颞下-耳前颞下窝入路对颈静脉孔区显露程度的定量研究

Quantitative study of exposure of subtemporal-preauricular infratemporal fossa approach to jugular foramen region

目的定量研究颞下-耳前颞下窝入路各手术步骤对颈静脉孔区的显露程度,为临床个体化的选择手术入路,保护重要结构功能提供可靠的解剖依据。方法选择经10%福尔马林固定的成人头颈湿标本6具(12侧),模拟颞下-耳前颞下窝入路,并分成连续的五个步骤,用脑立体定向仪测定各步骤对颈静脉孔区的显露面积,用游标卡尺测量颈内动脉垂直段的显露长度。结果颞下岩前入路对颈静脉孔区的显露面积为(370.86±123.46)mm2,切除颞下颌关节,移位颈内动脉后显露面积显著增加(P<0.05)。向前移位颈内动脉后,对颈内动脉前壁、侧壁的显露分别增至(13.69±4.54)mm和(12.64±3.84)mm,与切除颞下颌关节间存在显著差异(P<0.05)。结论颞下-耳前颞下窝入路自侧前方显露颈静脉孔区,前移颈内动脉后可显露颈静脉孔前缘,并显著增加对岩斜坡区和颈内动脉垂直段的显露。

Objective To evaluate the subtemporal-preauricular irrfratemporal fossa approach based on quantitative measurement of the exposure of the jugular foramen region obtained by each successive step of the approach. Methods The complete approach to the subtemporal-preauricular infratemporal fossa was reproduced in six （1 2 sides ） cadaveric adult head-neck specimens fixed with 1 0 % formalin. The exposure area to the jugular foramen region was obtained using a stereotactic device, and the length of exposure of the vertical portion of the petrous internal carotid artery （VPCA） was measured using a vernier caliper. Results The subtemporal anterior transpetrosal approach provided an exposure of only （3 7 0. 8 6 ±1 2 3. 4 6 ） mm^2 of the jugular foramen region. After the temporomarrfibular joint was resected and the petrous internal carotid artery was anteriorly displaced, the area increased significantly （ P 〈 0. 0 5 ）. After the petrous internal carotid artery were anteriorly displaced, the subtemporal-preauricular infmtemporal fossa approach provided an exposure of （13. 69±4. 54） mm of the anterior aspect and （12. 64±3. 84） mm of the lateral aspect of the VPCA. Conclusion The jugular foramen can he exposed anteriorly via the subtemporal-preauricular infmtemporal fossa approach. This approach alone can access the anterior part of the jugular foramen after reflecting the petrous portion of the internal carotid artery anteriorly.