【作者】 马荣昌；

【导师】 鞠建宝；

【作者基本信息】 青岛大学 ， 鼻科学， 2002， 硕士

【摘要】 目的 结合鼻内窥镜下眶尖部手术应用的需要，通过眶尖部结构的应用解剖及应用和断层影像解剖学相结合的研究，为鼻内窥镜下眶尖部手术寻求一安全、便捷的手术入路，确立安全的手术边界，为眶尖部疾病的临床诊断和鼻内窥镜手术提供可靠的解剖学依据，以取得良好的手术效果和减少并发症的发生。并将所获得的眶尖部影像学资料与实体解剖观测数据进行比较，以评估该区域CT断层扫描的准确度及临床应用价值。 方法 ①采用随机选取的30例外观无异常病损的经10％福尔马林固定的成人尸头(男21例，女9例)，正中矢状面将尸头锯开，切除脑组织，依照鼻窦内窥镜下眶尖部手术进路观测前鼻棘至眶尖部各结构的距离(深度)、侧偏角、仰角及旁开距等；视神经管各壁长度、内侧壁厚度、视神经管垂直径和横径及截面积等；眶上裂长度、内侧及外侧间距；部分穿经眶上裂的神经与眶上裂内、上壁的距离和与视神经管的最短距离等；②采用FV平面作为轴位扫描基线，与其相垂直的平面作为冠状位扫描平面，对9例完整成人尸头进行扫描，测量前鼻棘至眶尖部各解剖结构的距离；视神经管内、外侧壁长度及眶口、中部和颅口内侧壁厚度、内侧及外侧间距、垂直径和横径及截面积；视神经管与颅骨正中矢状面的夹角；眶上裂长度、内侧及外侧间距及最短距离。③将扫描过的尸头脱钙，依与断层影像扫描相同的基线对尸头进行断层解剖，显微镜下观察视神经管及眶上裂出现的层面，同时测量方法②中除视神经管与颅骨正中矢状面的夹角外的所有相关数据。 结果 前鼻棘至视神经管眶口、中部和颅口内、外、上、下壁的距离平均分别为62.01mm，70.04mm，65.02mm，67.15mm，65.60mm，72.36mm，66.52mm，69.54mm，68.23mm，74.60mm，68.01mm，72.67mm。前鼻棘至眶口和颅口内侧壁的侧偏角、仰角平均为9.56°和5.34°，38.77°和34.08°，随着 中文摘要深度的增加，角度逐渐减小。视神经管内侧壁长度及中部内侧壁厚度平均分别为 11．04mm和 0．55 mm，在各壁中最长和各段中最薄；视神经管中部裁面积平均为 15．86mm’，为视神经管最狭窄的部位。眶上裂长度、内侧间距、外侧问距及最短距离分别为 17．96mm，30．78mm，51．23 mm，28．98 mm．视神经管与颅骨正中矢状面的夹角平均为40．61士3．49”．冠状位断层影像解剖与应用解剖数据有较好的相关性。应用与断层影像解剖学结果基本一致。 结论①眶尖部鼻内窥镜下手术时，应严遵中线附近操作的手术原则，随着深度的增加，应相应减少各角度。②视神经管减压手术时，在安全范围内全程开放视神经管内侧壁至关重要。同时开放中部并将 Zinn”s环切开，松解，才能达到充分减压的目的。③以FV平面作为轴位扫描基线，与其垂直的平面作为冠状位扫描平面，能较好地反映眶尖部结构的解剖特征。而冠状位断层扫描图像对径线、夹角等解剖变量反映更精确。结合水平及冠状位断层图像进行分析，更有利于术中眶尖部解剖结构的准确定位。④采用薄层断层显微解剖切片与断层影像相结合，通过形态学观测及相关解剖数据相比较的方法，可较客观、准确地反映眶尖部的解剖学特征，是研究眶尖部结构的有效方法和手段。更多还原

【Abstract】 Purpose To meet the needs of the clinical operation of orbital apex ,a research has been performed to explore a secure and easy operating route and a safe border for the en-doscopic operation of the orbital apex by means of the applied anatomy , sectional anatomy and imaging scans, and to provide the reliable anatomy data for the clinical diagnosis and endoscopic operation on the diseases of the orbital apex. Therefore, satisfactory operation effect is obtained and the complications are reduced. By comparison of the imaging and the sectional anatomic data on the orbital apex , we can evaluate the accuracy and value of the CT scan in visualizing this region in detail.Methods CD 30 adult cadaveric heads without any lesion were selected at random (male 21, female 9) and cut along the midsagittal plane, whose brain tissues were removed subsequently. According to the approach of transnasal endoscopic operation to the orbital apex ,we have observed and measured the distance from anterior nasal spine to the various structures of the orbital apex, the angles of the lateral deviation and elevation and the lateral deviate distance. Quantitative measurement was done for the length of the optic canal walls, the thickness of medial wall, the distance of the medial and lateral margins. The transverse and vertical diameter and the transverse area of the canal were also measured in the orbital part, middle part and intracranial part. The superior orbital fissure was measured in the length , distance of medial and lateral margins. Meanwhile , the distances of some nerves crossing the superior orbital fissure to the superior and medial walls of fissure and to the optic canal were measured respectively. (2)CT scan was performed on 9 adult cadaveric heads with continuous 2mm sections thickness through the Frankfurt-Virchow planeCFV plane) which was adopted as axial baseline or plane and coronal plane(vertical plane of the axial plane). The content of study was almost as same as the mentioned in the method CD except the angle of elevation and the lateral deviate distance of the structures in the orbital apex, the distances of some nerves crossing the superior orbital fissure to the superior and medial walls of fissure and to the optic canal. Besides, the angle between the optic canal and the sagittal plane was also measured.(3)The specimens were decalcified and cut by the baseline of CT scan. The measurement of the item mentioned in the method (2) was done exceptfrom the angle to the sagittal plane(SP).Result The mean distances from anterior nasal spine to the medial, lateral, superior and inferior walls of the optic canal in orbital part, middle part and intracranial part are 62. Olmm, 70. 04mm, 65. 02mm, 67. 15mm, 65. 60mm, 72. 36mm, 66. 52mm, 69. 54mm, 68. 23mm, 74. 60mm, 68. Olmm, 72. 67mm respectively. The mean angles of the lateral deviation and the elevation in orbital and intracranial medial margins of the canal are 9. 56?and 5. 34? 38. 77?and 34. 08?respectively. With the depth increasing, the angles gradually decreased. 11. 04mm and 0. 55 mm are the length of the medial wall of the optic canal and the thickness of medial wall in the middle part of the canal which are the longest among the canal walls and the thinnest in three parts of the medial canal wall respectively. 15. 86mm2 is the mean transverse area of the canal in middle part which is the narrowest among three parts of the canal. 17. 96mm, 30. 78mm,51. 23mm and 28. 98mm are the length, distance of medial and lateral margins and the shortest distance of the superior orbital fissure respectively. The mean angle to the sagittal plane is 40. 61 + 3. 49? There exists a good correlation between the data of the coronal scans and sections. The results of the sectional anatomy are the same as that of CT scans on the whole.Conclusion (1)Allow for the orbital apex, the transnasal endoscopic operation must be performed near the middle line. With the depth increase, the angles must be decreased relatively. (2)For the decompression of the optic canal, it is imp更多还原