翼腭窝三维可视模型的建立及内镜下解剖结构分析

Establishment of a three-dimensional visible model of pterygopalatine fossa and endoscopic anatomy analysis

背景:正确理解翼腭窝解剖是翼腭窝手术的关键,翼腭窝可视模型对帮助医生详细了解内镜下翼腭窝的复杂结构非常重要。目的:建立翼腭窝三维可视模型显示内镜下翼腭窝的相关解剖结构,为翼腭窝手术入路提供指导。方法:依据一位患者冠状位CT血管成像数据,通过MOI自由设计大师和SketchUp软件构建三维数字模型,进行手术计划,模拟经鼻内镜入路,开放上颌窦口,去除上颌窦后壁,进入翼腭窝,提供特定视野及空间方向观察。结果与结论:成功构建翼腭窝及相邻解剖结构的可视模型,为鼻内镜手术入路提供帮助,使用者可与模型进行交互作用并可任意操作模型(包括射线模式,内部观察),可在特定视野内随时观察,为手术计划提供准确的形态信息,包括颌内动脉及其分支,腭降动脉,蝶腭动脉,后鼻动脉,圆孔,翼管,蝶窦,眶下裂,视神经管,翼突,颈内动脉等。可见内镜下空间方向发生改变。结果提示,SketchUp和MOI构建翼腭窝模型方法简单可行,可帮助理解内镜下翼腭窝的解剖结构,可模拟手术过程。

BACKGROUND：A thorough anatomical knowledge of the pterygopalatine fossa （PPF） is important for PPF surgery. It is very important to develop an digitized visible model that could illustrate the endoscopic anatomy of the PPF and familiarize the endoscopic surgeon with its complex anatomy. OBJECTIVE：To develop a digitized visible model to demonstrate the endoscopic anatomy of PPF to provide surgical instruction for transpterygoid approach. METHODS：According to coronal CT data of one patient,a digitized visible model of the PPF was established by MOI and SketchUp software package. The model was put in the ideal model of the nasal cavity. The wide nasoantral window was opened and the posterior antrum wall was removed to provide access to the PPF. The spatial directions were observed. RESULTS AND CONCLUSION：3D model of PPF and their adjacent structures was successfully established for endonasal endoscopic surgery,allowing the user to interact with the data and manipulate them （X-ray,internal observation）. The model can be observed in special visual field,providing accurate morphological data for surgery guidance plan. Using an endoscopic approach,the internal maxillary artery and its branches,descending palatine artery,sphenopalatine artery,posterior nasal artery,foramen rotundum,pterygoid canal,sphenoid sinus,infraorbital fissure,optic nerve canal pterygoid process of the sphenoid,and internal carotid artery were observed. The transformations of the spatial directions were observed. The method for creating digitized visible models using MOI and SketchUp software package is simple and feasible. This model provides the means to learn the endoscopic anatomy of the PPF and may be used for the simulation of surgical techniques.