經(jīng)面神經(jīng)隱窩入路人工耳蝸植入術(shù)相關(guān)解剖學(xué)研究
發(fā)布時間：2018-08-07 08:26
【摘要】：目的：通過對人工耳蝸植入術(shù)相關(guān)的面神經(jīng)隱窩及后鼓室解剖結(jié)構(gòu)進(jìn)行觀察測量,為人工耳蝸植入手術(shù)中避免面神經(jīng)、鼓索神經(jīng)等損傷及準(zhǔn)確定位鼓階開窗口提供理論參考。 材料：取經(jīng)福爾馬林浸泡的國人顳骨濕標(biāo)本10例20側(cè),其中女性7例(14耳),男性3例(6耳),均為成人標(biāo)本,均無中耳畸形及疾病(研究中證實)。標(biāo)本來自南方醫(yī)科大學(xué)解剖學(xué)教研室與珠江醫(yī)院神經(jīng)外科教研室。測量工具：自制仿鐙骨測量器、制圖用帶長針頭分規(guī)、電子游標(biāo)卡尺(精確度0.01mm)、Leica耳科手術(shù)顯微鏡、耳科手術(shù)電鉆、耳科顯微手術(shù)器械。 方法： 1.實驗步驟：耳后切口,剝離軟組織和骨膜,暴露乳突。行乳突輪廓化,保留外耳道后壁,暴露砧骨短腳,磨出面神經(jīng)垂直段(磨去骨管)和鼓索神經(jīng),保留后拱柱。在面神經(jīng)垂直段與鼓索神經(jīng)之間切開面神經(jīng)隱窩,進(jìn)入后鼓室,顯露砧鐙關(guān)節(jié)、錐隆起、鐙骨肌腱、圓窗龕、圓窗等結(jié)構(gòu)。再磨去后拱柱,摘除砧骨,顯露面神經(jīng)水平段(磨去骨管)和匙狀突；磨低圓窗龕,充分暴露圓窗膜,自下緣掀起圓窗膜后定位鼓階入口,并于圓窗膜前鉆開鼓階。徹底磨出耳蝸底回,暴露骨螺旋板,在耳蝸底回上方磨開耳蝸第二回。在各步驟中對實驗前擬定的測量指標(biāo)進(jìn)行測量。 2.主要觀察指標(biāo)：外耳道后上棘與砧骨短腳之間的距離,鼓索神經(jīng)發(fā)出點與莖乳孔之間的距離,砧骨短腳與鼓索神經(jīng)發(fā)出點之間的距離,而神經(jīng)隱窩最寬處與砧骨短腳之間的距離,面神經(jīng)隱窩最寬處與鼓索神經(jīng)發(fā)出點之間的距離,面神經(jīng)隱窩最大寬度,面神經(jīng)隱窩寬度(鐙骨頭水平),面神經(jīng)隱窩寬度(圓窗水平),錐隆起與圓窗膜前緣之間的距離,鐙骨頭與圓窗膜下緣之間的距離,砧骨短腳與圓窗龕之間的距離,鐙骨頭與圓窗龕之間的距離,面神經(jīng)垂直段與圓窗龕之間的距離,鼓階入口與卵圓窗最近距離之間的距離,匙狀突與圓窗龕之間的距離,鐙骨頭與耳蝸第二回切開點之間的距離,錐隆起與耳蝸第二回切開點之間的距離。 3.測量點的選擇：外耳道后上棘以尖端為測量點；砧骨短腳以砧骨短腳尖端為測量點；莖乳孔以乳突腔莖乳孔內(nèi)口為測量點；圓窗龕以圓窗龕上唇下緣為測量點；面神經(jīng)垂直段以面神經(jīng)垂直段前邊緣為測量點；錐隆起以錐隆起骨性尖端為測量點；圓窗膜前緣以圓窗膜前緣垂直切線為測量點；圓窗膜下緣以圓窗膜下緣垂直切線為測量點；面神經(jīng)隱窩寬度指所指平面面神經(jīng)至鼓索神經(jīng)的最短距離；匙狀突以匙狀突下緣為測量點；鼓階入口以基底膜起點下緣為測量點；卵圓窗以卵圓窗最下緣為測量點；耳蝸第二回切開點以第二回基底膜起點下緣為測量點。面神經(jīng)垂直段至圓窗龕(后唇前緣)之間距離指兩者間最小直線距離。 4.統(tǒng)計學(xué)處理：所有測量數(shù)據(jù)取3次測量值的平均值,所得平均值用SPSS13.0軟件做統(tǒng)計學(xué)處理,結(jié)果以均數(shù)±標(biāo)準(zhǔn)差表示,并列出測量范圍。 結(jié)果： 1.面神經(jīng)垂直段并非成一條直線垂直下行,而是先向后外有一拱形的弧度,然后內(nèi)下至莖乳孔出顳骨,從而形成了面神經(jīng)垂直段弧度最大位置�？偟淖呦蚴怯汕皟�(nèi)側(cè)逐漸移向后外側(cè),行程中前后方向呈“C”形彎曲。面神經(jīng)垂直段弧度最大位置約在砧骨短腳下6.28mm處。 2.有1側(cè)面神經(jīng)水平段骨管的缺如；2側(cè)面神經(jīng)垂直段前移影響圓窗龕的暴露；2側(cè)鼓索神經(jīng)由莖乳孔發(fā)出；1側(cè)鼓索神經(jīng)多支的變異：1側(cè)圓窗龕的變異。 3.外耳道后上棘至砧骨短腳之間的距離為(12.44±1.58)mm(8.35～14.46mm)；鼓索神經(jīng)發(fā)出點至莖乳孔之間的距離為(2.67±1.50)mm(0～5.22mm)；砧骨短腳至鼓索神經(jīng)發(fā)出點之間的距離為(15.22±2.67)mm(10.35～20.24mm)；面神經(jīng)隱窩最寬處至砧骨短腳之間距離為(6.28±1.27)mm(4.23～8.88mm)；面神經(jīng)隱窩最寬處至鼓索神經(jīng)發(fā)出點之間距離為(9.81±2.16)mm(5.55～13.76mm)；面神經(jīng)隱窩最大寬度為(2.73±0.64)mm(1.61～4.01mm)；鐙骨頭水平面神經(jīng)隱窩寬度為(2.48±0.68)mm(1.42～3.70mm)；圓窗水平的面神經(jīng)隱窩寬度為(2.24±0.61)mm(1.28～3.33mm)；錐隆起至圓窗膜前緣之間的距離為(2.22±0.70)mm(1.46～4.16mm)；鐙骨頭至圓窗膜下緣之間的距離為(2.16±0.48)mm(1.24～2.88mm)；砧骨短腳至圓窗龕之間的距離為(5.91±0.84)mm(4.49～8.02mm)；鐙骨頭至圓窗龕之間的距離為(2.11±0.58)mm(3.31～3.79mm)；面神經(jīng)垂直段至圓窗龕之間的距離為(6.70±0.61)mm(5.02～7.78mm)；鼓階入口與卵圓窗最近距離為(2.12±0.56)mm(1.24～3.43mm)；匙狀突至圓窗龕之間的距離為(3.79±0.56)mm(3.07～5.23mm)；鐙骨頭至耳蝸第二回切開點之間距離為(2.25±0.43)mm(1.35～2.93mm)；錐隆起至耳蝸第二回轉(zhuǎn)切開點之間距離為(2.28±0.62)mm(1.54～4.09mm)。 結(jié)論：在經(jīng)面神經(jīng)隱窩入路人工耳蝸植入術(shù)中,面神經(jīng)隱窩切開、鼓階入口的定位是手術(shù)的關(guān)鍵,關(guān)系到手術(shù)的成功與否。面神經(jīng)的損傷是人工耳蝸植入術(shù)中比較嚴(yán)重的并發(fā)癥之一。本研究認(rèn)為面神經(jīng)垂直段弧度最大位置處的面神經(jīng)隱窩前后距離最大,切開面神經(jīng)隱窩時損傷面神經(jīng)及鼓索神經(jīng)的幾率最小,是切開并充分開放面神經(jīng)隱窩起始位置。鐙骨頭、錐隆起是后鼓室比較容易找到并相對比較恒定的解剖標(biāo)志,當(dāng)術(shù)中圓窗龕暴露不良或不能暴露及耳蝸底轉(zhuǎn)骨化等情況時,可參考鐙骨頭、錐隆起來定位鼓階入口。本研究的相關(guān)數(shù)據(jù)為經(jīng)面神經(jīng)隱窩入路人工耳蝸植入手術(shù)中避免面神經(jīng)、鼓索神經(jīng)等重要結(jié)構(gòu)損傷及準(zhǔn)確定位鼓階入口提供理論參考。
[Abstract]:Objective: To observe and measure the anatomical structure of the facial nerve recess and the posterior tympanic cavity related to the cochlear implantation, and provide a theoretical reference for avoiding the facial nerve, tympani nerve and so on in the cochlear implantation.
Materials: 20 sides of the Chinese temporal bone wet specimens soaked by formalin, including 7 women (14 ears), 3 males (6 ears), were all adult specimens, all had no middle ear malformation and disease (confirmed in the study). The specimens were from the Department of anatomy teaching and research in Southern Medical University and Department of Neurosurgery, Zhujiang Hospital. Measurement tools: homemade stapes measuring apparatus, Drawing with a long needle gauge, electronic vernier caliper (accuracy 0.01 mm), Leica otology surgery microscope, otology surgery electric drill, otology microsurgical instruments.
Method:
1. the experimental procedure: after the ear incision, the soft tissue and periosteum were stripped and the mastoid was exposed. The posterior wall of the external auditory canal was retained, the posterior wall of the external auditory canal was retained, the anvil short foot was exposed, the vertical segment of the facial nerve (the bone canal) and the tympanum nerve were worn, and the posterior arch was retained. The facial nerve recess was cut in the vertical segment of the facial nerve and the tympani nerve, and the posterior tympanic cavity was entered and the incus stapes joint was exposed. Conical protruding, stapes tendon, round window niche, round window and so on. Then grinding the post arch column, removing the anvil, exposing the horizontal segment of the facial nerve (grinding the bone tube) and the spoon process; grinding the low round window niche, exposing the circular window film fully, setting the drum step after the round window film, and drilled the drum order before the round window membrane. Cochlear second times above the base of the cochlear. The measurement indexes before the experiment were measured in each step.
2. main indicators: the distance between the posterior upper spine and the short foot of the anvil, the distance between the emit point of the tympani and the orifice of the stem, the distance between the short foot of the anvil and the point of the tympani nerve, the distance between the widest part of the nerve recess and the short foot of the anvil, the distance between the widest part of the facial nerve recess and the point of the tympani nerve, and the facial deity The width of the recess, the width of the facial nerve recess (the level of the stapes), the width of the facial nerve recess (the level of the round window), the distance between the cones and the front of the round window membrane, the distance between the stapes and the lower edge of the round window membrane, the distance between the short feet of the incus and the niches of the round window, the distance between the stapes and the niches of the round window, the vertical segment of the facial nerve and the niches of the round window. Distance, the distance between the entrance of the drum and the nearest distance of the oval window, the distance between the spoon and the round window niche, the distance between the second incised points of the stapes and the cochlea, and the distance between the conical protruding and the second back incised point of the cochlea.
3. the selection of the measuring point: the tip of the posterior upper spine of the external auditory canal was measured at the point of the tip; the short foot of the anvil was measured at the tip of the short foot of the anvil; the stem lacteal hole was measured with the orifice of the mammary hole in the mastoid cavity; the round window niche was measured at the lower edge of the upper lip of the round window niche; the vertical segment of the facial nerve was measured at the front edge of the vertical segment of the facial nerve; the conical uplift was a conical bone. The front edge of the circular window membrane is measured by the vertical tangent line of the front edge of the circular window membrane; the lower edge of the circular window membrane is measured by the vertical tangent line of the lower edge of the circular window membrane; the width of the facial nerve recess refers to the shortest distance from the plane facial nerve to the drum nerve; the spoon process is the measuring point with the spoonful edge of the lower edge; the drum step entrance is under the base film starting point under the basement membrane. The margin is the measuring point; the oval window is measured at the bottom of the oval window, and the second point of the cochlea is measured at the lower edge of the base membrane of the second basilar membrane. The distance between the vertical section of the facial nerve to the round window niche (the posterior lip of the rear lip) refers to the minimum linear distance between the two.
4. statistical treatment: the average value of all measured data was taken for 3 times. The average value was processed by SPSS13.0 software. The results were expressed with the average number of standard deviation, and the range of measurement was listed.
Result:
The vertical section of the 1. facial nerve is not a straight line vertical downward, but an arched arc from the back to the outside, and then from the inside to the Stemal hole out of the temporal bone, thus forming the maximum position of the vertical segment of the facial nerve. The general direction is gradually shifted from the front to the lateral side, and the front and back side of the stroke is curved "C". The vertical segment of the facial nerve is the most curved. The large position is about 6.28mm at the foot of the anvil.
2. there were 1 sides of the nerve horizontal segment of the bone canal; the 2 sides of the vertical segment of the nerve affected the exposure of the niches of the round window; the 2 side of the tympanic nerve was emitted from the stem of the mammary gland; the variation of the multiple branches of the 1 side of the tympanic nerve: the variation of the 1 round window niches.
3. the distance between the posterior upper spine and the short foot of the anvil was (12.44 + 1.58) mm (8.35 ~ 14.46mm), the distance between the emit point of the cord to the stem mammary hole was (2.67 + 1.50) mm (0 to 5.22mm), the distance between the short foot of the incus and the point of the tympanus nerve was (15.22 + 2.67) mm (10.35 ~ 20.24mm), and the width of the facial nerve recess to the short foot of the anvil The distance was (6.28 + 1.27) mm (4.23 ~ 8.88mm), the width of the facial nerve recess was (9.81 + 2.16) mm (5.55 ~ 13.76mm), the maximum width of the facial nerve recess was (2.73 + 0.64) mm (1.61 to 4.01mm), the width of the saphenous fossa of the stapes' horizontal plane was (2.48 + 0.68) mm (1.42 ~ 3.70mm), and the level of the circular window was the level of the facial nerve. The width of the recess is (2.24 + 0.61) mm (1.28 ~ 3.33mm), the distance between the pyramid and the front of the circular window membrane is (2.22 + 0.70) mm (1.46 ~ 4.16mm); the distance between the stapes and the lower edge of the round window membrane is (2.16 + 0.48) mm (1.24 to 2.88mm); the distance between the short foot to the round window niche is (5.91 + 0.84) mm (4.49 ~ 8.02mm), and the stapes bone to the round window niche is the distance between the incus short feet to the round window niche. The distance between them was (2.11 + 0.58) mm (3.31 ~ 3.79mm), the distance between the vertical segment of the facial nerve and the round window niche was (6.70 + 0.61) mm (5.02 ~ 7.78mm), the nearest distance between the drum step entrance and the oval window was (2.12 + 0.56) mm (1.24 to 3.43mm), the distance between the spoon process and the round window niche was (3.79 + 0.56) mm (3.07 ~ 5.23mm), and the stapes bone to the cochlea second back cut. The distance between the opening points was (2.25 +0.43) mm (1.35-2.93 mm) and the distance between the cone protuberance and the second turning of the cochlea was (2.28 +0.62) mm (1.54-4.09 mm).
Conclusion: during the implantation of the cochlear implant with facial nerve recess, the location of the facial nerve recess is the key to the operation, which is related to the success of the operation. The injury of the facial nerve is one of the most serious complications in the cochlear implantation. The maximum probability of injury to the facial nerve and the tympane nerve in the incision of the facial nerve recess was the most likely to open and open the starting position of the facial nerve recess. The stapes bone, the conical bulge is the posterior tympanum which is relatively easy to find and relatively constant, when the recess of the round window is unexposed or unexposed and the cochlear ossification is not exposed. In the case of the case, the stapes bone can be referred to the cones to locate the drum step entrance. The relevant data of this study can provide theoretical reference for avoiding the important structural damage of the facial nerve, the tympani nerve, and the accurate location of the drum entrance during the cochlear implant surgery of the facial recess approach.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R764
本文編號：2169458
[Abstract]:Objective: To observe and measure the anatomical structure of the facial nerve recess and the posterior tympanic cavity related to the cochlear implantation, and provide a theoretical reference for avoiding the facial nerve, tympani nerve and so on in the cochlear implantation.
Materials: 20 sides of the Chinese temporal bone wet specimens soaked by formalin, including 7 women (14 ears), 3 males (6 ears), were all adult specimens, all had no middle ear malformation and disease (confirmed in the study). The specimens were from the Department of anatomy teaching and research in Southern Medical University and Department of Neurosurgery, Zhujiang Hospital. Measurement tools: homemade stapes measuring apparatus, Drawing with a long needle gauge, electronic vernier caliper (accuracy 0.01 mm), Leica otology surgery microscope, otology surgery electric drill, otology microsurgical instruments.
Method:
1. the experimental procedure: after the ear incision, the soft tissue and periosteum were stripped and the mastoid was exposed. The posterior wall of the external auditory canal was retained, the posterior wall of the external auditory canal was retained, the anvil short foot was exposed, the vertical segment of the facial nerve (the bone canal) and the tympanum nerve were worn, and the posterior arch was retained. The facial nerve recess was cut in the vertical segment of the facial nerve and the tympani nerve, and the posterior tympanic cavity was entered and the incus stapes joint was exposed. Conical protruding, stapes tendon, round window niche, round window and so on. Then grinding the post arch column, removing the anvil, exposing the horizontal segment of the facial nerve (grinding the bone tube) and the spoon process; grinding the low round window niche, exposing the circular window film fully, setting the drum step after the round window film, and drilled the drum order before the round window membrane. Cochlear second times above the base of the cochlear. The measurement indexes before the experiment were measured in each step.
2. main indicators: the distance between the posterior upper spine and the short foot of the anvil, the distance between the emit point of the tympani and the orifice of the stem, the distance between the short foot of the anvil and the point of the tympani nerve, the distance between the widest part of the nerve recess and the short foot of the anvil, the distance between the widest part of the facial nerve recess and the point of the tympani nerve, and the facial deity The width of the recess, the width of the facial nerve recess (the level of the stapes), the width of the facial nerve recess (the level of the round window), the distance between the cones and the front of the round window membrane, the distance between the stapes and the lower edge of the round window membrane, the distance between the short feet of the incus and the niches of the round window, the distance between the stapes and the niches of the round window, the vertical segment of the facial nerve and the niches of the round window. Distance, the distance between the entrance of the drum and the nearest distance of the oval window, the distance between the spoon and the round window niche, the distance between the second incised points of the stapes and the cochlea, and the distance between the conical protruding and the second back incised point of the cochlea.
3. the selection of the measuring point: the tip of the posterior upper spine of the external auditory canal was measured at the point of the tip; the short foot of the anvil was measured at the tip of the short foot of the anvil; the stem lacteal hole was measured with the orifice of the mammary hole in the mastoid cavity; the round window niche was measured at the lower edge of the upper lip of the round window niche; the vertical segment of the facial nerve was measured at the front edge of the vertical segment of the facial nerve; the conical uplift was a conical bone. The front edge of the circular window membrane is measured by the vertical tangent line of the front edge of the circular window membrane; the lower edge of the circular window membrane is measured by the vertical tangent line of the lower edge of the circular window membrane; the width of the facial nerve recess refers to the shortest distance from the plane facial nerve to the drum nerve; the spoon process is the measuring point with the spoonful edge of the lower edge; the drum step entrance is under the base film starting point under the basement membrane. The margin is the measuring point; the oval window is measured at the bottom of the oval window, and the second point of the cochlea is measured at the lower edge of the base membrane of the second basilar membrane. The distance between the vertical section of the facial nerve to the round window niche (the posterior lip of the rear lip) refers to the minimum linear distance between the two.
4. statistical treatment: the average value of all measured data was taken for 3 times. The average value was processed by SPSS13.0 software. The results were expressed with the average number of standard deviation, and the range of measurement was listed.
Result:
The vertical section of the 1. facial nerve is not a straight line vertical downward, but an arched arc from the back to the outside, and then from the inside to the Stemal hole out of the temporal bone, thus forming the maximum position of the vertical segment of the facial nerve. The general direction is gradually shifted from the front to the lateral side, and the front and back side of the stroke is curved "C". The vertical segment of the facial nerve is the most curved. The large position is about 6.28mm at the foot of the anvil.
2. there were 1 sides of the nerve horizontal segment of the bone canal; the 2 sides of the vertical segment of the nerve affected the exposure of the niches of the round window; the 2 side of the tympanic nerve was emitted from the stem of the mammary gland; the variation of the multiple branches of the 1 side of the tympanic nerve: the variation of the 1 round window niches.
3. the distance between the posterior upper spine and the short foot of the anvil was (12.44 + 1.58) mm (8.35 ~ 14.46mm), the distance between the emit point of the cord to the stem mammary hole was (2.67 + 1.50) mm (0 to 5.22mm), the distance between the short foot of the incus and the point of the tympanus nerve was (15.22 + 2.67) mm (10.35 ~ 20.24mm), and the width of the facial nerve recess to the short foot of the anvil The distance was (6.28 + 1.27) mm (4.23 ~ 8.88mm), the width of the facial nerve recess was (9.81 + 2.16) mm (5.55 ~ 13.76mm), the maximum width of the facial nerve recess was (2.73 + 0.64) mm (1.61 to 4.01mm), the width of the saphenous fossa of the stapes' horizontal plane was (2.48 + 0.68) mm (1.42 ~ 3.70mm), and the level of the circular window was the level of the facial nerve. The width of the recess is (2.24 + 0.61) mm (1.28 ~ 3.33mm), the distance between the pyramid and the front of the circular window membrane is (2.22 + 0.70) mm (1.46 ~ 4.16mm); the distance between the stapes and the lower edge of the round window membrane is (2.16 + 0.48) mm (1.24 to 2.88mm); the distance between the short foot to the round window niche is (5.91 + 0.84) mm (4.49 ~ 8.02mm), and the stapes bone to the round window niche is the distance between the incus short feet to the round window niche. The distance between them was (2.11 + 0.58) mm (3.31 ~ 3.79mm), the distance between the vertical segment of the facial nerve and the round window niche was (6.70 + 0.61) mm (5.02 ~ 7.78mm), the nearest distance between the drum step entrance and the oval window was (2.12 + 0.56) mm (1.24 to 3.43mm), the distance between the spoon process and the round window niche was (3.79 + 0.56) mm (3.07 ~ 5.23mm), and the stapes bone to the cochlea second back cut. The distance between the opening points was (2.25 +0.43) mm (1.35-2.93 mm) and the distance between the cone protuberance and the second turning of the cochlea was (2.28 +0.62) mm (1.54-4.09 mm).
Conclusion: during the implantation of the cochlear implant with facial nerve recess, the location of the facial nerve recess is the key to the operation, which is related to the success of the operation. The injury of the facial nerve is one of the most serious complications in the cochlear implantation. The maximum probability of injury to the facial nerve and the tympane nerve in the incision of the facial nerve recess was the most likely to open and open the starting position of the facial nerve recess. The stapes bone, the conical bulge is the posterior tympanum which is relatively easy to find and relatively constant, when the recess of the round window is unexposed or unexposed and the cochlear ossification is not exposed. In the case of the case, the stapes bone can be referred to the cones to locate the drum step entrance. The relevant data of this study can provide theoretical reference for avoiding the important structural damage of the facial nerve, the tympani nerve, and the accurate location of the drum entrance during the cochlear implant surgery of the facial recess approach.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R764
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