乙状窦后入路骨瓣开颅应用解剖学研究

Applied Anatomic Study of the Craniotomy via Retrosigmoid Approach

目的对乙状窦后入路的骨瓣设计进行改良研究,寻找一种安全、快速、有效、并发症少的骨瓣开颅技术。材料成人颅骨标本10例,福尔马林固定尸头标本15例,新鲜头颅标本3例。高速磨钻。电动开颅钻。照像器械:Sony S-75数码相机。Leica M500-N,Opton手术显微镜。方法确定横窦和乙状窦的交界内下缘(A点)和星点(枕乳缝和人字缝交叉点,S点)的解剖关系;乙状窦垂直部和水平部交汇处内下缘(B点)和枕乳缝乳突基底水平处(C点)的关系。测量A-S和B-C点的距离。在距星点内侧3cm处横窦的下缘钻孔M点,测量星点和枕外粗隆-星点连线的垂直距离。结果1.横窦和乙状窦交点的位于星点外下方,横断面上,平均距离为10.8±1.1mm。在矢状位方向,平均距离为3.5±0.7mm。且颅骨和头颅标本无明显的统计学差异。2.乙状窦水平段和垂直段交点(B点)位于乳突基底水平枕乳缝点(C点)的外下方,在横断面上平均距离5.8±1.8mm。矢状位方向距离为8.4±0.8mm.头颅标本所测得的数据和颅骨的数据在统计学上无显著差异。3星点内侧3cm处横窦下缘(M点)和枕外粗隆-星点连线的垂直距离(M-P)左右存在差异,左侧1.2±0.3mm,右侧4.2±0.4mm.右侧高于左侧。结论行乙状窦后入路骨瓣开颅时,取星点外下方、枕乳缝乳突基底外下方为钻孔点是安全、快速的方法;在横窦下方钻孔时要注意左右横窦高度的。

Objective To make the craniotomy safer, faster and more effective and reduce its postoperative complication by improving the craniotomy via retrosigmoid approach. Methods Twenty-eight cadaveric heads of adult （10 skulls, 15 embalmed cadaveric heads and 3 fresh cadaveric heads） were operated to determine the anatomic relationship between the point A （the medial and inferior border of the intersection for the sigmoid sinus and the transverse sinus）and the point S （the asterion）, the point B （the medial and inferior border of the intersection for the perpendicular and the horizontal of sigmoid sinus）and the point C （the fundus of the mastoid process of the occipitomastoid suture）, and the point M（the point which was 3cm to the medial border of asterion at the inferior border of the transverse sinus） to the line P （the line between the protuberantia occipitalis externa and the asterion）. Then the distance from point A to point S, point B to point C and the perpendicular distance from point M to the line P were measured, repectively. Results The point A located laterally and inferiorly to the point S, the mean distance between them was 10. 8± 1. lmm on the transverse plane and 3.5±0. 7mm on the sagittal plane, respectively. The point B located laterally and inferiorly to the point C, the mean distance between them was 5.8± 1.8mm on the transverse plane and 8.4±0. 8mm on the sagittal plane, respectively. There was no significant difference between the data from the skulls and the cadaveric heads. The length of the point M to the line P was 1.2±0. 3mm on the left and 4. 2±0. 4mm on the right,there were significant differ-ences between them and the right was higher than the left. Conclusion It is safe and fast when the lateral two holes were drilled laterally and inferiorly to the point S and the point C in the craniotomy via ret.rosigmoid approach. Meanwhile,more attention should be paid to the different heights of the lateral sinus on both sides when drilling.