CAJ | 학술논문

目的对于复杂颅前窝的理解对于鼻内镜手术至关重要,在CT三维重建的图像中对嗅沟及邻近结构数据进行测量,应用动态的解剖学的观测有利于医师做出术前精细的手术计划以避免对前颅底的损伤.方法 100例成年人的鼻窦图像在EBW2.0工作站上应用多平面重建技术进行重建,在嗅沟最前端的冠状面对两侧筛板深度及其邻近结构的数据进行测量,邻近结构包括嗅沟的侧板的高度,筛板与同侧眶纸样板的距离,中鼻甲的高度,眼眶的高度,筛板与鼻底的高度.结果嗅沟被划分为有别于KEROS分型的3型:平台型(60%),斜坡型(17%)和混合型(23%).其中平台型嗅沟的侧板的高度为右侧(5.03±0.17)mm,左侧(5.39±0.19)mm;混合型其高度为右侧(2.79±0.49)mm,左侧(4.72±0.49)mm,两型对比左右两侧数据有显著性差异;筛板与同侧眶纸样板的水平距离和筛板与鼻底的垂直距离在平台型和混合型嗅沟之间有显著性差异.该数据在男女性别方面也存在差异.结论不同类型的嗅沟存在不同的特点,在进行鼻内镜手术时需谨慎.
목적 대우복잡로전와적리해대우비내경수술지관중요,재CT삼유중건적도상중대후구급린근결구수거진행측량,응용동태적해부학적관측유리우의사주출술전정세적수술계화이피면대전로저적손상.방법 100례성년인적비두도상재EBW2.0공작참상응용다평면중건기술진행중건,재후구최전단적관상면대량측사판심도급기린근결구적수거진행측량,린근결구포괄후구적측판적고도,사판여동측광지양판적거리,중비갑적고도,안광적고도,사판여비저적고도.결과 후구피화분위유별우KEROS분형적3형:평태형(60%),사파형(17%)화혼합형(23%).기중평태형후구적측판적고도위우측(5.03±0.17)mm,좌측(5.39±0.19)mm;혼합형기고도위우측(2.79±0.49)mm,좌측(4.72±0.49)mm,량형대비좌우량측수거유현저성차이;사판여동측광지양판적수평거리화사판여비저적수직거리재평태형화혼합형후구지간유현저성차이.해수거재남녀성별방면야존재차이.결론 불동류형적후구존재불동적특점,재진행비내경수술시수근신.
OBJECTIVE An understanding of the complex anatomy of the anterior skull base is crucial for the surgeon doing endoscopic surgery. The anatomic data of the olfactory sulcus and adjacent structures in Chinese patients were defined using 3-dimensional reconstruction images. The surgeon is encouraged to develop a detailed pre-operative surgical plan by utilizing these dynamic anatomical observations to avoid intracranial injury. METHODS The paranasal sinus CT scanning images of 100 adults were reconstructed for observation using EBW2.0 software and multiplanar reformation. All data obtained were in the coronal plane from the anterior point of the olfactory sulcus. The cribriform plate depth as compared to the ethmoid roof and adjacent structures, was measured bilaterally. Data obtained on adjacent structures include the vertical height of the lateral lamella of olfactory sulcus, the horizontal distance between the cribriform plate and the orbital lamella, the length of the middle turbinate, the height of the orbit, and the vertical distance between the cribriform plate and the nasal floor. RESULTS The olfactory sulcus was classified into three types: platform type (60 %), sloping type (17 %) and mixed type(23 %), as distinguished from Keros classification. In this study the vertical height of the lateral lamella of olfactory sulcus was (5.03 ± 0.17) mm (R) and (5.39 ± 0.19) mm (L) in platform type, and (2.79 ± 0.49) mm (R) and (4.72 ± 0.49) mm (L) in the mixed type. There were statistically significant differences between the right side and the left side in these two types (P＜0.01). The horizontal distance between the cribriform plate and the orbital lamella on the same side was significantly different between the platform type and the mixed type of olfactory sulcus. A similar result was observed for the vertical distance between the cribriform plate and the nasal floor. Gender differences exist in the horizontal distance between the cribriform plate and orbital lamella on the same side and the vertical distance between the cribriform plate and the nasal floor. CONCLUSION Different types of olfactory sulcus have distinct characteristics, hence care which must be taken into account when doing endoscopic surgery.