中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2012年
1期
13-18
,共6页
颞骨%体层摄影术,X线计算机%解剖学,局部%耳外科手术
顳骨%體層攝影術,X線計算機%解剖學,跼部%耳外科手術
섭골%체층섭영술,X선계산궤%해부학,국부%이외과수술
Temporal bone%Tomography,X-ray computed%Anatomy,regional%Otologic surgical procedures
目的 探讨双斜面CT MPR重组技术对面神经隐窝进路手术中关键手术剖面涉及到的解剖标志同层显示的可行性及方法.方法 在尸体头颅标本上观察面神经隐窝入路手术中涉及到的关键手术剖面及相关解剖标志,利用双斜面MPR重组技术,对30具(60侧)完整的成年国人尸体头颅标本进行关键手术剖面重组,对比手术剖面主要解剖标志观察结果,对4个不同方位图像(横断面、冠状面、矢状面及双斜矢状面)同层显示主要解剖标志的程度进行分级评价.主要手术解剖标志同层显示为100％者记为4级、显示为90％～99％记为3级、显示为80％～89％记为2级、显示70％～79％记为l级,显示＜70％记为0级.对所得资料行x2检验.结果 面神经隐窝入路手术中涉及到4层关键手术剖面,均为斜矢状面.4层关键手术剖面双斜面MPR重组的旋转中心标志点分为水平半规管、砧骨窝、锥隆起及圆窗后缘；重组水平参考轴线及水平旋转角度分别为砧骨短突及22.15° ±5.22°、砧骨短突及20.15°±5.52°、面神经水平段及32.53°±5.22°、卵圆窗上缘及50.15°±8.02°；重组垂直参考轴线均为面神经垂直段,垂直旋转角度分别为14.35°±4.02°、13.15°±3.33°、15.05° ±4.43°及15.25°±4.12°.对于主要解剖标志同层显示的程度,在第1层关键手术剖面中,双斜矢状面为4级60侧,横断面为2级12侧、3级48侧,冠状面为2级15侧、3级45侧,矢状面为3级10侧、4级50侧；第2层关键手术剖面中,双斜矢状面为4级60侧,横断面为2级11侧、3级49侧,冠状面为2级13侧、3级47侧,矢状面为3级11侧、4级49侧；第3层关键手术剖面中,双斜矢状面为4级60侧,横断面为2级10侧、3级50侧,冠状面为2级11侧、3级49侧,矢状面为3级9侧、4级51侧；第4层关键手术剖面中,双斜矢状面为4级60侧,横断面为2级9侧、3级51侧,冠状面为2级8侧、3级52侧,矢状面为3级5侧、4级55侧；4层关键手术剖面解剖标志同层显示在不同方位图像显示程度差异均有统计学意义(x2值分别为123.3200、121.4231、122.4011、125.4213,P值均＜0.05);4层关键手术剖面解剖标志双斜面同层显示成功率均为100％(60/60侧).结论 双斜面MPR重组技术可清晰同层显示面神经隐窝径路手术剖面相关解剖标志,能为术者提供更有使用价值的影像学信息.
目的 探討雙斜麵CT MPR重組技術對麵神經隱窩進路手術中關鍵手術剖麵涉及到的解剖標誌同層顯示的可行性及方法.方法 在尸體頭顱標本上觀察麵神經隱窩入路手術中涉及到的關鍵手術剖麵及相關解剖標誌,利用雙斜麵MPR重組技術,對30具(60側)完整的成年國人尸體頭顱標本進行關鍵手術剖麵重組,對比手術剖麵主要解剖標誌觀察結果,對4箇不同方位圖像(橫斷麵、冠狀麵、矢狀麵及雙斜矢狀麵)同層顯示主要解剖標誌的程度進行分級評價.主要手術解剖標誌同層顯示為100％者記為4級、顯示為90％～99％記為3級、顯示為80％～89％記為2級、顯示70％～79％記為l級,顯示＜70％記為0級.對所得資料行x2檢驗.結果 麵神經隱窩入路手術中涉及到4層關鍵手術剖麵,均為斜矢狀麵.4層關鍵手術剖麵雙斜麵MPR重組的鏇轉中心標誌點分為水平半規管、砧骨窩、錐隆起及圓窗後緣；重組水平參攷軸線及水平鏇轉角度分彆為砧骨短突及22.15° ±5.22°、砧骨短突及20.15°±5.52°、麵神經水平段及32.53°±5.22°、卵圓窗上緣及50.15°±8.02°；重組垂直參攷軸線均為麵神經垂直段,垂直鏇轉角度分彆為14.35°±4.02°、13.15°±3.33°、15.05° ±4.43°及15.25°±4.12°.對于主要解剖標誌同層顯示的程度,在第1層關鍵手術剖麵中,雙斜矢狀麵為4級60側,橫斷麵為2級12側、3級48側,冠狀麵為2級15側、3級45側,矢狀麵為3級10側、4級50側；第2層關鍵手術剖麵中,雙斜矢狀麵為4級60側,橫斷麵為2級11側、3級49側,冠狀麵為2級13側、3級47側,矢狀麵為3級11側、4級49側；第3層關鍵手術剖麵中,雙斜矢狀麵為4級60側,橫斷麵為2級10側、3級50側,冠狀麵為2級11側、3級49側,矢狀麵為3級9側、4級51側；第4層關鍵手術剖麵中,雙斜矢狀麵為4級60側,橫斷麵為2級9側、3級51側,冠狀麵為2級8側、3級52側,矢狀麵為3級5側、4級55側；4層關鍵手術剖麵解剖標誌同層顯示在不同方位圖像顯示程度差異均有統計學意義(x2值分彆為123.3200、121.4231、122.4011、125.4213,P值均＜0.05);4層關鍵手術剖麵解剖標誌雙斜麵同層顯示成功率均為100％(60/60側).結論 雙斜麵MPR重組技術可清晰同層顯示麵神經隱窩徑路手術剖麵相關解剖標誌,能為術者提供更有使用價值的影像學信息.
목적 탐토쌍사면CT MPR중조기술대면신경은와진로수술중관건수술부면섭급도적해부표지동층현시적가행성급방법.방법 재시체두로표본상관찰면신경은와입로수술중섭급도적관건수술부면급상관해부표지,이용쌍사면MPR중조기술,대30구(60측)완정적성년국인시체두로표본진행관건수술부면중조,대비수술부면주요해부표지관찰결과,대4개불동방위도상(횡단면、관상면、시상면급쌍사시상면)동층현시주요해부표지적정도진행분급평개.주요수술해부표지동층현시위100％자기위4급、현시위90％～99％기위3급、현시위80％～89％기위2급、현시70％～79％기위l급,현시＜70％기위0급.대소득자료행x2검험.결과 면신경은와입로수술중섭급도4층관건수술부면,균위사시상면.4층관건수술부면쌍사면MPR중조적선전중심표지점분위수평반규관、침골와、추륭기급원창후연；중조수평삼고축선급수평선전각도분별위침골단돌급22.15° ±5.22°、침골단돌급20.15°±5.52°、면신경수평단급32.53°±5.22°、란원창상연급50.15°±8.02°；중조수직삼고축선균위면신경수직단,수직선전각도분별위14.35°±4.02°、13.15°±3.33°、15.05° ±4.43°급15.25°±4.12°.대우주요해부표지동층현시적정도,재제1층관건수술부면중,쌍사시상면위4급60측,횡단면위2급12측、3급48측,관상면위2급15측、3급45측,시상면위3급10측、4급50측；제2층관건수술부면중,쌍사시상면위4급60측,횡단면위2급11측、3급49측,관상면위2급13측、3급47측,시상면위3급11측、4급49측；제3층관건수술부면중,쌍사시상면위4급60측,횡단면위2급10측、3급50측,관상면위2급11측、3급49측,시상면위3급9측、4급51측；제4층관건수술부면중,쌍사시상면위4급60측,횡단면위2급9측、3급51측,관상면위2급8측、3급52측,시상면위3급5측、4급55측；4층관건수술부면해부표지동층현시재불동방위도상현시정도차이균유통계학의의(x2치분별위123.3200、121.4231、122.4011、125.4213,P치균＜0.05);4층관건수술부면해부표지쌍사면동층현시성공솔균위100％(60/60측).결론 쌍사면MPR중조기술가청석동층현시면신경은와경로수술부면상관해부표지,능위술자제공경유사용개치적영상학신식.
Objective To explore the method of demonstrating main operative section of facial recess approach with multi-slice CT by using double oblique muttiplanar reconstruction.Methods Similarly as surgical procedure of facial recess approach,30 (60 eras) normal temporal bones in cadavers were reconstructed to observe main operative sections and anatomical marks.Main images of operative section of facial recess approach were reconstructed using double oblique multiplanar reconstruction on multislice CT.With the reference of operative anatomical marks,the ratios of visibility of anatomical marks on the transverse plane,coronal plane,sagittal plane and double oblique were calculated and compared.The degree,of which major anatomical landmarks were displayed on the same plane ( axial,coronal,sagittal,or doubleoblique sagittal plane),was classified using the following criteria: level 4: 100％ of anatomical landmarks were presented in the same plane; level 3: 90％ to 99％ of anatomical landmarks were presented in the same plane; level 2: 80％ to 89％ of anatomical landmarks were presented in the same plane; level 1: 70％ to 79％ of anatomical landmarks were presented in the same plane ; level 0: ＜ 70％ of anatomical landmarks were presented in the same plane.Classification data were tested by chi-square test.Results Four key operative section were involved in facial recess approach,which were of oblique sagittal orientation.The central mark of the first key operative section was semicircular canal by using double oblique multi-planar reformation.On reconstructed images of the first key operative section,horizontal reference line was short process of incus,and the angle adjusting the reference line on the transverse plane was 22.15° ±5.22°.On the reconstructed images of the first key operative section,coronal reference line was tympanic segment of facial canal,and the angle adjusting the reference line on the coronal plane was 14.35° ± 4.02°.On the reconstructed images of the second key operative section,the central mark was fossa incudis,the horizontal reference line was short process of incus and the angle was 20.15° ± 5.52°,while the coronal reference line was tympanic segment of facial cana,and the angle was 13.15° ± 3.33°.On the reconstructed operative images of the third key section,the central mark was pyramidal eminence,the horizontal reference line was the horizontal portion of the facial nerve and the angle was 32.53° ±5.22°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.05° ± 4.43°.On the fourth reconstructed images of the key operative section,the central mark was the posterior border of round window,the horizontal reference line was the superior border of oval window,and the angle was 50.15° ± 8.02°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.25° ± 4.12°.For the four planes (double-oblique sagittal,axial,coronal,or sagittal plane),the results of the degree to which they could include the major anatomical landmarks in the same layer of the first section were: level 4 in 60 sides,level 2 in 12 sides and level 3 in 48 sides,level 2 in 15 sides and level 3 in 45 sides,level 3 in 10 sides and level 4 in 50 sides,respectively.The results of the second section were: level 4 in 60 sides,level 2 in 11 sides and level 3 in 49 sides,level 2 in 13 sides and level 3 in 47 sides,level 3 in 11 sides and level 4 in 49 sides,respectively.The results of the third section were: level 4 in 60 sides,level 2 in 10 sides and level 3 in 50 sides,level 2 in 11 sides and level 3 in 49 sides,level 3 in 9 sides and level 4 in 51 sides,respectively.The results of the fourth section were: level 4 in 60 sides,level 2 in 9 sides and level 3 in 51 sides,level 2 in 8 sides and level 3 in 52 sides,level 3 in 5 sides and level 4 in 55 sides,respectively.The four planes differed significantly in the degree to which they could include the major anatomical landmarks in the same layer ( x2 =123.3200,121.4231,122.4011,125.4213,all,P ＜ 0.05 ).The visibility ratio of every section is 100％ (60/60).Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative section of facial recess approach in one slice.The reconstructive images of operative section with double oblique multi-planer reconstruction may provide valuable information for operation.
