成人颅骨标本翼腭窝的断层解剖学与影像解剖学对照研究

Sectional anatomy characteristics versus image anatomy of pterygopalatine fossa

目的观察成人颅骨标本翼腭窝的断层解剖学,并与影像学的结果相对照。方法将45例干颅随机分为3组,每组15例,使用SHIMADZU型CT机,将第1组干颅按颅底检查仰卧摆放,层厚1mm,冠状面扫描从硬腭后缘开始,不间断扫描扫至上颌窦后壁结束;将第2组干颅行横断面扫描,横断面以硬腭平面为基线,层厚2mm,平行向上扫描至眶下裂;将第3组干颅行矢状面扫描,以正中剖面矢状面为基线,层厚2mm,平行向外扫描至上颌窦外侧壁。按影像扫描基线分别在三组颅骨标本上做好标记。使用自制的切片刀分别沿CT的冠状面、水平面及矢状面扫描基线行相应的断层切片。逐层测量冠状面、水平面及矢状面的有关孔距和径值,并与CT结果相对照。结果冠状面上,左右两侧翼腭窝的第一至第六层70%(21侧)呈斜倒梯形,30%(9侧)呈斜四边形;第七至第十层均表现为管形。水平面上,左右两侧翼腭窝第一、二层其前、后壁主要表现为凸面均向后的双弧形80%(24侧);第三、四层主要表现为凸面相对的双弧形约66.7%(20侧);第五、六层主要表现为管形60%(18侧);第七、八、九、十层则全部表现为管形。水平面上,第一至六层翼腭窝左右径大于前后径,第七、八、九、十层翼腭窝左右径约等于前后径。在颅骨矢状面上测量:上颌窦后外侧壁后部的高度平均值为(19.21±3.42)mm;厚度平均值为(0.74±0.42)mm;上颌窦顶壁与后壁交界处的厚度平均值为(0.63±0.31)mm。左右两侧翼腭窝CT扫描各项数据的测量结果与左右两侧翼腭窝的相关测量指标解剖测量结果一致。结论骨性翼腭窝断层解剖学研究弥补了对其局部解剖的局限,并为其影像学研究提供了翔实的依据。

Objective To provide anatomic evidences for clinical operation of PPF tumor by measurement of distance between relate holes and diameter value of adult cranial bone in coronal plane, sagittal plane and horizontal level, and by observation morphologic variation, of PPF. and the comparison with the CT results. Methods The 45 craniums were randomly divided into 3 groups （n= 15, each group）. Under CT machine （SHIMADZU type）, the first group was set according to cranial base examination （layer thickness lmm）, then uninterruptedly coronal scanned from posterior border of hard palate to posterior wall of maxillary sinus. The second group was cross-section scanned （layer thickness 2 mm） in parallel upwards from baseline acted as hard palate to inferior orbital fissura. The third group was sagittal scanned （layer thickness 2 mm） in parallel outwards from baseline acted as medial sagittal plane to lateral wall of maxillary sinus. All the cranium specimens were marked according to image scanning condition and sectioned into cross-sec- tional slices along the CT scan baseline in coronal plane, transverse level and sagittal plane, with self-made microtome knife. Thereafter, the related distance of holes or diameter was measured in per layer, compared to the results from CT. Result At the coronal plane,the 1st to 6th layers of bilateral PPF presented with inclined inverted trapezoid（70%,21 sides）, and inclined quadrilateral（30% ,9 sides）,and the 7th to 10 th layers of bilateral PPF presented with canal-shape （100%）. The mean value of right orbit-rotundum distance was （5.0±2.7） ram, and that of left orbit-rotundum distance was（5.3 ± 2.1）mm：The mean value of right rotundum, pterygoid canal distance I was（6.4 ± 3.9）ram,and that of left ro- tundum-pterygoid canal distance I was（6.1±4.3）mm：The mean value of right rotundum-pterygoid canal distance Ⅱwas （7.3±2.6）mm,and that of left rotundum, pterygoid canal distance ]] was （7.5±2.1）mm. （ At horizontal plane：The anterior and posterior walls of the 1 st and 2 nd layers of bilateral PPF mainly presented with double curves with palinal convex surfaces（80%, 24 sides）; the 3rd and 4 th layers mainly presented with opposing convex surfaces （66.7%, 20 sides） ;The 5 th to 6 th layers mainly presented with canal shape（60%, 18 sides） ;And the 7 th to 10th layers presented with canal shape （100%）. At horizontal plane,for the PPF in the 1 st to 6 th layers,its lateral dimension was larger than its anteroposterior dimension, and for the PPF in the 7 th to 10th layers, its lateral dimension was equal to its anteropos- terior dimension. The scanned results of left and right PPF with CT are coincidence with the datum by respective anatomy measurement. Conclusions The investigation of sectional anatomy for PPF overcomes the topographic limitation in itself. The manifestation of sectional anatomy for PPF provides detailed datum for its imaging research.