【摘要】：目的:1.描述雙側(cè)橫竇的走形和引流規(guī)律,測(cè)量和定位雙側(cè)橫竇的位置,計(jì)算橫竇溝的深度和厚度,總結(jié)如何利用體表標(biāo)志來準(zhǔn)確定位橫竇的位置,測(cè)量雙側(cè)頸內(nèi)靜脈和頸外靜脈在頸總動(dòng)脈末端處的橫截面積。2.探討進(jìn)行橫竇—頸內(nèi)靜脈/頸外靜脈搭橋來治療橫竇、乙狀竇及頸靜脈孔區(qū)等部位的病變。對(duì)象和方法:在門診病人中選取100例我國成人CTA的全部影像資料,用計(jì)算機(jī)重建出骨窗與血管的圖像,建立以后正中線連線為Y軸,以枕外隆凸最高點(diǎn)為原點(diǎn),以Y的垂線為X軸的直角坐標(biāo)系,測(cè)量橫竇在-40mm~40mm區(qū)間內(nèi)每間隔5mm處的坐標(biāo)系數(shù)據(jù),將右側(cè)橫竇溝上緣的點(diǎn)依次命名為點(diǎn)1a、1b、1c、1d、1e、1f、1g、1h,將右側(cè)橫竇溝下緣的點(diǎn)依次命名為2a、2b、2c、2d、2e、2f、2g、2h;左側(cè)分別為-1a、-1b、-1c、-1d、-1e、-1f、-1g、-1h和-2a、-2b、-2c、-2d、-2e、-2f、-2g、-2h。并記錄各個(gè)孔中點(diǎn)的坐標(biāo),從而系統(tǒng)化地分析橫竇的解剖位置。并測(cè)量出雙側(cè)橫竇溝在這一區(qū)間內(nèi)的深度和其距離顱骨表面的最近距離即厚度。對(duì)比枕內(nèi)粗隆與枕外隆凸的位置關(guān)系、測(cè)量出枕內(nèi)粗隆與枕外隆凸平面之間的距離。在選取的影像資料中,分別在雙側(cè)頸總動(dòng)脈末端的層面上測(cè)量出胸鎖乳突肌內(nèi)側(cè)的頸內(nèi)靜脈橫截面積以及胸鎖乳突肌表面的頸外靜脈橫截面積。對(duì)20例成人濕性頭顱標(biāo)本模擬后顱窩的開顱手術(shù)并暴露出橫竇的位置,為準(zhǔn)確驗(yàn)證橫竇的走形和定位提供解剖學(xué)依據(jù)。結(jié)果:國人橫竇呈右側(cè)優(yōu)勢(shì)者占56%,其中絕對(duì)優(yōu)勢(shì)者占8%,相對(duì)優(yōu)勢(shì)者占28%,稍優(yōu)勢(shì)者占20%;國人橫竇呈左側(cè)優(yōu)勢(shì)者占20%,其中絕對(duì)優(yōu)勢(shì)者占4%,相對(duì)優(yōu)勢(shì)者占4%,稍優(yōu)勢(shì)者占1.2%。而左右兩側(cè)差別不大的病例占24%。通過研究橫竇溝的走形我們發(fā)現(xiàn),左側(cè)的橫竇位置要比右側(cè)橫竇低,而且左側(cè)橫竇走形時(shí)的彎曲程度比右側(cè)要小。右側(cè)橫竇溝各坐標(biāo)點(diǎn)在Y軸上的平均值分別是:1a:28.18±2.13,1b:25.34±2.19,1c:20.29±1.76,1d:17.94±1.69,1e:16.98±1.21,1f:16.66±1.03,1g:14.97±2.08,1h:12.98±2.12;2a:15.74±2.24,2b:11.24±2.1,2c:9.46±1.20,2d:7.34±2.57,2e:7.12±2.28,2f:7.09±1.13,2g:4.26±1.60,2h:3.28±1.41;左側(cè)橫竇溝各坐標(biāo)點(diǎn)在Y軸上的平均值分別是:-1a:19.91±1.41,-1b:17.45±2.14,-1c:15.42±2.12,-1d:15.07±2.2,-1e:14.61±1.71,-1f:14.35±2.01,-1g:12.92±1.91,-1h:12.2±2.01;-2a:10.87±2.11,-2b:8.47±1.67,-2c:7.38±1.81,-2d:7.23±3.03,-2e:6.93±1.65,-2f:5.47±2.13,-2g:4.57±1.89,-2h:4.50±2.11。右側(cè)頸內(nèi)靜脈的橫截面積平均值為125.44±23.18mm2,其中以右側(cè)為優(yōu)勢(shì)側(cè)的患者中橫截面積平均值為159.32±20.31 mm2,以左側(cè)為優(yōu)勢(shì)側(cè)的患者其橫截面積平均值為64.92±21.02 mm2。左側(cè)頸內(nèi)靜脈橫截面積的平均值為113.26±19.25mm2,其中以左側(cè)為優(yōu)勢(shì)側(cè)的患者橫截面積平均值為138.79±28.99mm2,以右側(cè)為優(yōu)勢(shì)側(cè)的患者其橫截面積平均值為74.98±12.18 mm2。右側(cè)頸外靜脈的平均橫截面積為47.34±6.23mm2,左側(cè)頸外靜脈的平均橫截面積為42.22±5.86mm2,兩者之間無明顯差異。在所有病例中,右側(cè)頸外靜脈橫截面積較大者占45%,左側(cè)頸外靜脈橫截面積較大者占51%,右側(cè)頸外靜脈在頸總動(dòng)脈末端層面的胸鎖乳突肌表面處缺如者占3%,左側(cè)缺如者占1%。枕外隆凸與枕內(nèi)粗隆相比,枕內(nèi)粗隆較枕外隆凸高者占76%,這些病例中枕內(nèi)粗隆比枕外隆凸平均高9.03±2.11mm;枕內(nèi)粗隆較枕外隆凸低者占13%,平均比枕外隆凸低8.03±1.86mm;兩者處于同一水平面者占11%。橫竇溝在距離中線40mm內(nèi)最大深度的平均值為2.89±0.79mm,而橫竇溝最深處至顱骨外表面的厚度平均值為8.24±1.31mm。結(jié)論:1.術(shù)前了解橫竇的位置和走形,有助于提高在神經(jīng)外科手術(shù)過程的安全性;2.術(shù)前了解頸內(nèi)靜脈和頸外靜脈的橫截面積有助于術(shù)前設(shè)計(jì)手術(shù)方案;3.對(duì)于橫竇、乙狀竇以及頸內(nèi)靜脈上段等部位的病變,在不能經(jīng)常規(guī)治療或常規(guī)治療困難時(shí),可以考慮行橫竇—頸內(nèi)靜脈/頸外靜脈的搭橋來治療;4.進(jìn)行橫竇—頸內(nèi)靜脈/頸外靜脈的搭橋治療是相對(duì)安全、有效、簡(jiǎn)捷的。
[Abstract]:Objective: 1. To describe the shape and drainage of bilateral transverse sinuses, measure and locate the position of bilateral transverse sinuses, calculate the depth and thickness of transverse sinus sulcus, summarize how to locate the position of transverse sinuses accurately by body surface markers, and measure the cross-sectional area of bilateral internal jugular veins and external jugular veins at the end of the common carotid artery. Objectives and Methods: 100 Chinese adults were selected from the outpatient clinic to reconstruct the image of bone window and blood vessel, and then the median line was established as the Y axis, the highest point of occipital eminence was the origin, and the vertical line of Y was the X axis. In the rectangular coordinate system, the coordinate coefficients of the transverse sinus are measured at 5 mm intervals between - 40mm and 40 mm. The points on the upper edgeof the right transverse sinus groove are named points 1a, 1b, 1c, 1d, 1d, 1e, 1f, 1f, 1g, 1h, 1h, and the points on the lower edgeof the right transverse sinus groove are named 2a, 2b, 2b, 2c, 2d, 2e, 2e, 2f, 2g, 2h; on the left side are - 1a, - 1b, - 1c, - 1c, - 1d, - 1e, - 1f, - 1f, - 1g, - 1g, - 1g, - 1h, - 1g, - 1h, -2e, -2 F, - 2g, - 2h. and the coordinates of the central points of each hole were recorded to systematically analyze the anatomical position of the transverse sinus. The depth of the bilateral transverse sinus groove in this region and the nearest distance from the skull surface were measured. The distance between the intraoccipital tuberosity and the occipital protuberance was measured by comparing the position of the intraoccipital tuberosity and the occipital protuberance. The cross-sectional area of the internal jugular vein in the medial sternocleidomastoid muscle and the external jugular vein on the surface of the sternocleidomastoid muscle were measured at the bilateral end of the common carotid artery, respectively. Results: 56% of the Chinese had right superiority, 8% had absolute superiority, 28% had relative superiority, 20% had slight superiority, 20% had left superiority, 4% had absolute superiority, 4% had relative superiority and 1.2% had slight superiority. By studying the shape of the transverse sinus sulcus, we found that the position of the left transverse sinus was lower than that of the right transverse sinus, and the curvature of the left transverse sinus was smaller than that of the right. .97鹵2.08,1h:12.98鹵2.12;2a:15.74鹵2.24,2b:11.24鹵2.1,2c:9.46鹵1.20,2d:7.34鹵2.57,2e:7.12鹵2.28,2f:7.09鹵1.13,2g:4.26鹵1.60,2h:3.28鹵1.41;宸︿晶妯娌熷悇鍧愭爣鐐瑰湪Y杞翠笂鐨勫鉤鍧囧，

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