计算机三维软件辅助下乙状窦后入路骨瓣一次成型的实验研究

Osteoplastic flap for surgery through retrosigmoid approach was made once with the aid of three-dimensional computer software in adult cadaveric heads

目的探讨计算机三维软件辅助的行乙状窦后入路手术骨瓣一次成型的方法。方法 10例灌注后的头颅标本经320排螺旋CT Aquilion ONE扫描。图像由DICOM格式保存,并导入3D view软件,重建颅骨、静脉窦等结构,在计算机模型上进行乙状窦后入路骨瓣成型的相关解剖,测量并记录与其入路相关的解剖结构的数据,并进行统计学分析。结果该计算机模型能准确定位横窦及乙状窦位置。所有标本入路的骨瓣均一次成型。在骨窗范围内尸头16侧(16/20)发现乳突导静脉,17侧(17/20)乳头气房开放。结论计算机重建模型与实际解剖相对应结构的解剖数据吻合度高。这表明该技术可以综合评价乙状窦后入路的对应血管和骨性结构,仿真性高,可进一步应用于术前设计、规划及手术模拟,具有临床实用性。

Objective To explore method to make once osteoplastic flap for surgery through retrosigmoid approach （RSA）. Methods The red and blue dyes solutions were perfused into the common carotid arteries, vertebral arteries and internal jugular veins respectively and CT contrast media （12.5% Iopamidol） were perfused into the bilateral common carotid arteries and vertebral arteries in 10 cadaveric heads. Then the heads were scanned by 320 multi-detector helical CT. All the imaging data of anatomy related to RSA were collected to reconstruct some important anatomic structures by 3D view software. The procedures of surgery through RSA were first simulated in computer model and then performed in the cadaveric heads according to the guidance of computer model. Results The asterion, lambdoidal suture, occipitomastoid suture, parietomastoid suture and lineae nuchae superior could be seen clearly on the image. The bone window with a size of 3 cm ~ 3 cm was successfully once made in the computer model along the medial edge of the transverse sinus and the sigmoid sinus. The same size of the bone window was successfully made once by the surgical procedures in the cadaveric heads. The venae emissaria mastoideas were found in the operative fields of 16 （16/20） sides of the heads and the mastoid air cells were open in the operative fields of 17 （17/20） sides of the heads. Conclusion All the data of anatomy of the cavaderic heads may be in accordance with that of the computer model. The ostcoplastic flap for the surgery through RSA may be made once with the aid of three-dimensional computer software.