内镜下经鼻扩大入路齿状突切除术的自由度分析  

Surgical freedom of odontoidectomy via endoscopic endonasal approach

作　　者：李瑞春[1] 梁晨[1] 郭世文[1] 杨诚 廉民学[1] 宋千[1] 何百祥[1] 杨旭 鲍刚[1] LI Ruichun;LIANG Chen;GUO Shiwen;YANG Cheng;LIAN Minxue;SONG Qian;HE Baixiang;YANG Xu;BAO Gang(Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061;Department of Surgery,Xi’an Central Hospital of Shaanxi Province, Xi’an 710048;Department of Neurosurgery, Pucheng County Hospital, Weinan City 715500, 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71006 [2]陕西省新安中心医院外科,陕西西安710048 [3]陕西省蒲城县医院,陕西渭南715500

出　　处：《西安交通大学学报（医学版）》2021年第3期345-348,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省重点研发计划项目(No.2018SF-137)。

摘　　要：目的定量分析内镜下经鼻入路齿状突磨除的手术自由度。方法对7例成人头颅标本实施内镜下经鼻入路鞍区和颅颈交界区解剖,暴露出鞍底中央(CenSF)、外侧视神经管颈内动脉隐窝(LOCR)、枕骨大孔、寰椎、寰枕关节和齿状突尖(TOP)。利用神经导航的空间坐标定位系统,计算TOP的手术自由度,并与LOCR和CenSF进行比较分析。结果CenSF和LOCR是在经鼻内镜手术中常见的容易暴露的骨性标志,TOP与其手术自由度比较结果显示:①轴面自由度分析,TOP、LOCR和CenSF 3组间差异有统计学意义(中位数5.7°vs.6.9°vs.8.5°,P=0.004),其中TOP小于CenSF(P=0.003);②矢状面自由度分析,TOP、LOCR和CenSF 3组间差异有统计学意义(中位数6.3°vs.7.0°vs.9.5°,P=0.009),TOP小于CenSF(P=0.008);③TOP与LOCR手术自由度差异均无统计学意义(P=0.604,P=0.688)。结论内镜下经鼻入路可以为齿状突切除术提供足够的手术自由度。Objective To quantitatively analyze the surgical freedom of odontioectomy via endoscopic endonasal approach.Methods Seven adult head specimens were dissected by the endoscopic transnasal approach to the sellar region and craniocervical junction.The center of sellar floor(CenSF),opticocarotid recess(LOCR),foramen magnum,atlas,atlas-occipital joint and tip of odontoid process(TOP)were exposed.The surgical freedom of TOP was calculated by using the spatial coordinate positioning system of neuronavigation,and compared with that of LOCR and CenSF.Results CenSF and LOCR were common landmarks in the endonasal endoscopic approach.When the surgical freedom between TOP and CenSF and LOCR was compared,it indicated that①The angle of attack on axial plane(AAAP):There was a significant difference among TOP,LOCR and CenSF(5.7°vs.6.9°vs.8.5°,P=0.004).The comparison between the two groups showed that TOP was less than CenSF(P=0.003).②The angle of attack on sagittal plane(AASP):There was a significant difference among TOP,LOCR and CenSF(6.3°vs.7.0°vs.9.5°,P=0.009).The TOP was less than CenSF(P=0.008).③There was no statistical significance between TOP and LOCR in surgical freedom(P=0.604,P=0.688).Conclusion Endoscopic transnasal approach can provide sufficient surgical freedom for odontoidectomy.

关 键 词：齿状突切除 内镜 经鼻入路 手术自由度 

分 类 号：R651.1[医药卫生—外科学]