CAJ | 학술논문

目的：构建岩尖虚拟现实三维解剖模型，探讨颞下入路显露过程中的微创策略。方法对15例尸体头颅进行头颅C T和M RI扫描后获得影像数据，在虚拟现实系统中利用影像数据建模。在颅盖和颅底中选择骨性标志点模拟颞下入路显露岩尖的手术路径，缩小手术路径体积进行微创设计，观察测量和比较微创化过程中路径中解剖结构的显露情况。结果虚拟现实模型清晰显示颞下入路显露岩尖的手术路径中所包含的骨性和神经血管结构。伴随路径微创化，手术路径a、b、c和路径中所包含骨性结构、颞叶、三叉神经和静脉的体积逐渐减小，路径a显露面听神经复合体、岩浅大神经和迷路的体积多于路径 b ，上述差异均有统计学意义（P ＜0．01）。仅路径 a显露岩骨内颈内动脉。结论在颞下入路显露岩尖的手术路径微创化过程中，计算机虚拟现实技术能够提供客观量化数据。该入路方向固定时，路径范围缩小导致手术创伤和靶点显露随之缩小，为手术微创化提供指导信息。
목적：구건암첨허의현실삼유해부모형，탐토섭하입로현로과정중적미창책략。방법대15례시체두로진행두로C T화M RI소묘후획득영상수거，재허의현실계통중이용영상수거건모。재로개화로저중선택골성표지점모의섭하입로현로암첨적수술로경，축소수술로경체적진행미창설계，관찰측량화비교미창화과정중로경중해부결구적현로정황。결과허의현실모형청석현시섭하입로현로암첨적수술로경중소포함적골성화신경혈관결구。반수로경미창화，수술로경a、b、c화로경중소포함골성결구、섭협、삼차신경화정맥적체적축점감소，로경a현로면은신경복합체、암천대신경화미로적체적다우로경 b ，상술차이균유통계학의의（P ＜0．01）。부로경 a현로암골내경내동맥。결론재섭하입로현로암첨적수술로경미창화과정중，계산궤허의현실기술능구제공객관양화수거。해입로방향고정시，로경범위축소도치수술창상화파점현로수지축소，위수술미창화제공지도신식。
Objective To construct three-dimensional anatomical model of petrous apex virtual reality and discuss the minimally invasive strategy for exposure of petrous apex through subtemporal ap‐proach .Methods Obtaining image data from 15 cases of cadaver heads with head CT and MRI scanning , which was used to establish model in the virtual reality system .Osseous landmark points on the calvaria and skull base were selected to simulate subtemporal approach for exposure of petrous apex .Minimally invasive design was performed by reducing the volume of approach .Changes of anatomy exposures were observed ,measured and compared following minimally invasive design .Results Virtual reality model could clearly show bone and neurovascular structures as subtemporal approach for exposure of petrous a‐pex .Following minimally invasive design ,volumes of surgical route a ,b ,c and osseous structures , temporal lobe ,trigeminal nerve and vein decreased gradually .Volumes of facial -acoustic nerve com‐plex ,greater superficial petrous nerve and labyrinth in road a were more than those in road b .There differences were statistically significant (P< 0 .01) .The differences of above items reached statistical significance .Petrous segment of internal carotid artery only displayed in road a .Conclusions During the minimally invasive design of subtemporal approach exposing petrous apex ,computed virtual reality skill can provide quantitative and objective data .When fixing the approach direction ,narrow path leading to surgical trauma and targets shrunk ,providing guidance for the minimally invasive surgery .