经颞骨岩部入路中乳突切除术的应用解剖  

Applied anatomy of mastoidectomy through the posterior transpetrosal approach

作　　者：王君玉[1] 卢亦成[1] 党瑞山 廖建春 

机构地区：[1]第二军医大学附属长征医院神经外科上海市神经外科研究所,上海200003 [2]解剖学教研室,上海200433 [3]附属长征医院耳鼻咽喉科,上海200003

出　　处：《中国临床解剖学杂志》2011年第4期363-366,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的为临床侧颅底入路手术中乳突切除术提供解剖学基础。方法经10%福尔马林固定成人尸头标本25具(50侧),电动磨钻磨除乳突骨质,暴露乙状窦、岩上窦、颅中窝底硬膜、乙状窦前的颅前窝硬膜,岩上窦,轮廓化3个骨半规管、面神经乳突段。统计相关解剖结构出现变异情况并观察影响乳突切除术的因素。结果气化良好的乳突可分为三层结构:表面骨皮质、乳突蜂房骨质、覆盖深层结构的坚硬骨质。乳突表面距乙状窦、横窦-乙状窦-岩上窦交点、外骨半规管隆凸顶点、面神经乳突段中点、二腹肌嵴的最小距离分别为(7.28±2.14)mm、(14.22±2.74)mm、(16.56±2.10)mm、(13.31±1.87)mm、(11.58±1.60)mm。乙状窦出现的变异包括乙状窦粗大、前置、高位颈静脉球。面神经乳突段及骨性半规管未发现明显变异。结论熟识乳突局部解剖学特点有助于安全、快速的完成乳突切除术。Objectives To provide anatomic data for mastoidectomy through the posterior transpetrosal approach. Methods The mastoidectomy was simulated in 25 cadaveric specimens. Electric drill was used to move the superficial bone of the mastoid to expose the underlying structures. The sigmoid sinus, superior petrosal sinus, dura mater of middle cranial fossa, posterior cranial fossa, bony semicircular canals and mastoid segment of the facial nerve were exposed and skeletonized. Variations of the structures in the mastoid were observed and important data were collected. Results Mastoid bone can be divided into three layers including the superficial cortical bone, the mastoid air cell and the Ivory bone encasing the sigmoid sinus, the facial nerve and the labyrinth. The minimal distances from the superficial mastoid to the sigmoid sinus, the junction of the transverse sinus, sigmoid sinus and the superior petrosal sinus, the top point of the eminence of the horizontal semicircular canal, the middle part of the mastoid segment, the digastric ridge was （7.28±2.14）mm, （ 14.22±2.74）mm,（ 16.56±2.10）mm,（ 13.31±1.87）mm,（ 11.58±1.60）mm separately. The variations of the sigmoid sinus included the enlargement of the sinus, the far-advanced sigmoid sinus and high jugular bulb. No variations of the mastoid segment of facial nerve and the bony semicircular canals were observed. Conclusions Be familiar with the anatomic characteristics of the mastoid can make the mastoidectomy more safe and efficient.

关 键 词：乳突切除术 骨半规管 外耳道后上棘 乙状窦 应用解剖 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]