半月裂孔的解剖学分型及临床意义研究

Anatomical characteristics of the hiatus semilunaris in middle meatus and the clinical significance

目的 观察半月裂孔(HS)的解剖特征并划分类型,为内镜治疗鼻旁窦疾病提供参考依据。方法 50例结构完整的人鼻腔外侧壁标本,测量中鼻道前端宽度(AW)、中间宽度(MW)、后端宽度(PW)及长度;观察HS的形态及变异,测量HS的垂直部长轴与水平部长轴角度α,并对HS划分解剖学类型。结果 (1)男性左、右两侧中鼻道AW(P=0.875)、MW(P=0.703)、PW(P=0.268)及长度(P=0.675)比较,差异均无统计学意义(P>0.05)。(2)中鼻道AW(4.53±2.27)mm,MW(4.39±1.64)mm,PW(5.69±1.67)mm;PW显著高于AW与MW(P=0.001,F=7.196)。(3)根据HS形态与α值,HS分为:(1)经典型16例,即HS呈月牙形,α介于100°~160°;(2)U型11例,HS的垂直部与水平部长度相当,水平部末端略翘起,α介于100°~160°;(3)J型8例,HS垂直部明显比水平部更长;(4)直线型14例,α>160°;(5)L型1例,α介于80°~100°。结论 对中鼻道、HS的定量研究及分型,是对既往研究的补充。利用鼻内窥镜处理鼻旁窦病变,应根据患者鼻腔外侧壁解剖特征选择入路方式,获取更好的治疗效果,减少并发症。

Objective To explore the morphometry of the hiatus semilunaris(HS)in the middle meatus.Methods Lateral nasal wall of 50 adults were included in this study.The anterior width(AW),middle width(MW),posterior width(PW)and length of the middle meatus were measured using a venier caliper.Angles(α)between the long axis of vertical portion and horizontal portion of the HS were examined with a protractor.Results(1)There were no statistic differences in the AW(P=0.875),MW(P-=0.703),PW(P=0.268)and the length(P=0.675)of the middle meatus between the two sides in man.The difference was not statistically significant(P>0.05).(2)The AW,MW and PW of the middle meatus were(4.53±2.27)mm,(4.39±1.64)mm and(5.69±1.67)mm,respectively.PW was longer than AW and MW(P=0.001,F=7.196).(3)The HS occurred in five types:lunar shape in 16 cases,withαbetween 100°-160°;U shape in 11 cases with the posterior part of the middle meatus ascending;J shape in 8 cases,and the horizontal portion was obviously shorter than the vertical portion;Linear shape in 14 cases withα>160°;L shape in 1 case withαbetween 80°-100°.Conclusion The morphological types of the HS is a supplement to previous studies.The endoscopic approach should be selected according to the anatomical characteristics of the lateral wall of the nasal cavity.Knowing the distinct types of the hiatus semilunaris allows the differences of normal variation versus pathologic conditions.