中华整形外科杂志
中華整形外科雜誌
중화정형외과잡지
CHINESE JOURNAL OF PLASTIC SURGERY
2011年
3期
217-221
,共5页
韩娟%卢九星%邢宁%林琳%蒋海越%庄洪兴
韓娟%盧九星%邢寧%林琳%蔣海越%莊洪興
한연%로구성%형저%림림%장해월%장홍흥
小耳畸形%解剖学%横断面
小耳畸形%解剖學%橫斷麵
소이기형%해부학%횡단면
Microtia%Anatomy,cross-sectional
目的 通过对先天性小耳患者外、中耳的畸形断面影像解剖学特征的系统研究,比较其与正常解剖之间的差异,总结重要解剖结构的变异规律及相互关系,以利于临床分型及手术治疗.方法 选取2009年6月至12月中国医学科学院整形外科医院外耳整形中心住院诊断为小耳畸形的36例患者,采用自身对照研究.研究组50只耳,其中单侧畸形22例22只,双侧畸形14例28只;对照组为单侧畸形之健侧耳22例22只.行螺旋CT颞骨高分辨扫描,应用Mimics软件,生成冠状位、矢状位图像及三维重建图像,进行距离和角度的测量.结果 小耳畸形患者以Max分型,鼓室前后径Ⅰ、Ⅱ、Ⅲ型分别为(7.75±1.92)mm、(6.17±2.56)mm、(6.31±3.40)mm(F=5.777,P=0.001);鼓室上下径Ⅰ、Ⅱ、Ⅲ型分别为(14.66±4.75)mm、(14.35±5.12)mm、(9.97±4.36)mm(F=6.601,P=0.001);3型小耳畸形乳突气化程度分别为硬化型13.33%、13.64%、30.77%,板障型13.33%、18.18%、7.69%,混合型0、9.09%、38.46%,气化型73.33%、59.09%、23.08%(x2=24.11,P=0.002);面神经遮盖前庭窗的发生率分别为21.43%、47.62%、54.55%(x2=23.44,P=0.002).研究组与对照组间差异有统计学意义.结论 小耳畸形根据Max分型,具有随耳廓畸形程度增加,中耳畸形程度亦增加的趋势,其中Ⅱ型小耳的解剖结构变异复杂,可进行亚分型.
目的 通過對先天性小耳患者外、中耳的畸形斷麵影像解剖學特徵的繫統研究,比較其與正常解剖之間的差異,總結重要解剖結構的變異規律及相互關繫,以利于臨床分型及手術治療.方法 選取2009年6月至12月中國醫學科學院整形外科醫院外耳整形中心住院診斷為小耳畸形的36例患者,採用自身對照研究.研究組50隻耳,其中單側畸形22例22隻,雙側畸形14例28隻;對照組為單側畸形之健側耳22例22隻.行螺鏇CT顳骨高分辨掃描,應用Mimics軟件,生成冠狀位、矢狀位圖像及三維重建圖像,進行距離和角度的測量.結果 小耳畸形患者以Max分型,鼓室前後徑Ⅰ、Ⅱ、Ⅲ型分彆為(7.75±1.92)mm、(6.17±2.56)mm、(6.31±3.40)mm(F=5.777,P=0.001);鼓室上下徑Ⅰ、Ⅱ、Ⅲ型分彆為(14.66±4.75)mm、(14.35±5.12)mm、(9.97±4.36)mm(F=6.601,P=0.001);3型小耳畸形乳突氣化程度分彆為硬化型13.33%、13.64%、30.77%,闆障型13.33%、18.18%、7.69%,混閤型0、9.09%、38.46%,氣化型73.33%、59.09%、23.08%(x2=24.11,P=0.002);麵神經遮蓋前庭窗的髮生率分彆為21.43%、47.62%、54.55%(x2=23.44,P=0.002).研究組與對照組間差異有統計學意義.結論 小耳畸形根據Max分型,具有隨耳廓畸形程度增加,中耳畸形程度亦增加的趨勢,其中Ⅱ型小耳的解剖結構變異複雜,可進行亞分型.
목적 통과대선천성소이환자외、중이적기형단면영상해부학특정적계통연구,비교기여정상해부지간적차이,총결중요해부결구적변이규률급상호관계,이리우림상분형급수술치료.방법 선취2009년6월지12월중국의학과학원정형외과의원외이정형중심주원진단위소이기형적36례환자,채용자신대조연구.연구조50지이,기중단측기형22례22지,쌍측기형14례28지;대조조위단측기형지건측이22례22지.행라선CT섭골고분변소묘,응용Mimics연건,생성관상위、시상위도상급삼유중건도상,진행거리화각도적측량.결과 소이기형환자이Max분형,고실전후경Ⅰ、Ⅱ、Ⅲ형분별위(7.75±1.92)mm、(6.17±2.56)mm、(6.31±3.40)mm(F=5.777,P=0.001);고실상하경Ⅰ、Ⅱ、Ⅲ형분별위(14.66±4.75)mm、(14.35±5.12)mm、(9.97±4.36)mm(F=6.601,P=0.001);3형소이기형유돌기화정도분별위경화형13.33%、13.64%、30.77%,판장형13.33%、18.18%、7.69%,혼합형0、9.09%、38.46%,기화형73.33%、59.09%、23.08%(x2=24.11,P=0.002);면신경차개전정창적발생솔분별위21.43%、47.62%、54.55%(x2=23.44,P=0.002).연구조여대조조간차이유통계학의의.결론 소이기형근거Max분형,구유수이곽기형정도증가,중이기형정도역증가적추세,기중Ⅱ형소이적해부결구변이복잡,가진행아분형.
Objective To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery. Methods From Jun. to Dec. 2009,36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured. Results The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7. 75 ± 1. 92) mm and ( 14. 66 ± 4. 75 ) mm for type Ⅰ ; (6.17±2.56) mm and(14. 35 ±5. 12) mm for type Ⅱ ; (6. 31 ±3. 40) mm and (9.97 ±4.36) mm for type Ⅲ ( P = 0.001). The mastoid pneumatization degree for type Ⅰ , Ⅱ , Ⅲ were 13.33% , 13.64% ,30.77% in sclerotic type, 13. 33% , 18. 18 % , 7. 69% in diploetic type, 0, 9. 09% , 38. 46% in composite type,73. 33% ,59. 09% ,23. 08% in pneumatic type(x2 = 24. 11 ,P = 0. 002 ). The cover of fenestra vestibuli by facial nerve was 21. 43% ,47.62%, 54.55% (x2 =23.44, P = 0. 002 ) for type Ⅰ , Ⅱ , Ⅲ. There was a statistical difference between the microtia group and the control group. Conclusions According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type Ⅱ microtia, which should be sub-classified.
