中耳手术中细化面神经定位的临床解剖学研究

The study of locating facial nerve precisely in middle ear surgery based on clinical anatomy

目的:通过对面神经与周围相关解剖结构的观察、测量,探讨中耳手术中细化面神经定位的解剖学方法。方法:结合手术入路,在15例(30侧)新鲜尸头标本上进行显微解剖,重点观察面神经走形特点及其与周围结构的空间位置关系,并测量面神经与周围解剖结构之间的距离。结果:外耳道后壁中点(鼓沟水平)距离面神经垂直段的最短距离为(3.37±0.34)mm;乙状窦前缘距离面神经垂直段的最短距离为(7.40±0.71)mm;颈静脉球外侧缘距离面神经的最短距离为(5.58±0.79)mm;Henle棘距离面神经锥曲段的最短距离为(12.76±1.24)mm;砧骨短脚后缘与面神经锥曲段的最短距离为(1.56±0.35)mm;后半规管下缘与面神经锥曲段的最短距离为(2.56±0.41)mm;水平半规管下缘与面神经水平段之间的最短距离为(1.28±0.32)mm;前庭窗上缘距离面神经水平段的最短距离为(0.67±0.15)mm。结论:掌握颞骨相关解剖和面神经的定位方法,将有助于减少中耳手术中面神经的医源性损伤。

Objective： To investigate the methods of locating facial nerve precisely in middle ear surgery through the ohservation and measurement of the facial nerve and surrounding anatomical structures and to provide reference for the middle ear surgery. Method：Combined surgical approach on 15 cases（30 sides） fresh adult cada- verie specimens were dissected, observed the characteristics of facial nerve and its shape and spatial relationship of the surrounding structures, and measured the distance between the facial nerve and its surrounding structures. Re- suit： The shortest distance from the midpoint of the posterior wall of external auditory canal （annulus level） to the vertical segment of the facial nerve was （3.37±0.34）mm, the shortest distance from the leading edge of the sig- mold sinus to the vertical segment of facial nerve was （7.40±0.71）mm, the shortest distance from the lateral margin of jugular bulb to the facial nerve was （5.58±0.79）mm, the shortest distance from Henle crest to the py- ramidal segment of facial nerve was （12.76±1.24）mm, the shortest distance between the pyramidal segment of facial nerve and the posterior short limb of incus was （1.56± 0.35）mm, the shortest distance between the pyrami- dal segment of facial nerve and the lower edge of posterior semicircular canal was（2.56±0.41） mm, the shortest distance between the lower edge of horizontal semicircular canal and the horizontal segment of facial nerve was （1.28± 0.32） mm, the shortest distance between the upper edge of vestibular window and the horizontal segment of facial nerve was（0.67± 0.15）mm. Conclusion.. A good command of the anatomy of temporal bone as well as the methods of locating facial nerve will provide the key to reduce the probability of iatrogenic facial nerve injury in middle ear surgery.