先天性小耳外中耳畸形断面影像解剖学分析  

Sectional anatomical analysis of auricular and middle ear malformation in patients with microtia

作　　者：韩娟[1] 卢九星[1] 邢宁[2] 林琳[1] 蒋海越[1] 庄洪兴[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院整形七科,北京100144 [2]中国人民解放军总医院放射科

出　　处：《中华整形外科杂志》2011年第3期217-221,共5页Chinese Journal of Plastic Surgery

基　　金：卫生部临床学科重点项目（2004468）,博士后基金资助项目（20080430333）

摘　　要：目的通过对先天性小耳患者外、中耳的畸形断面影像解剖学特征的系统研究，比较其与正常解剖之间的差异，总结重要解剖结构的变异规律及相互关系，以利于l临床分型及手术治疗。方法选取2009年6月至12月中国医学科学院整形外科医院外耳整形巾心住院诊断为小耳畸形的36例患者，采用自身对照研究。研究组50只耳，其中单侧畸形22例22只，双侧畸形14例28只；对照组为单侧畸形之健侧耳22例22只。行螺旋CT颞骨高分辨扫描，应用Mimics软件，生成冠状位、矢状位图像及三维重建图像，进行距离和角度的测量。结果小耳畸形患者以Max分型，鼓室前后径I、Ⅱ、Ⅲ型分别为（7．75±1．92）mm、（6．17±2．56）mm、（6．31±3．40）mm（F=5．777，P=0．001）；鼓室上下径I、Ⅱ、Ⅲ型分别为（14．66±4．75）mm、（14．35±5．12）mm、（9．97±4．36）mm（F=6．60l，P=0．001）；3型小耳畸形乳突气化程度分别为硬化型13．33％、13．64％、30．77％，板障型13．33％、18．18％、7．69％，混合型0、9．09％、38．46％，气化型73．33％、59．09％、23．08％（X^2=24．11，P=0．002）；面神经遮盖前庭窗的发生率分别为21．43％、47．62％、54．55％（X^2=23．44，P：0．002）。研究组与对照组间差异有统计学意义。结论小耳畸形根据Max分型，具有随耳廓畸形程度增加，中耳畸形程度亦增加的趋势，其中Ⅱ型小耳的解剖结构变异复杂，可进行亚分型。Objective To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery. Methods From Jun. to Dec. 2009,36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and3D reconstruction images were created with Mimic software. Several distances and degrees were measured. Results The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were （7.75 ± 1.92） mm and （ 14.66 ± 4. 75 ） mm for type I ; （6.17 ± 2.56） mm and（14.35±5.12） mm for type II ; （6.31±3.40） mm and （9.97±4.36） mm for type re（P= 0. 001 ）. The mastoid pneumatizatiou degree for type Ⅰ , Ⅱ , Ⅲ were 13.33% , 13.64% , 30. 77% in sclerotic type, 13.33% , 18.18 % , 7.69% in diploetic type, 0, 9. 09% , 38.46% in composite type, 73.33% ,59.09% ,23.08% in pneumatic type（X^2 = 24. 11 ,P =0.002）. The cover of fenestra vestibuli by facial nerve was21.43%,47.62%,54.55% （X^2 =23.44,P=0.002）for type Ⅰ , Ⅱ , Ⅲ . There was a statistical difference between the microtia group and the control group. Conclusions According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in tvoe U microtia, which should be sub-classified.

关 键 词：小耳畸形 解剖学 横断面 

分 类 号：R76[医药卫生—耳鼻咽喉科]