基于容积CT中耳圆窗及圆窗龛的解剖学研究

The Anatomic Study of the Round Window and Round Window Niche By the Volume CT

目的探讨正常圆窗及圆窗龛形态学特点,为进一步研究该区相关疾病的影像学诊断和手术提供解剖学数据。方法搜集2011年4月至2012年7月在本院行颞骨64层螺旋CT检查,且符合纳入标准的受检者240例(480耳),并将其按年龄分为四组:儿童组(﹤18岁),青年组(18岁≤年龄﹤45岁),中年组(45岁≤年龄﹤60岁),老年组(≥60岁)。每组60例,男女各30例。采用后处理工作站Extended BrillianceTMWorkspace(EBW)多平面重组,图像经标准化处理后测量圆窗及圆窗龛各径线、方位以及对圆窗龛形态进行分类。左、右侧别的比较采用配对样本t检验,男、女性别的比较采用独立样本t检验,设定P值﹤0.05有统计学意义。结果 (1)横轴位圆窗最大径、龛深及冠状位圆窗龛外口径长、内壁径长在左、右侧别间比较,P值﹤0.05,差异有统计学意义;圆窗及圆窗龛各测量值在性别间及不同年龄组间比较,P值均﹥0.05,差异无统计学意义。(2)240例圆窗及圆窗龛各测量值及95%置信区间分别为(单位:mm):横轴位圆窗最大径1.52±0.24(1.05～2.69);龛深1.04±0.20(0.65～1.43)。冠状位圆窗最大径1.03±0.29(0.46～1.60);龛外口径长1.72±0.56(0.62～2.82);龛外壁径长1.43±0.27(0.94～1.96);龛内壁径长2.76±0.51(1.76～3.76)。(3)圆窗空间位置及95%置信区间分别为:圆窗前后方位外倾角73.28°±10.10°(53.48°～93.08°);圆窗上下方位内倾角71.99°±10.70°(51.02°～92.96°)。(4)圆窗龛形态在横轴位图像上呈半圆形、三角形、圆点形及不规则形,发生率分别为52.50%、15.83%、15.63%、16.04%;在冠状位图像上呈壶腹形、喇叭形、直条形、弯条形及不规则形,发生率分别为28.54%、25.83%、25.63%、9.79%、10.21%。结论圆窗及圆窗龛位置深在隐蔽、形态多样,容积CT可很好显示该区细微结构影像解剖,结合后处理技术可准确进行量化测量,为该区病变的诊断及避免术中意外损伤提供可靠信息。

Objective To investigate the morphological features of the round window and the round window niche in normal people and provide the significant data for the future imaging diagnosis and the operations in this area. Methods The patients who underwent temporal CT scan were collected from Apr. 2011 to Jul. 2012. The 240 cases （480 sides）who met the inclusion criteria were divided into 4 groups：the child group（ 〈 18 years）, the teenager group （ 18 years ≤ the age 〈 45 years ）, the middle age group（45 years ≤ the age 〈 60 years） ,the older group（≥60years）. Through the muhipla- nat reconstruction of the images in postprocessing workstation, the measurements in the round window and the round window niche were performed. Results 1. There was statistically significant differences in the largest diameter of the round win- dow, the depth of the round window niche in axial plane and the length in exterior open and the interior wall of the round window niche in coronal plane in sides（ P 〈 0.05 ） ; there was no statistically significant differences in other measurements of the round window and the round window niche in genders and different groups（ P 〉0.05 ）. 2. The measurements in the round window and the round window niche and 95% confidence interval were as follow ： at axial plane, the largest diameter of the round window was 1.52 ± 0.24 （ 1.05 - 2.69 ; the depth of the round window niche was 1.04 ± 0.20 （0.65 - 1.43 ） ; at coronal plane, the largest diameter of the round window wasl. 03 ±0.29（0.46 - 1.60） ;the length of the niche in exterior open was 1.72 ± 0.56 （0.62 - 2.82）, the length of the niche in exterior wall was 1.43 ± 0.27 （0.94 - 1.96）. 3. The spacial position of the round window and 95% confidence interval were as follow： the extraversion angle of the round win- dow in anterior posterior position was 73.28° ± 10.10° （53.48° -93.08° ） ,the one in the superior inferior position 71.99° ± 10.70°（51.02° -92.96°）.4. The morphology of the round window at axial plane included the semicircle, triangle, round dot and the irregular shape, the incidence rate were 52.50% , 15.83% , 15.63% , 16.04% respectively; the ones at coronal plane included bulb, tubaeform, vertical bar, bent bar, and the irregular shape, the incidence rate were 28.54% , 25.83% , 25.63% ,9.79% , 10.21% respectively. Conclusion The volume CT clearly display the location and the mor- phology of the round window and the round window niche, with the postprocessing technology,it can provide more useful in- formation for the imaging diagnosis and the operations.