数字化颅底外科的解剖及影像学研究

Digitalized skullbase surgery:an anatomical and medical imageology study

目的通过对解剖学、影像学、神经导航三种测量方式精确度的对比,对数字化颅底外科手术的可行性进行量化评估。方法取颅底标本25个,对前半规管-卵圆孔之间的距离(50侧),分别进行游标卡尺测量(解剖学测量)、影像学测量及神经导航测量。所得数据进行记录,并采用SPSS 19.0软件进行统计分析,比较三种测量方式各自的精确度。结果①解剖学测量的平均偏差(离均差平均值)>影像学测量数据与解剖学测量均数的平均偏差(P<0.01);②神经导航测量的与解剖学测量均数的平均偏差>影像学测量与解剖学测量均数的平均偏差(P<0.01);③神经导航测量的与解剖学测量均数的平均偏差略>解剖学测量的平均偏差,但P(90%)>0.8。结论①影像学测量数据在评估个体解剖学特征方面的精密度,高于基于群体的解剖学测量数据;②神经导航系统在注册及应用中会出现一些偏差,影响神经导航系统的精确性;③即使不可避免地存在着误差,从统计学角度来看,神经导航测量依然无可否认地可视为与解剖学测量为等效(把握度高达90%)。

Objective To quantitatively evaluated the feasibility of digitalized skull base surgery by comparing the cor- responding accuracy of anatomical, imageology and neuronavigator based measurements. Methods Distance between the anterior semicircular canal and the oval foramen of 25 cadaver skull bases （ 50 sides） were measured with caliper （an anatomical measurement）, CT （an imageology base measurement） and neuronavigator （a neuronavigator based measurement）, respectively. The data were documented and the accuracy of three different methods of measurement was statistically analyzed with Spssl9.0 software. Results （1） The mean deviation of anatomical measurement was lar- ger than that of the imageology based measurement from the corresponding mean of anatomical measurement （ P 〈 0.01 ） ; （2） The mean deviation of the neuronavigator based measurement was larger than that of the imageology based measurement from the mean of anatomical measurement （ P 〈 0.01 ） ; （3） The mean deviation of the neuronavigator based measurement from the mean of anatomical measurement was a little bit larger than that of the anatomical measure- ment, whereas the P value （90%） was larger than 0.8. Conclusion （1） The data from imageology based measurement are more accurate than those from group-based anatomical measurement in evaluating individual anatomical characteris- tics; （2） Errors occurred during registration and application will compromise the accuracy of a neuronavigator to a more or less extent; （3） Statistically equivalent accuracy is undeniable（ the power of the test was as high as 90% ）between the anatomical and neuronavigator based measurements, even if deviations from the latter are inevitable.