X线下显示颅底卵圆孔的新方法及其临床价值

X-ray revealed new methods for foramen ovale of cranial base and the clinical value

目的:探究颅底卵圆孔显示新方法,为临床提供透视下准确穿刺卵圆孔的解剖影像学依据。方法:对37例(74侧)颅底骨标本,将卵圆孔涂钡(造影组)及不涂钡(平片组),在透视下观察卵圆孔与周围骨性结构的关系,寻找能显示卵圆孔的规律性;头颅湿标本13例(26侧),进行靶点验证穿刺。结果:发现在头颅侧轴位片上,中颅凹骨骼在卵圆孔前后方各形成一条弧形线影,分别与卵圆孔前后缘相连(简称中颅凹弧形线),卵圆孔正好位于两弧线相交点。在平片组卵圆孔前后两线的相交点可清晰分辨。74侧例标本卵圆孔显示最佳时,球管所倾斜的角度分别在30～39°(34.50±2.06),总体均数的95%的可信区间为(34.02,34.98),左右两侧进行了配对t检验,得左右两侧差异无统计学意义(P=0.716>0.05);26侧例标本靶点验证,卵圆孔穿刺成功率100%。结论:利用"中颅凹弧形线"这一骨性标志,可在头颅侧轴位准确显示颅底卵圆孔。使用此定位方法可在透视下实时观察、准确穿刺卵圆孔。

Objective：This study is X-ray revealed to search for new method of site-specific puncture technology of foramen ovate of cranial base by observation of anatomy imageology. Methods：37 skull bone bases were collected and forarnen ovate was smeared with barium sulfate （visualization group）. With standard head-lateral position, the relationship between the foramen ovule smeared with Ba and the surrounding bone structures was observed under digital fluroscopy. The axial view films of various angles were taken respectively. After the barium of the visualization group was washed out, the films were taken again by the method above （plain film group）. Regularity found can be showed foramen ovate. The trial puncture of the foramen ovate was taken on 13 head speeimens with tissues on it （26 specimens of lateral sides）. Results： When the X-ray sucker turned head at the angle of over 15°, opaeification of foramen ovate in visualization group was demonstrated. Two bands of bony arc linked with the opacification of foramen ovate were found, which were anterior and posterior to the foramen respectively and composed similar to semieircle are （we call it as the mid-cranial fossa arch line）. The foramen ovate was found just at the place of intersection of two lines. In plain film group, the display rate of the mid-cranial fossa comma line was 100% when the X-ray sucker turned more than 15°, and the intersection of two lines anterior and posterior to the foramen ovate can be clearly seen. When the X-ray sucker turned more than 30°, foramen ovate can still be clearly displayed. Seventy four specimens with lateral sides of the foramen ovale were shown at the angle between 30 -39 degrees （34.50 ± 2.06） of the sucker. There was no signifieant difference between the both sides. According to the intersection of the two lines, punctures of the foramen ovate of all the 26 head specimens were successful. The success rate of foramen ovate puncture was 100% .Conclusion：With the mid-cranial fossa arch line as a marker, foramen ovate in the base of skull can be concisely displayed, and this method can be targeted in the perspective of real-time observation, accurate puncture oval hole.