué)測量的適用范圍推廣到的所有患者,大大提高術(shù)前測量和評估的準(zhǔn)確性。將骨性鼻中隔與過鼻尖點的矢狀面影像重疊后的測量結(jié)果更大,避免了因鼻中隔偏曲而導(dǎo)致的平面選擇時的面積損失,是更加準(zhǔn)確的測量方法。3.術(shù)前的三維CT掃描數(shù)據(jù)進(jìn)行重建獲得的鼻中隔軟骨形態(tài)與手術(shù)中獲得的鼻中隔軟骨在形態(tài)上相符程度很高,CT重建測量的結(jié)果可以準(zhǔn)確的估計手術(shù)中保留10mm L型支架后可移植的軟骨大小。4.鼻中軟骨的面積在不同人種間變異較大。中國人鼻中隔軟骨較高加索人和印度人小,較多數(shù)韓國人的測量值也小,需要更多研究數(shù)據(jù)來確定更準(zhǔn)確的解剖特征。
[Abstract]:Objective: 1. by direct measurement to determine the dorsal nasal septum cartilage length and caudal length and thickness. The use of specific parts of the software measurement of nasal septum cartilage area, and can be used in the area of cartilage transplantation in type 10mmL stent. Retained cartilage and cartilage of nasal septum and three-dimensional reconstruction of nasal fusion length by CT scan data and angle with the nasal septum cartilage, three-dimensional reconstruction and measurement methods to develop a head CT scan based on the data analysis of.2. and the nasal septum cartilage thickness measuring CT indication is extended to include patients with nasal septum deviation, all the people will get.3. by CT scan after nasal septum cartilage three-dimensional reconstruction measurement results with the same patients with nasal septum forming in vitro direct measurement of intraoperative results detected by CT three-dimensional reconstruction measurement method in this study compared the effect of.4. test The septal cartilage size of other ethnic groups reported by Chinese nasal septal cartilage area and in the literature. Methods: 1. through autopsy obtained nasal septum nasal cartilage complex, CT scanning and three-dimensional reconstruction of cartilage thickness.2 CT scan brain imaging data were measured by. 3D reconstruction of nasal septal cartilage and selected sagittal image superposition calculation of nasal septal cartilage area, select the optimal scheme of the.3. reconstruction of nasal septum in vitro forming cartilage of nasal septum surgery was measured, compared with the preoperative CT three-dimensional reconstruction of nasal septum cartilage area, compare the reported data of nasal the septal cartilage area and the literature evaluation reliability of.4. measured by CT three-dimensional reconstruction will be in operation in the measurement, analysis of differences between Chinese septal cartilage and size of other races. Results: 1. anatomic measurement showed that the total area of nasal septum cartilage was 612.4 + 130.9mm2, can be transplanted to the nasal septum cartilage area was 253.5 + 75.06mm2, the thickness distribution of the image can be seen in the central part of nasal septum cartilage thickness, anterior septal angle thin L stent region thickness is not uniform. Overall than the central region of the thin.2. sagittal reconstruction of nasal tip after measurement of nasal septum cartilage area is greater than by the anterior nasal spine sagittal reconstruction area, with significant difference (P0.05).3. from intraoperative cartilage total area was 613.8 + 114.8mm2, retention of 10mmL type support after transplantation of cartilage area was 255 + 70.19mm2. nasal septal cartilage CT three-dimensional reconstruction measurement of the total area of cartilage was 668.8 + 130.5mm2, 10mm type L stent can retain cartilage grafts for measuring area of 282.7 + 76.86mm2. the results of the two methods. Comparison was statistically significant difference between the total area of nasal septal cartilage (P0.05) had great variation in.4. reported in the literature and the total area of nasal septum cartilage transplantation area. This study measured results with the Jun Sik Kim reported a total area of cartilage, there was no statistically significant difference (p= 0.81), there were significant differences with other study (P0.05). This study can be measured in the literature area and cartilage grafts reported results there were significant differences (P0.05). Conclusion: 1. in the retention of 10mm L support, can be harvested for nasal septum soft bone graft area is 253.5mm2, and the dorsal and caudal length at around 15mm, the size of the cartilage is not enough to be used for nasal septum fixed support graft. The septal cartilage thickness distribution shows that the middle and top of thick, thin septum around the anterior horn of the law, in the range of L type bracket is thinner That should pay attention to the proper width of.2. retained L stent by osteoseptum 3D images and sagittal images can overlap nasal septal cartilage boundary is determined accurately in operation, suitable for patients with nasal septum deviation, all patients scope extended to the nasal septal cartilage imaging measurement, greatly improve the accuracy preoperative measurement and assessment. The measurement of sagittal imaging of the bony nasal septum and nasal tip overlap results after more, to avoid the loss caused by the plane area of nasal septum deviation of nasal septum cartilage was obtained with three-dimensional CT scan data measurement more accurate preoperative.3. reconstruction. The nasal septum cartilage morphology and surgery in highly consistent with each other in the form, the CT can be transplanted after reconstruction retained 10mm L support estimate accurate operation of cartilage in nasal.4. size In the area of cartilage in interracial variation. Chinese nasal septal cartilage than Caucasians and Indians, the majority of Koreans measurement value is small, more research is needed to determine the anatomical characteristics more accurately.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R622

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