【摘要】：目的： 通過顳骨高分辨率CT(HRCT)圖像觀察、手術(shù)中觀察及三維重建闡明錐上間隙的位置、發(fā)生率、形態(tài)學(xué)特點,以期有助于慢性中耳炎患者面神經(jīng)的術(shù)中定位和識別。 方法： 收集300例慢性中耳炎患者術(shù)前顳骨HRCT圖像,對錐上間隙進(jìn)行術(shù)中觀察和HRCT圖像觀察,確定錐上間隙的出現(xiàn)率和位置；對錐上間隙及其周圍解剖結(jié)構(gòu)進(jìn)行三維重建,確定錐上間隙與面神經(jīng)的關(guān)系。收集同期無明確耳部疾病行顳骨HRCT檢查的門診病人的顳骨HRCT圖像資料160例作為對照組,對錐上間隙進(jìn)行HRCT圖像觀察。 結(jié)果： 手術(shù)組,在68.3%(205例)病人的術(shù)中觀察到了錐上間隙,錐上間隙通常是后鼓室面隱窩骨壁上面神經(jīng)錐曲段表面唯一的一個氣房或者如果周圍有小氣房存在的話也是該區(qū)域氣房中最大的一個,其位置在：面神經(jīng)管錐曲段外側(cè),后鼓環(huán)內(nèi)側(cè),砧骨窩和鼓竇入口下方,鼓索嵴上方。錐上間隙的形態(tài)大致可分為：類圓形(11.7%,35例)、彎桿狀(52.7%,158例)和不規(guī)則形(4%,12例)。對照組,錐上間隙的觀察率為76%(122例),與手術(shù)組差異無統(tǒng)計學(xué)意義(p0.05)。顳骨HRCT對錐上間隙診斷的靈敏度和特異度分別為：79.0%和88.4%。 結(jié)論： 錐上間隙是否出現(xiàn)及形態(tài)如何都不是確定的,但錐上間隙和面神經(jīng)管錐曲段的位置關(guān)系是相對確定的,因此,錐上間隙可以作為中耳術(shù)中面神經(jīng)管錐曲段定位的一個新的解剖標(biāo)志。顳骨HRCT圖像對于錐上間隙的診斷價值是有限的,尤其當(dāng)該間隙不典型時。
[Abstract]:Objective: to investigate the location, incidence and morphological features of the superior cone space by observing and reconstructing the temporal bone with high resolution CT (HRCT) images, so as to help the location and recognition of the facial nerve in the patients with chronic otitis media. Methods: HRCT images of temporal bone were collected from 300 patients with chronic otitis media before operation. Intraoperative and HRCT images were observed to determine the occurrence rate and location of the supraconical space. The three dimensional reconstruction of the superior cone space and its surrounding anatomical structure was carried out to determine the relationship between the superior cone space and the facial nerve. The data of HRCT images of temporal bone of outpatients who had no definite HRCT examination of temporal bone in the same period were collected as control group. The HRCT images of the superior cone space were observed. Results: in the operation group, the supraconical space was observed in 68.3% (205 cases) of patients. The space above the cone is usually the only gas chamber on the surface of the conical segment of the facial nerve on the posterior tympanic surface of the recess, or, if there are any small chambers around it, the largest of the gas chambers in the region, which is located on the outside of the conical segment of the facial nerve tube. The medial posterior tympanic ring, incus fossa and inferior entrance of the tympanic sinus, above the crest of the tympanic cord. The shape of the supraconical space can be roughly divided into three types: round shape (11.710%), curved rod shape (52.7%) and irregular shape (4 cases). In the control group, the observation rate of the superior cone space was 76% (122 cases), and there was no significant difference between the operation group and the operation group (p0.05). The sensitivity and specificity of HRCT in the diagnosis of supraconical space were 79.0% and 88.4%, respectively. Conclusion: the appearance and shape of the superior cone space are uncertain, but the position relationship between the superior cone space and the conical segment of the facial canal is relatively certain. The superior cone space can be used as a new anatomic marker for the location of the conical segment of the facial nerve canal during middle ear operation. HRCT images of temporal bone are of limited value in the diagnosis of supraconical space, especially when the space is not typical.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R764.21

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 陳兵;;術(shù)中面神經(jīng)定位及醫(yī)源性面癱的預(yù)防[J];中國眼耳鼻喉科雜志;2009年05期

2 遲放魯;王t，

本文編號：2327791