2种体位下颈静脉孔区周围结构3D-CT重建的对比研究  

Three D-CT reconstruction of surrounding structures of jugular foramen areas under two positions： a comparative study

作　　者：马亚宾[1] 王向宇[2] 徐伟伟[2] 龙青山[3] 覃成箭[4] 

机构地区：[1]南方医科大学珠江医院神经外科、广东神经外科研究所、广东省脑功能修复与再生重点实验室,广州510282 [2]暨南大学附属第一医院神经外科,广州510630 [3]惠州市第三人民医院神经外科,516002 [4]右江民族医学院附属医院神经外科,百色533000

出　　处：《中华神经医学杂志》2014年第12期1212-1214,共3页Chinese Journal of Neuromedicine

基　　金：国家临床重点建设专科资助项目;广东省神经外科临床中心资助项目.

摘　　要：目的对比研究头颅正中前屈位与斜仰卧位对远外侧入路中颈静脉孔区（JF）周围结构的位移程度，为该区域手术入路及相关结构的保护提供解剖学依据。方法41例健康成人均经荷兰飞利浦电子公司64排CT机按骨窗条件以1mm层厚分别在头颅正中前屈位（即模拟术中侧卧位）与斜仰卧位进行连续轴位扫描，扫描范围包括外耳道水平至C3水平的骨性标志，扫描所得的图像输入飞利浦扩展华晨工作站进行CT的多平面重建（MP鼬，测量相关数据。结果在模拟侧卧位（即头颅正中前屈位）时测量寰椎横突（C1）至同侧乳突尖、茎突尖、枕髁外缘中点等解剖标志的距离分别为（20．99±4．18）mm、（20．49±5．47）mm、（22．035±4．27）mm。在斜仰卧位时测量寰椎横突至同侧乳突尖、茎突尖、枕髁外缘中点等解剖标志的距离、分别为（22．795±3．29）mm、（22．315±5．48）mm、（23．025±3．91）mm。与头颅正中前屈位比较，斜仰卧位时3段距离均较长，差异有统计学意义（p〈0．05）。结论经JF手术入路中，斜仰卧位可以改变相关结构间的相对空间位置关系，增加对颈静脉区的显露空间，使面神经、椎动脉、后组脑神经颅外段等结构得到保护，减少对周围组织结构的损伤及并发症的发生。Objective To comparatively study the displacement of surrounding structures of jugular foramen （JF） via far lateral approach under middle cranial flexion supine and oblique supine, and to provide the anatomical basis for the protection of these relative structures during choosing regional surgical approaches. Methods Forty-one healthy adults were scanned by PHILIPS Brilliance 64-slice CT according to the conditions： 1 mm thick bone window under the middle cranial flexion supine position and oblique supine positions, continuous axial scanning, and being ranged fi＇om horizontal canal to C3 levels bony landmarks. The scanned images were inputted Philips Extended Brilliance Workspace CT reconstruction of multi-plane （MPR） and the data were measured. Results In the middle cranial flexion supine position, the distances fi＇om transverse process atlas to the ipsilateral mastoid tip, tip of the styloid process, the midpoint of the outer edge in occipital condyle were （20.99±4.18） mm, （20.49±5.47） mm, and （22.035±4.27） mm. In the supine oblique position, the distances fi＇om transverse process aflasto the ipsilateral mastoid tip, tip of the styloid process, the midpoint of the outer edge in occipital condyle were （22.795±3.29） mm, （22.315±5.48） mm and （23.025±3.91） mm. Significant differences were notedin these three distances between the two positions （P〈0.05）. Conclusion In the JF surgical approach, supine oblique can change the relative spatial relationship of correlative structures, increase the exposure of the jugular vein area, therefore, protect the facial nerve, vertebral artery and posterior extracranial structures, and reduce the damage to surrounding structural tissues and the complications.

关 键 词：体位 CT三维重建 颈静脉孔区 解剖 

分 类 号：R651.1[医药卫生—外科学]