枕骨大孔和枕髁数字化形态的三维重建  

Digital morphology of foramen magnum and occipital condyle:an observation based on three-dimensional reconstruction

作　　者：王建[1] 王星[1,2] 李琨[1,2] 高尚[1] 王超群 张少杰[1,2] 李志军[1,2] Wang Jian;Wang Xing;Li Kun;Gao Shang;Wang Chaoqun;Zhang Shaojie;Li Zhijun(Human Anatomy Teaching and Research Section,Inner Mongolia Medical University,Hohhot 010110,Inner Mongolia Autonomous Region,China;Digital Medicine Center,Inner Mongolia Medical University,Hohhot 010110,Inner Mongolia Autonomous Region,China;Imaging Center of Affiliated Hospital,Inner Mongolia Medical University,Hohhot 010110,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学人体解剖学教研室,内蒙古自治区呼和浩特市010110 [2]内蒙古医科大学数字医学中心,内蒙古自治区呼和浩特市010110 [3]内蒙古医科大学附属医院影像中心,内蒙古自治区呼和浩特市010110

出　　处：《中国组织工程研究》2023年第20期3117-3122,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81860383),项目负责人:李志军;国家自然科学基金资助项目(81860382),项目负责人:王星;内蒙古自治区自然科学基金资助项目(2020LH08021),项目负责人:李志军;内蒙古自治区自然科学基金资助项目(2020MS03061),项目负责人:王星;内蒙古自治区自然科学基金资助项目(2019MS08017),项目负责人:张少杰;内蒙古自治区高等学校青年科技英才支持计划资助(NJYT22009),项目负责人:王星;内蒙古自治区科技计划项目(2019GG158),项目负责人:王星;内蒙古医科大学科研重点项目(YKD2021ZD011),项目负责人:王星;内蒙古医科大学青年基金项目(YKD2020QNCX055),项目负责人:李琨;内蒙古自治区卫生健康委医疗卫生科技计划项目(202201217),项目负责人:王星。

摘　　要：背景:脑干腹侧面周围结构的病变位于颅颈交界处深面,周围毗邻重要结构,远外侧入路是基本术式,但入路时要考虑性别、侧别间的差异。目的:通过三维重建测量手段对枕骨大孔和枕髁进行形态特征分析,为临床颅底远外侧手术入路提供解剖学参数。方法:选择拍摄头颈部电子计算机断层扫描图像的成年人共673例,男448例,女225例,年龄20-87岁。经软件三维重建颅底,测量枕骨大孔长度和宽度,利用公式计算枕骨大孔面积和指数,测量枕髁长度、宽度,枕髁长轴与矢状轴的夹角,枕骨大孔前、后缘中点连线与枕髁后缘和枕骨大孔交点连线的夹角,枕骨大孔前、后缘连线中点与舌下神经管后壁中点连线的夹角。对各指标进行性别和侧别差异分析。结果与结论:(1)枕骨大孔指标中除枕骨大孔指数不存在性别间统计学差异外,其余指标均存在性别间的差异(P<0.05);枕髁指标中,除男性左枕髁宽小于女性外(P>0.05),左枕髁长、右枕髁长、右枕髁宽男性均大于女性(P<0.05);(2)男性枕髁长轴与矢状轴的夹角小于女性,且左枕髁长轴与矢状轴的夹角在性别间差异有显著性意义(P<0.05);(3)枕骨大孔前、后缘连线中点与枕骨大孔前缘中点和舌下神经管内口后壁中点连线的夹角在侧别间无统计学差异;枕髁长、枕髁宽、枕髁长轴与矢状轴的夹角、枕骨大孔前、后缘中点连线与枕髁和枕骨大孔交点连线的夹角在侧别间差异均有显著性意义(P<0.05);(4)提示枕骨大孔和枕髁的相关参数在性别和侧别间存有差异,临床远外侧髁后及经髁入路中,右侧入路暴露范围较大;男性枕骨大孔长、宽、面积均大于女性,男性枕髁长、枕骨大孔前缘中点和枕髁后缘连线与矢状面夹角大于女性,远外侧入路时应考虑性别间差异。BACKGROUND:Lesions of structures around the ventral side of the brainstem are located in the deep surface of the craniocervical junction,surrounded by important structures.The far lateral approach is the basic surgical method,but sex and lateral differences should be considered in the approach.OBJECTIVE:To analyze the morphological characteristics of the foramen magnum and occipital condyle by three-dimensional reconstruction measurements,thereby providing anatomical parameters for the far lateral approach to the skull base in clinical practice.METHODS:A total of 673 adult patients(448 males and 225 females)with head and neck CT scans were selected.The age ranged from 20 to 87.The length and width of the foramen magnum were measured.The area and index of the foramen magnum were then calculated by formulas.The length and width of the occipital condyle were measured,as well as the angle between the long and sagittal axis of the occipital condyle(O-S angle),the angle between the line connecting the midpoints of anterior and posterior foramen magnum and the line connecting the midpoint of anterior foramen magnum and the intersection of posterior occipital condyle and lateral foramen magnum(F-O angle),and the angle between the line connecting the midpoints of anterior and posterior foramen magnum and the line connecting the midpoint of anterior foramen magnum and the midpoint of the posterior wall of the hypoglossal canal(F-H angle).The sex and lateral differences of each index were analyzed.RESULTS AND CONCLUSION:There were statistical differences in foramen magnum indexes except between sexes(P>0.05).The indexes of occipital condyle were significantly higher in males than in females(P<0.05)except that the left occipital condyle width in males was lower than that in females(P>0.05).The O-S angle in males was smaller than that in females,and there was a significant difference in the left O-S angle between sexes(P<0.05).There was no statistical difference between right and left F-H angles.Significant differences were o

关 键 词：枕骨大孔 枕髁 电子计算机断层扫描图像 三维重建 远外侧入路 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R651