钩突上端和鼻丘气房的解剖学和影像学观察  

Anatomical and computed tomographic analysis of the interaction between uncinate process and agger nasi cells

作　　者：张罗[1] 韩德民[1] 葛文彤[2] 周兵[2] 鲜军舫[3] 刘仲燕[1] 王奎吉[1] 贺飞[1] 

机构地区：[1]北京市耳鼻咽喉科研究所,100005 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 [3]首都医科大学附属北京同仁医院放射科

出　　处：《中华耳鼻咽喉头颈外科杂志》2005年第12期912-916,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市科技计划项目(Y0204004040531)

摘　　要：目的通过观察钩突上端和鼻丘气房的解剖关系,进一步阐明鼻丘径路鼻内镜下额窦开放手术的解剖学基础.方法鼻内解剖标志完整的成人颅骨21个(42侧)和成人尸头1个,①鼻内镜观察颅骨钩突前上端与中鼻甲和鼻腔外侧壁的毗邻关系;②16排螺旋CT扫描(层距0.300 mm,层厚0.625 mm)结合三维重建技术(层厚0.625 mm),观察颅骨钩突前上端与鼻丘气房的关系,以及钩突上端的附着点,同时测量鼻丘气房的前后径、横径和高度;③火棉胶包埋后冠状位薄层(100 μm)断层经苏木精伊红染色后,观察成人尸头钩突前上端的毗邻关系.结果①鼻内镜下中鼻甲垂直板前缘中部与钩突前缘上部相互融合,在中鼻道前端顶部与鼻腔外侧壁间形成骨性穹隆;钩突前上缘除附着于上颌骨额突(42侧,100%)外,多数还同时附着于上颌骨额突后方的泪骨(33侧,78.6%).②冠状位CT显示钩突上端的附着点可位于眶内壁、颅底或中鼻甲(垂直板)上,单一钩突上端附着点的位置,多数位于眶内壁上(33.3%),额窦在该平面经钩突上端内侧引流入中鼻道;其余附着于颅底(9.5%),额窦在该平面经钩突上端外侧引流入筛漏斗.2个附着点的钩突,多数附着于眶内壁和颅底(31.0%);少数附着于眶内壁和中鼻甲(21.4%).③多数鼻丘(90.5%)含1～2个气房,钩突参与组成鼻丘气房的内、下和上壁,左侧和右侧钩突的横径、高度以及前后径均无显著性差异.④尸头冠状位连续断层的观察结果与鼻内镜下和CT观察结果一致.结论钩突上端参与组成鼻丘气房,并与中鼻甲前端形成骨性连接.通过开放鼻丘气房可从前下部疏通额窦引流通道.Objective To investigate the anatomical interaction between uneinate process and agger nasi cell to better understand the anatomy of the frontal sinus drainage pathway by endoscopy, spiral computed tomography （CT） and sectioning. Methods Twenty-one skeletal skulls （forty-two sides） and one cadaver head （two sides） were studied by spiral CT together with endoscopy and collodion embedded thin sectioning at coronal plane. The sections with the thickness of 100μm were stained with hemotoxylin and eosin. Results Under endoscopy, a leaflet of bone to the middle turbinate, which is given off by uneinate process, forms the anterior insertion of the middle turbinate onto the lateral nasal wall. The middle portion of the uneinate process attached to the frontal process of the maxilla in all of the skeletal nasal cavities, as well as the lacrimal bone in 78.6% of the skeletal nasal cavities. On CT scans, the agger nasi cell is present in 90. 5% of the skeletal nasal cavities. While the lateral wall of the agger nasi cell is formed by lacrimal bone, the medial wall of the agger nasi cell is formed by uneinate process. And the anterior wall is formed by the frontal process of the maxilla. The superior portion of the uneinate process forms the medial, posterior and top wall of the agger nasi cells. The superior portion of the uneinate extends into the frontal recess and may insert into lamina papyraeea （33.3%）, skull base （9.5%）, middle turbinate, combination of these （57.2%）. Conclusions The agger nasi cell is the key that unlocks the frontal recess.

关 键 词：额窦 解剖学 体层摄影术 X线计算机 内窥镜检查 

分 类 号：R765[医药卫生—耳鼻咽喉科]