儿童半侧颜面短小畸形颅底形态学的测量研究

Study of morphological measurement of skull base with hemifacial microsomia in children

目的通过对儿童半侧颜面短小畸形(HFM)的颅底进行三维重建及测量, 探讨其颅底的形态学特点。方法收集2010年2月至2020年12月就诊于中国医学科学院整形外科医院颌面整形一中心的未接受过任何治疗、单侧受累的HFM患儿头颅螺旋CT三维数据资料, 根据Pruzansky-Kaban分型标准将患儿分为Ⅰ型、Ⅱa型、Ⅱb型及Ⅲ型共4组, 应用Mimics 17.0软件对其颅底进行三维重建及测量。颅底线性测量指标包括:鞍结节至视神经管(OT)、圆孔(FrT)、卵圆孔(FT)、内耳道(IT)、舌下神经管(HT)的距离及前床突至蝶骨小翼(ClS)、颞骨岩脊(ClP)的距离;颅底角度测量指标包括:前颅角、中颅角、后颅角及岩脊角。使用SPSS 26.0软件对测量结果进行统计学分析, 各分型组内比较时采用配对样本t检验, 不同分型组间比较时采用单因素方差分析, P<0.05为差异具有统计学意义。结果共收集HFM患儿40例, 男22例, 女18例;年龄5~15岁;每组10例。颅底的角度测量结果显示, Ⅰ型HFM健侧中颅角明显大于患侧, Ⅲ型HFM健侧中颅角及岩脊角明显大于患侧, 差异均具有统计学意义(P<0.05);Ⅱa及Ⅱb型HFM健侧及患侧颅底角度差异无统计学意义(P>0.05)。颅底的线性距离测量结果显示, Ⅰ型HFM健侧FrT、HT大于患侧, Ⅱa型HFM健侧FrT、IT、HT、ClP均大于患侧, Ⅱb型HFM健侧IT、HT及ClP均大于患侧, Ⅲ型HFM健侧HT大于患侧, 差异均具有统计学意义(P<0.05)。单因素方差分析显示, 4组HFM颅底FrT及ClP的测量值比率(患侧/健侧)差异有统计学意义(P<0.05)。结论 HFM的患侧与健侧颅底形态具有差异, 颅底角度方面差异主要集中于中颅角, Ⅰ型及Ⅲ型具有相似性, 患侧中颅角明显小于健侧;线性测量方面差异主要位于舌下神经管, 各型HFM患侧舌下神经管至鞍结节距离均明显短于健侧, 表明患侧颅底的生长发育受到了一定程度的影响。

Objective To investigate the morphological characteristics of skull base in children with hemifacial microsomia(HFM)by three-dimensional reconstruction and measurement of skull base.Methods Three-dimensional spiral CT data of HFM children with unilateral involvement who had not received any treatment from the First Center of Maxillofacial Plastic Surgery,Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from February 2010 to December 2020 were collected.The patients were divided into four groups according to the Pruzansky-Kaban classification standard:Ⅰ,Ⅱa,Ⅱb andⅢ.The three-dimensional reconstruction and measurement of the skull base were performed using Mimics 17.0 software.Linear measurements of the skull base included the distance from tuberculum sellae to optic canal(OT),foramen rotundum(FrT),foramen ovale(FT),internal acoustic meatus(IT),hypoglossal canal(HT),and the distance from anterior clinoid process to the lesser wing of the sphenoid bone(ClS)and the petrous ridge of the temporal bone(ClP).The measurement indexes of skull base angle included anterior cranial angle(ACA),middle cranial angle(MCA),posterior cranial angle(PCA),and petrous ridge angle(PRA).SPSS 26.0 software was used for statistical analysis of the measurement result.Paired t-test was used for comparison within each group,and one-way ANOVA was used for comparison between different types.P<0.05 was statistically significant.Results A total of 40 children with HFM were collected,with 10 cases in each group.The result of skull base angle measurement showed that the MCA of the healthy side of typeⅠHFM was significantly larger than that of the affected side,and the MCA and PRA of the healthy side of typeⅢHFM were larger than those of the affected side(P<0.05).There was no significant difference in the angle of skull base between the healthy side and the affected side of typeⅡa andⅡb HFM(P>0.05).In terms of linear distance measurement of skull base,FrT and HT on the healthy side of typeⅠHFM were longer than those on the affected side;FrT,IT,HT and ClP on the healthy side of typeⅡa HFM were significantly longer than those on the affected side;IT,HT and ClP on the healthy side of typeⅡb HFM were longer than those on the affected side;and HT on the healthy side of typeⅢHFM was longer than those on the affected side(P<0.05).The difference between FrT and ClP(affected/healthy)of four types of HFM was statistically significant(P<0.05).Conclusions The morphology of HFM is different between the affected side and the healthy side.As for the angle of skull base,MCA was obvious smaller in the affected side than that in the healthy side in the typeⅠand typeⅢHFM.As for the linear measurement,the distance from the hypoglossal canal to the tuberculum sellae on the affected side is shorter than that on the healthy side in each type HFM,indicating that the growth and development of the cranial base on the affected side is affected in a certain degree.