乙状窦、颈静脉球及面神经位置变化的相关性分析

Linear correlative analysis of the displacement of sigmoid sinus, jugular bulb and facial nerve

目的 研究乙状窦、颈静脉球及面神经位置变化的相关性。方法 16侧正常成人头颈标本,手术显微镜下进行显微解剖,观察乙状窦、颈静脉球及面神经的形态及其毗邻关系,建立它们位置的三维空间参照系,测量相关数据,并进行线性相关分析。结果 乙状窦与外耳门距离与颈静脉球高度、乙状窦降段中点外侧骨壁厚度、鼓索起点高度呈负相关,与面神经—乙状窦前缘距离呈正相关;颈静脉球高度与棘孔-颈静脉球距离呈负相关。结论 乙状窦、颈静脉球及面神经三者位置变化有一定相关性,乙状窦前移则颈静脉球顶位置偏高,乙状窦降段表面骨质偏厚,鼓索起点位置偏高,而面神经不受影响;乳突气化程度影响乙状窦的前后移位,但不影响颈静脉球高度;颈静脉球高度与颈静脉球的前后位移有关,颈静脉球顶高则颈静脉球前移。在侧颅底外侧入路手术中,掌握以上规律有助于乙状窦、颈静脉球及面神经的定位以及术中重要结构损伤的控制。

Objective To study the correlation of displacement of sigmoid sinus, jugular bulb and facial nerve. Methods Dissection was made on one side of sixteen formalin-fixed skull specimens of adults without signs of congenital malformation or disease under a surgical microscope. Each specimen was dissected to achieve adequate exposure of the sigmoid sinus, jugular bulb, facial nerve, and relevant structures. Three-dimensional reference system describing the displacement of the sigmoid sinus, jugular bulb and facial nerve was established. Measurement was made by modified calipers. Linear correlative analysis was made with mean and standard deviation, correlation coefficient etc. Results The distance between sigmoid sinus and external acoustic pore was negatively correlated with the height of jugular bulb, thickness of lateral bone wall at level of the midpoint of vertical segment of the sigmoid sinus and height of the initial point of chorda tympanic, and was positively correlated with the distance between facial nerve and sigmoid sinus. The height of jugular bulb was negatively correlated with the distance between foramen spinosum and jugular bulb. Conclusion The displacements of the sigmoid sinus, jugular bulb and facial nerve are correlated. While the sigmoid sinus is of antedisplacement, the jugular roof is higher, the surface bone matrix of the vertical segment of the sigmoid sinus is thicker, but the facial nerve is not affected. The degree of mastoid pneumatisation could affect the anteroposterior displacement of the sigmoid sinus, but the jugular bulb is not affected. The height of jugular roof is correlated with the anteroposterior displacement of the jugular bulb. These regularities have great clinical significance.