鼻内窥镜下筛泡的应用解剖研究

Applied anatomy of ethmoid bulla on endoscopy

目的 :对筛泡行应用解剖学研究 ,以冀为鼻内窥镜筛泡切除术确定安全的手术界限 ,减少并发症的发生。方法 :30例、6 0侧外观无异常经 10 %福尔马林固定的成人尸头 (男 2 3例 ,女 7例 ) ,用MJ3435型带锯机 ,沿眉弓上缘及枕骨粗隆上 1cm连线水平锯开颅盖骨 ,去除脑组织 ;沿正中线矢状锯开头颅 ,去除鼻中隔 ;经眶下孔与正中剖面平行矢状锯开 ,用解剖刀、筛泡钳和剥离器等按鼻内窥镜下筛窦手术的体位和路径 ,逐层解剖并测量各解剖结构的径线 ,观测其变异。结果 :筛泡内外径 8.91± 2 .82mm ,筛泡垂直径 13.92± 7.0 8mm ,筛泡骨壁厚 0 .2 3± 0 .10mm ,筛泡中心到下鼻甲附着缘的最小平均距离 11.96± 2 .31mm。钩突与筛泡之间平均距离 :上 0 .6 8± 0 .36mm ,中 1.71± 0 .78mm ,下 2 .81± 0 .5 8mm。结论 :由于筛泡变异大 ,了解其解剖结构的径线 ,对鼻内窥镜手术有重要作用。

Objective:To explore a safe border for the endoscopic ethmoid bulla surgery by means of the applied anatomy.Methods: 30 adult cadaveric heads without any lesion were selected at random (male 23,female 7 )and split on the level between the line of superior superciliary arch above and 1.0cm high of occipital bone with Model MJ3435 band,were removed brain tissue,and then split axially on midline,also were removed the nasal septum,after that split axially skull bone between the infraorbital foramen and central section. According to the approach of endoscopic ethmoid bulla sinus surgery,the meridian of the anatomical structures were measured and the variations of ethmoid bulla were observed.Result:The maximum transversal diamete of ethmoid bulla was 8.91±2.82mm; its maximum vertical diamete was 13.92±7.08mm;its depth was 0.23±0.10mm;the minimum average distance from the center of ethmoid bulla to the attachment of inferior turbinate was 11.96±2.31mm . The average distance from the uncinate processs to the ethmoid bulla was 0.68±0.36mm (superior), 1.71±0.78 mm (intermedium),2.81±0.58 mm(inferior).Conclusion:The anatomy data of ethmoid bulla would play key role in nasal endoscopic ethmoid bulla surgery because of its great variation.