跨横窦区硬膜外血肿手术改良及枕骨鳞部相关解剖学研究  

Modified surgical method for supra-and infratentorial epidural hematoma and related anatomical study of the squamosal part of the occipital bone

作　　者：李瑞春[1] 梁晨 郭世文[1] 鱼潇 廉民学[1] LI Ruichun;LIANG Chen;GUO Shiwen;YU Xiao;LIAN Minxue(Department of Neurosurgery,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院神经外科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2020年第6期915-918,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的探索跨横窦区硬膜外血肿(SIEDH)手术方法改良和枕骨区域的相关解剖分析。方法收集我院神经外科2019年1月至2019年8月的无颅脑外伤史的30例成年患者的颅底CT扫描资料,取正中矢状面,定义直线A(人字缝到枕外粗隆)和直线B(枕外粗隆到枕骨大孔后缘)之间的夹角θ为枕骨鳞部转折角度。测量角度θ并分析其均值在男性和女性之间的差异;分析单一幕上开颅清除SIEDH的解剖学依据。同期共收集8例SIEDH为主要手术目的颅脑外伤患者,探讨改良手术方法的步骤和效果。结果枕骨鳞部转折角度男性平均(117.4±4.3)°,女性平均(130.0±4.9)°,最小角度108.3(男性),最大角度138.7°(女性)。枕骨鳞部转折角度男性小于女性,差异有统计学意义(P<0.001)。该角度越小越利于单纯从幕上开颅探查幕下病变。8例SIEDH手术患者的骨瓣设计在横窦上方,术中可以从幕上顺利地探查幕下硬膜外血肿并彻底清除,避免了常规幕下开窗导致的颅骨缺损。结论横窦上幕上开颅术治疗SIEDH有可靠的解剖学基础,在实践中是一种快速有效的手术方式。Objective To explore the modified surgical method of supra-and infratentorial epidural hematoma(SIEDH)and analyze the related anatomy of the occipital bone.Methods CT scan data of 30 adult patients with no history of craniocerebral trauma were collected in our hospital from January to August 2019.The median sagittal plane was taken to define line A(from lambdoid suture to the extraoccipital turbercle)and line B(from extraoccipital turbercle to the posterior edge of the foramen magmun).The angleθwas defined between the two lines.The mean value ofθwas analyzed for comparison between genders and for exploration of the anatomical basis of single supratentorial craniotomy for SIEDH.Eight patients with SIEDH were recruited in the same period to analyze the procedure and results of the modified surgical method.Results The average angle of theθwas(117.4±4.3)°for men and(130.0±4.9)°for women;the minimum was 108.3°for men and the maximum was 138.7°for women.Theθwas smaller in men than in women(P<0.001).The smaller the angle was,the more conductive it was to detect the lesions from superior to inferior tentorial apartment.The bone flaps of the eight patients were designed above the transverse sinus.During the operation,epidural hematoma was completely removed,and no skull defects occurred like in conventional supra-inferior tentorial craniotomy.Conclusion The supratentorial craniotomy above the tranverse sinus has reliable anatomical basis and is an effective surgical method for SIEDH.

关 键 词：横窦 硬膜外血肿 枕骨 手术方法 

分 类 号：R651.1[医药卫生—外科学]