低位筛前动脉与周围解剖结构的影像学关系和临床意义

Anatomical Radiologic Relationship and Clinical Significance between Low-lying Anterior Ethmoidal Arteries and Surrounding Anatomical Structures

目的通过CT研究低位筛前动脉(low-lying anterior ethmoidal artery,LAEA)与周围结构的解剖影像学关系,明确其定位,避免术中损伤。方法回顾研究2018年5月~2021年5月于上海交通大学医学院附属第六人民医院确诊的126例慢性鼻窦炎(chronic rhinosinusitis,CRS)患者,所有患者均行鼻窦CT检查,通过Horos软件重建,测量筛前动脉(anterior ethmoidal artery,AEA)与颅底的距离、额窦前壁到颅底水平部与垂直部相交点的最大水平距离(longest horizontal diameter from the anterior wall of the frontal sinus to the skull base at which point the slope turns vertical to horizontal,APF)、包含LAEA的骨板与颅底向前的夹角(forward angle between the lamella containing the low anterior ethmoid artery and the skull base,FALS),测量筛板外侧板(lateral lamella of the cribriform plate,LLCP)高度并按Keros分型分类,按国际额窦解剖分类方法(international frontal sinus anatomy classification,IFAC)定义患者气房类型。t检验、χ^(2)检验做差异性分析,Spearman、Pearson分析比较其相关性。结果在126例(252侧)患者中,有、无眶上筛房(supraorbital ethmoid cell,SOEC)及有、无筛泡上气房(supra bulla cell,SBC)患者的AEA低位走行率比较,差异均有统计学意义(χ^(2)=141.40,P<0.001;χ^(2)=138.05,P<0.001);KerosⅠ型、Ⅱ型、Ⅲ型与LAEA分别呈负相关(r=-0.592,P<0.001)、正相关(r=0.531,P<0.001)、正相关(r=0.172,P<0.001);LAEA与颅底之间的距离和APF之间呈正相关(r=0.25,P<0.001);当存在SOEC、SBC,KerosⅡ型、KerosⅢ型及更大的APF,AEA低位走行率明显升高。在FALS中,91.5%为锐角,7.8%为直角,0.7%为钝角。结论SOEC、SBC、高级别Keros分型、APF长度及FALS是术前定位LAEA的可靠标志。通过术前阅片,明确其解剖关系,对于内镜手术时减少AEA损伤有重要临床意义。

Objective To determine the relationship and radiologic features between the low lying anterior ethmoidal artery(LAEA)and the surrounding structures via CT images,and to clarify its location to avoid intraoperative injury.Methods A retrospective study was conducted on 126 patients with chronic rhinosinusitis in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from May 2018 to May 2021.All patients underwent CT scanning and the images were reconstructed by Horos software.The distance between AEA and skull base,the longest horizontal diameter from the anterior wall of the frontal sinus to the skull base at which point the slope turns vertical to horizontal(APF),and the forward angle between the lamella containing the low anterior ethmoid artery and the skull base(FALS)were measured.The height of the lateral lamella of the cribriform plate(LLCP)was measured and classified according to the keros classification.The cell pneumatization pattern was classified according to the international frontal sinus anatomy classification(IFAC).Statistical difference was assessed by Student′s t test andχ^(2) test.Correlation was valued via the Spearman and Pearson analysis.Results A total of 126 patients with 252 sides were recruited.Statistically significant difference was identified in the incidence of low anterior ethmoidal artery between patients with and without SOEC(r=141.40,P<0.001),also with and without SBC(r=138.05,P<0.001).The Keros typeⅠclassification was negatively correlated with the LAEA(r=-0.592,P<0.001).Whereas the Keros typeⅡandⅢclassification were positively correlated with the LAEA(r=0.531,P<0.001;r=0.172,P<0.001),respectively.Positive correlation between the vertical distance from the low anterior ethmoidal artery to the skull base and APF was identified(r=0.25,P<0.001).When SOEC,SBC,Keros typeⅡ,typeⅢ,and greater APF values are present,the AEA low travel rate increases significantly.Among the FALS,91.5%were acute angles,7.8%were vertical angles and 0.7%were obtuse angles.Conclusion SOEC,SBC,greater Keros grade,the greater APF length and FALS are reliable land markers for locating LAEA by image CT before operation.Well known of these anatomical relationships through preoperative CT reading is of great significance to reduce the injury of anterior ethmoidal artery during endoscopic sinus surgery.