小型猪耳后入路内耳导入术的解剖学研究  

An Anatomical Study of Retroauricular Approach to the Inner Ear in Mini Pigs

作　　者：安丰伟[1,2] 侯昭晖[1] 陈伟[1] 任丽丽[1] 郭维[1] 张悦[1] 杨仕明[1] AN Fengwei;HOU Zhaohui;CHEN Wei;REN Lili;GUO Wei;ZHANG Yue;YANG Shiming(Institute of Otorhinolayngology,Chinese PLA GeneraI Hospital;Beijing Key Laboratory of Hearing Impairment Prevention and Treatment;Key Laboratory of Hearing Impairment Science(Chinese PLA Medical School),Ministry of Education;Laboratory of Military Acoustic Trauma Protection,Beijing 100853,China;Department of Otolaryngology Head&Neck Surgery,Jinan Military General Hospital.Jinan 250031)

机构地区：[1]中国人民解放军总医院耳鼻咽喉头颈外科,耳鼻咽喉科研究所,聋病防治重点实验室,聋病教育部重点实验室,军事声损伤防护实验室,北京100853 [2]济南军区总医院,耳鼻咽喉头颈外科,济南250031

出　　处：《中华耳科学杂志》2018年第4期458-462,共5页Chinese Journal of Otology

基　　金：全军后勤重点项目(BWS14J045)Military noise grant(BWS14J045);首都卫生发展科研专项重点攻关项目(2016-1-5014);国家自然基金面上项目(81670940);军事医学创新工程和青年培育项目(16QNP133);北京市属医院科研培育计划项目-PX2017046资助。

摘　　要：目的明确小型猪耳后入路内耳导入的手术过程中相应的解剖标志及注意事项,论证其保存外耳和中耳传音特性的可能性。方法选择6月龄贵州小型猪5头,麻醉后手术分为五个主要步骤进行:1.耳后沟切开;2.暴露茎突;3.暴露面神经;4.轮廓化外耳道;5.暴露鼓室、圆窗及鼓阶导入。结果每个步骤的主要解剖标志为:1.眶下缘、颧弓上缘、耳后沟、下颌骨升支、耳后肌腱;2.茎突尖、茎突脊、茎突根部隆起、枕骨髁;3.面神经垂直段、骨性外耳道;4.面神经与外耳道间的"小舌"状骨片;5.上鼓室外侧壁、面神经水平段,鼓索神经、圆窗。主要的解剖要点为:1.耳后切开长度约6cm;2.骨面暴露向后不要超过茎突脊尾侧0.5cm;3磨骨范围不必超过面神经垂直段尾侧;4.不要损伤外耳道皮肤;5.鼓膜掀起范围要尽量小,导入方向为圆窗腹侧部。结论耳后入路内耳导入手术过程中解剖标志明确,是理想的导入方式,但由于小型猪自身解剖特点,耳后入路必然会部分改变外耳和中耳的传音特性。Objective To clarify important anatomical landmarks and key points for retroauricular approach to the inner ear in minipigs,and to determine the probability of preserving acoustic conduction characteristics of the outer and middle ear in the process.Methods The right ear in 5 six-months old normal mini pigs was used in the study.The approach involved five steps:1.post-auricular incision,2.exposure of the styloid process,3.exposure of the facial nerve,4.skeletonization of the external ascoustic meatus,and 5.exposure of the tympanic cavity and insertion via the round window/scala tympani.Results Key landmarks in each step:1.infraorbital rim,superior border of zygomatic arch,retroauricular groove,mandibular ramus,retroauricular tendon;2.styloid process,occipital condyle;3.vertical facial nerve,bony external acoustic meatus;4.bony“tongue”between facial nerve and external acoustic meatus;5.lateral wall of attic,horizontal facial nerve,chorda tympani,round window.Key points for each step:1.The size of the retroauricular incision was approximately 6 cm;2.bone exposure was to be limited to within 0.5 cm caudal to the styloid process;3.bone removal was not to exceed vertical facial nerve;4.caution was needed not to damage skin of external ascoustic meatus;5.elevation of the tympanic membrane should be limited and insertion should be directed toward the ventral part of round window.Conclusion The retroauricular approach provides clear anatomical landmarks and is ideal for inner ear insertion.However,because of the inherent anatomical features of the minipig,some change in acoustic conduction characteristics is inevitable in retroauricular approach.

关 键 词：小型猪 耳后入路 内耳导入 传音特性 圆窗 

分 类 号：R764[医药卫生—耳鼻咽喉科]