成人正常闭膜管MSCT影像解剖学研究

MSCT imaging anatomy of the obturator canal in normal adults

目的:采用多层螺旋CT(MSCT)定量观测成人正常闭膜管活体影像解剖,并探讨闭孔疝可能的发生机制。方法:选择240例健康成人行腹盆腔MSCT扫描,根据受试者年龄段分为18~29、30~39、40~49、50~59、60~69及70岁以上,共6组,分别标记为1~6组,每组男、女性各20例。在后处理工作站重建闭膜管区域多平面重组影像,并观测闭膜管倾斜方向、倾斜角、内外口形态、闭膜管脂肪含量、闭膜管长度、内外口最大长径、与之垂直的最大宽径及面积。结果:闭膜管多向内下(77.71%)及前下(93.75%)方向倾斜走行,且左侧闭膜管矢状倾斜角大于右侧(P<0.05)。86.35%的闭膜管内外口呈椭圆形,且82.50%的受试者两侧闭膜管内口对称,77.50%的受试者两侧闭膜管外口对称。闭膜管脂肪含量可分为Ⅰ级(17侧,3.54%)、Ⅱ级(262侧,54.58%)、Ⅲ级(112侧,23.34%)和Ⅳ级(89侧,18.54%),脂肪含量在不同年龄组间差异有统计学意义(P<0.05)。男性闭膜管长度、内口宽径、外口面积、长径及宽径均大于女性(P<0.05),闭膜管内口面积、长径及宽径、矢状倾斜角在不同年龄组之间差异有统计学意义(P<0.05),且随年龄增大而增大。结论:闭膜管内口大小和面积随年龄增大而增大,可能是老年人发生闭孔疝的原因之一,闭膜管倾斜角和脂肪含量随年龄增大而增大可能对闭膜管结构稳定具有保护作用,左侧闭膜管脂肪含量更高且矢状倾斜角更大,可能也是闭孔疝少见于左侧的重要原因。

Objective:To quantitatively observe the bioimaging anatomy of normal obturator tubes in adults by multi-slice spiral CT(MSCT)and explore the possible mechanism of obturator hernia.Methods:A total of 240 healthy adults were selected for abdominal and pelvic MSCT scanning,and they were divided into 6 groups according to age from small to large:18~29,30~39,40~49,50~59,60~69 and over 70 years old.They were labeled as 1~6 groups,with 20 males and 20 females in each group.A post-processing workstation was used to reformat the multi-planar reformation images in the obturator tube area.The oblique direction,inclination angle,fat content and length of the obturator canal,and the shape,maximum length,width and area of its inner and outer orifices were observed.Results:The obturator tubes tended to incline inwards(77.71%)or anteriorly(93.75%),and the sagittal inclination angle of the left obturator tubes was significantly greater than that of the right ones(P<0.05).The inner and outer orifices of the obturator tube were elliptical in 86.35%of the subjects,and the inner orifices on both sides were symmetrical in 82.50%of the subjects,and the outer orifices were symmetrical in 77.50%of the subjects.The fat content of the obturator tubes could be divided into gradeⅠ(17 sides,3.54%),gradeⅡ(262 sides,54.58%),gradeⅢ(112 sides,23.34%)and gradeⅣ(89 sides,18.54%),and the difference of fat content among different age groups was significant(P<0.005).The length,inner orifice width,outer orifice area,length and width of male obturator tubes were larger than those of female ones(P<0.05).There were significant differences among different age groups in inner orifice area,length and width,and sagittal inclination angle of obturator tubes,which showed an increasing trend with age(P<0.05).Conclusion:The increase of the size and area of the inner orifice of the obturator tube with age may be one of the reasons for the occurrence of obturator hernia in the elderly,obturator canal inclination angle and fat content increase with age is likely to have a protective effect on the structure stability of the obturator canal.The fat content of the left obturator tube is higher and the sagittal inclination angle is larger,which may also be important reasons for fewer obturator hernia on the left.