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
[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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