筛前动脉与前颅底解剖变异相关性的三维重建CT分析  

Three-dimensional CT reconstruction analysis of correlation between anatomical variations of anterior ethmoidal artery and anterior skull base

作　　者：袁星 连荣[1] 张国正[1] 庞博 赵焓宇 常吉祥 刘月 余文发[1] YUAN Xing;LIAN Rong;ZHANG Guozheng;PANG Bo;ZHAO Hanyu;CHANG Jixiang;LIU Yue;YU Wenfa(the Second Ward of Department of Otolaryngology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang,Henan,453100)

机构地区：[1]新乡医学院第一附属医院耳鼻咽喉科二病区,河南新乡453100

出　　处：《实用临床医药杂志》2025年第8期12-16,共5页Journal of Clinical Medicine in Practice

基　　金：河南省省部共建项目(SBGJ2018056)。

摘　　要：目的探讨筛前动脉(AEA)与前颅底解剖变异的相关性,并分析AEA悬空的预测因素。方法回顾性分析159例接受内镜鼻窦手术(ESS)患者的鼻窦CT影像数据。利用Mimics 21.0软件进行三维重建,测量AEA及前颅底的解剖结构参数并进行分型。通过Pearson及Spearman相关性分析评估各解剖参数及其分型之间的相关性。采用多因素二元Logistic回归分析筛选AEA悬空的独立预测因素。结果不同Keros分型的AEA悬空率比较,差异有统计学意义(P<0.001)。AEA悬空率随Keros分型等级的升高而增加(P<0.001)。眶上筛房(SOEC)的横径、高度、体积,嗅凹深度、筛外侧板(LLCP)长度及额窦气化分型等级均与AEA至颅底的距离呈正相关(P<0.05)。多因素二元Logistic回归分析显示,SOEC的存在(OR=4.178,95%CI:2.517~6.935,P<0.001)、嗅凹深度增加(OR=1.433,95%CI:1.197~1.715,P<0.001)以及额窦气化分型等级升高(OR=1.621,95%CI:1.121~2.345,P=0.01)为AEA悬空的独立预测因素。结论术前详细的CT影像学评估,尤其是对SOEC、嗅凹深度及额窦气化分型的分析,有助于精准评估AEA的解剖位置,从而有效降低AEA损伤的风险,提高手术的安全性和成功率。Objective To investigate the correlation between the anterior ethmoidal artery(AEA)and anatomical variations of the anterior cranial base,and to analyze the predictive factors for AEA suspension.Methods Sinus CT imaging data of 159 patients undergoing endoscopic sinus surgery(ESS)were retrospectively analyzed.Mimics 21.0 software was utilized for three-dimensional reconstruction,measuring parameters of AEA and anterior cranial base anatomy and performing classification.Pearson and Spearman correlation analyses were used to evaluate the correlations among various anatomical parameters and their classifications.Multivariate binary logistic regression analysis was performed to screen for independentpredictive factors of AEA suspension.Results The rates of AEA suspension differed significantly across different Keros classifications(P<0.001),with an increase rate as the Keros classification level increased(P<0.001).The transverse diameter,height and volume of supraorbital ethmoid cells(SOEC),olfactory fossa depth,lateral lamella of the cribriform plate(LLCP)length and frontal sinus pneumatization classification grade were positively correlated with the distance from AEA to the cranial base(P<0.05).Multivariate binary Logistic regression analysis showed that the[JP2]presence of SOEC(OR=4.178,95%CI,2.517 to 6.935,P<0.001),increased olfactory fossa depth(OR=1.433,95%CI,1.197 to 1.715,P<0.001),and higher frontal sinus pneumatization classification grade(OR=1.621,95%CI,1.121 to 2.345,P=0.01)were independent predictive factors for AEA suspension.Conclusion Detailed preoperative CT imaging assessment,especially the analysis of SOEC,olfactory fossa depth and frontal sinus pneumatization classification,aids in accurately assessing the anatomical position of AEA,thereby effectively reducing the risk of AEA injury,and improving the safety and success rate of surgery.

关 键 词：筛前动脉 解剖变异 内镜鼻窦手术 CT评估 三维重建 眶上筛房 悬空率 额窦气化分型 

分 类 号：R765.4[医药卫生—耳鼻咽喉科] R445.3[医药卫生—临床医学] R319