正常额窦引流通道的三维CT研究

3D computed tomographic study of frontal sinus drainage pathway in volunteers without frontal sinus disease

目的研究正常额窦引流通道的三维CT影像解剖学特征。方法对51例健康成人(102侧),采用16排螺旋CT扫描,层距0．300 mm,层厚0．625 mm,使用三维重建技术,观察额窦引流通道毗邻气房分布、钩突附着情况、测量额窦引流通道不同径线。结果1～4型额气房、1型额气房、眶上筛房、泡状中甲的出现率没有显著性差异(P＞0．05)。额窦中隔气房、终末隐窝的出现率有显著性差异(P＜0．05)。双侧额窦引流通道各径线,除额隐窝左-右径有统计学差异外(P＜0．05),其余各组间差异均没有显著性(P＞0．05)。钩突顶端同时附着于眶纸板和中鼻甲(垂直板)的为82．35%,同时附着于中鼻甲(垂直板)和颅底的为17．65%。钩突的顶端与中鼻甲之间总有骨性连接,钩突与中鼻甲(垂直板)之间有第二骨性连接的达55．88%。钩突的顶端与眶纸板之间骨性连接有0～4个不等,分别占0．98%、7．84%、68．63%、21．57%、1．96%。当钩突的顶端与眶纸板之间骨性连接的个数≤1个的时候,观察不到鼻丘气房的存在。结论以三维影像解剖为基础,构建额窦引流通道毗邻空间立体构象,正确的认识额窦引流通道,有助于个性化地选择鼻内镜下额窦开放术式,提高手术的成功率。

OBJECTIVE To study the related structures with frontal sinus drainage passway. （FSDP）in volunteers without： frontal sinus disease. METHODS 0.625 mm spiral CT scans were taken in 51（102sides）adult volunteers＇heads and then studied with Centricity Radiology RA 600 V7.0 software （GE Medical Systems, U.S） that provides continuous coronal, sagittal, and axial sections.The following aspects were studied： 1. The anteroposterior and transverse diameters of the FR ostium and FSDP; 2. Variations of the uncinate process＇superior attachment and their frequency; 3. The prevalence of the agger nasi cells, frontal cells, supraorbital ethmoid cell, frontal bullar cell, interfrontal sinus septal cell, recessus terminalis. RESULTS We identified： 1. The anterior, posterior, medial, and lateral boundaries of the FR and FSDP; 2. There were no statistically differences in the frequency of frontal cell （total and type 1）, supraorbital ethmoid cell and concha bullosa between R- and L- side, and there were statistiically differences in the frequency of interfrontal sinus septal cell, recessus terminalis between R- and L- side. There were no statistically differences in the anteroposterior and transverse diameters of the FR ostium and FSDP except the transverse diameters of frontal recess between R- and L- side. 3. The uncinate process＇main superior attachment into the surrounding structures was found to have the following distribution： 82.35 % to the lamina papyracea and the middle turbinate, 17.65 % to the skull base and the middle turbinate. The uncinate process＇ attachment with the lamina papyracea ranged from 0-4 points（0.98 %, 7.84 %, 68.63 %, 21.57 % and 1.96 % respectively）. When the junction point less than 1, absence of agger nasi cell occurred. CONCLUSION To widen the frontal sinus drainage pathway, CT scans to create a 3-dimensional picture of the cellular structure of this region in needed, which allows surgeons to formulate a step-wise surgical plan prior to surgery and encourages cell-by-cell removal of the obstructing cells during surgery. This improved understanding of the anatomy of this complex region should allow the surgeon to perform a competent and complete dissection with improved results.