经乳突-面隐窝入路人工耳蜗植入手术的三维影像解剖学研究

The three-dimension CT study on the anatomy of posterior tympanum related operation through the transmastoid facial recess approach

目的:探讨经乳突-面隐窝入路人工耳蜗植入手术的相关解剖结构,并对其进行观察测量,为该入路手术提供解剖学资料。方法:选取就诊患者30例,行颞骨部位螺旋CT检查,在重建后的3D图像上观察和测量外耳道上棘、面神经、面隐窝、锥隆起、圆窗、前庭窗、砧骨等相关的解剖结构,以及上述结构之间的空间距离,并对数据进行统计学处理。结果:经过3D重建后,面隐窝区域的结构清晰可辨,并可对其中重要结构进行测量。其中锥隆起至圆窗距离为(3.78±2.11)mm,前庭窗至圆窗距离为(3.23±1.12)mm,砧骨头至圆窗距离为(7.78±3.23)mm,砧骨短脚至圆窗距离为(8.13±3.19)mm,砧骨短脚至锥隆起距离为(5.27±2.19)mm,面隐窝纵径(5.78±2.34)mm,面隐窝横径为(3.16±2.33)mm。结论:经乳突-面隐窝入路人工耳蜗植入手术中部分重要解剖结构位置相对恒定,结构间距离及角度在一定范围内变化。同时CT3D成像可为人工耳蜗手术提供可靠的影像资料,可以作为指导临床手术的可靠依据。

Objective： To provide the anatomic data for cochlear implant operation on the posterior tympanum through the transmastoid facial recess approach and measurement of related anatomic structure. Methods： Thirty patients（ 60 sides） were involved in the study. All the subjects underwent spiral computed tomography scans. The 3D model of frontal recess was obtained through special reconstruction protocol. Then the 3D images of frontal recess were analyzed and summarized. Observation and measurement of the suprameatal spine,facial nerve,facial recess,pyramidal eminence,round window,oval window measured,ponticulus,pseudosubiculum and other related anatomical structure,statistical datas which were statistically analyzed. Results： The average distance from pyramidal eminence to the anterior lip of round window niche,from oval window to round window niche was（ 3. 78 ± 2. 11） mm,（ 3. 23 ± 1. 12） mm,espectively. The average distancsfrom short crus incus to round window niche,from short crus incus to pyramidal eminencewere（ 8. 13 ± 3. 19） mm and（ 5. 27 ± 2. 1） mm respectively. The average value of transverse and sagittal diameter of the fascial recess was（ 5. 78 ± 2. 34） mm and（ 3. 16 ± 2. 33） mm. Conclusion：The position of anatomic structure in middle ear was constant and the relationship including distance and angle between anatomic structures changed in limited region. The anatomical parameters provide a reliable data for avoiding the injury during the operation. The projects resulted in better preoperative patient counseling and in predicting postoperative improvement in clinical status.