翼管神经的应用解剖学  

Clinical anatomy of the vidian nerve

作　　者：徐明[1] 江凯[2] 王新东[3] 张彬[1] 何勇[1] 

机构地区：[1]宁波大学医学院附属医院耳鼻咽喉科,浙江宁波315020 [2]宁波大学医学院附属医院影像科,浙江宁波315020 [3]宁波大学医学院附属医院神经外科,浙江宁波315020

出　　处：《解剖学报》2015年第2期227-231,共5页Acta Anatomica Sinica

基　　金：浙江省医药卫生科技计划资助项目(2013KYA183)

摘　　要：目的探讨翼管神经血管束的解剖结构及其作为内镜经鼻颅底手术中解剖标志的临床意义。方法观察256例慢性鼻炎患者的蝶窦冠状位CT中翼管与蝶窦底壁的位置关系,三维重建26例患者蝶窦CT片,测量翼管相关解剖数据;解剖6具湿性成人尸头,观察翼管神经血管束周围解剖结构关系,评价翼管神经血管束等作为解剖标志的临床意义。结果翼管完全突入蝶窦内为18.8%(48/256),半突入蝶窦腔内为32.8%(84/256),完全走行蝶窦底壁骨质内为48.4%(124/256)。翼管前口及圆孔内径分别是(4.6±0.5)mm、(2.7±0.7)mm,翼管前口边缘至圆孔边缘、蝶腭孔边缘和破裂孔间距分别为(6.0±2.4)mm、(3.6±0.9)mm和(16.9±1.9)mm。翼管神经是翼腭窝内寻找蝶腭神经节、上颌神经的重要标志;翼管位于蝶窦底壁及外侧壁交界处,翼管神经血管束指向颈内动脉膝状部,也是海绵窦前部和Meckel腔的标志。结论翼管神经血管束作为解剖标志对于内镜经鼻颅底手术有重要的指导作用,正确认识这些解剖标志有助于提高手术安全性。Objective To explore clinical anatomy of the vidian canal as an anatomical landmark in endoscopic endonasal skull base surgery. Methods Coronary CT images of the sphenoid sinus from 256 patients with chronic rhinitis and three-dimensional bone CT reconstruction of the vidian canal from 26 patients with allergic rhinitis were studied.Dissection was performed on 6 cadavers（ 12 sides） to better understand the complicated anatomical relationships of the vidian nerve and analyze the clinical significance of vidian nerve as an anatomical landmarks. Results The vidian canals protruding into the sphenoid sinus cavity was observed in 18. 8%（ 48 /256）,within-the-floor of the canals in 32. 8%（ 84 /256）,and under the floor in 48. 8%（ 124 /256）. The distances between the anterior opening of the vidian canal（ VC） and the sphenopalatine foramen（ SPF）,foramen rotundum（ FR） were（ 6. 0 ± 2. 4） mm,（ 3. 6 ± 0. 9） mm and（ 16. 9 ± 1. 9）mm. The mean diameters of the VC and FR were（ 4. 6 ± 0. 5） mm and（ 2. 7 ± 0. 7） mm,respectively. Vidian canal served as a route for resection of maxillary nerve or pterygopalatine ganglion and was an important landmarks in directing endoscopic approaches to the petrous carotid and the anteromedial part of the cavernous sinus and Meckel ＇s cave.Conclusion Vidian neurovascular bundle is important for guiding endoscopic endonesal skull base surgery and precisely localizing them is helpful to ensure the safety of endoscopic endonasal skull base surgery.

关 键 词：翼管神经 鼻内镜 应用解剖 外科手术 断层影像 人 

分 类 号：R32[医药卫生—人体解剖和组织胚胎学]