【作者】 孟庆玲；

【导师】 韩卉；

【作者基本信息】 安徽医科大学 ， 人体解剖与组织胚胎学， 2003， 硕士

【摘要】 目的 研究颞骨内部结构的显微解剖及计算机三维重建图像，为临床耳外科及神经外科手术提供解剖学依据。方法 ①对30例(60侧)成人颅底骨性标本、15例(30侧)成人颅底湿标本内耳道、脑桥小脑角及面神经管穿经结构、30例(60侧)成人内耳骨迷路硅胶铸型及10例(20侧)CT蜗神经管断层平面进行解剖学观测；②对4例(8侧)颞骨螺旋CT多层面重建(multi planar reconstruction,MPR)、表面遮盖重建(surface shaded display,SSD)和CT仿真内窥镜(CT virtual endoscopy,CTVE)重建图像、15例(30侧)内耳MR最大密度投影(maximum intensty projection,MIP)重建图像及颞骨薄层切片重建图像进行观测。结果 ①内耳门位于颞骨岩部后面，83.3％呈椭圆形，25.0％有内耳道口上棘，其与前庭导水管外口的距离为(9.71±1.38)mm、与后半规管凸距离为(15.62±2.40)mm；②面神经管裂孔与内耳道底投影点的距离为(8.04±2.01)mm；③60侧硅胶铸型模型满意显示内耳骨迷路的解剖结构，前骨半规管的跨度最大，外骨半规管最粗，后骨半规管的高度及弧长最大；④蜗神经管CT直径正常参考值为2.08mm～2.23mm(95％可信区间)；⑤面神经管迷路段最狭窄；⑥MPR能在不同切面显示耳蜗、半规管、内耳道及面神经管垂直段等结构，显示率为100％；SSD能清晰显示颞骨重要的骨性结构，如内耳门、前庭导水管外口等，冠状位切割后的SSD图像能生动地显示锤骨、砧骨的立体形态及空间关系；CTVE可模仿内窥镜从外耳向中耳移动，清晰显示骨性外耳道、鼓室内侧壁及听骨链等结构；⑦MIP重建图像能满意的显示两侧内耳道及内耳膜迷路的解剖结构，其中3个膜半规管、椭圆囊、球囊、蜗管及内耳道呈高信号；⑧在SCI工作站上获得清晰、准确的颞骨内部结构的三维重建图像，重建的所有结构可单独、任意搭配或总体显示。结论① 内耳门可作为耳显微外科及神经外科手术的定位标志。②面神经管裂孔可作为内耳道定位的标志。③3个骨半规管的大小、形态各异。④获得的蜗神经管直径的正常参考值安徽医科大学硕士学位论文孟庆玲可作为人工电子耳蜗植入术前辅助的评估标准。⑤熟悉面神经的显微解剖及与毗邻结构间的解剖位置关系，有利于术中面神经定位，提高面神经的保留率。⑥MPR、sSD、CTVE可准确、立体地显示颖骨内部结构，增加耳颖部疾病的诊断信息，提高诊断率，对手术方案的设计、医学教学等多个领域具有重要的指导意义。⑦MRI水成像能立体、直观地显示内耳道及膜迷路的细微结构;首次制定了国人内耳主要结构的MRI测量值。⑧颖骨薄层切片三维重建的图像能清晰显示颖骨内部结构，重建的结构可单独显示、任意组合显示或整体显示，可进行旋转从多个角度进行观察，为耳科及神经外科手术、人体颅底模型的建立及解剖学教学效果的提高提供解剖学资料。更多还原

【Abstract】 Objective The microanatomy of intratemporal structures and computer-aided three-dimensional reconstructed images were studied by using various methods in order to provide anatomic basis for otolosurgery and neurosurgery. Methods (1)We observed and measured Osseous structures of the temporal bones in 30 skulls, the structures passing the internal auditory meatus, cerebellopontine angles and the facial canals in 15 adult cadaveric heads, the plastic models of bony labyrinth in 30 skulls and 2D images spiral CT of cochlea nerve canals in 10 skulls under macro-microscopy and Voxel Q CT working station.(2)3D images spiral CT in 8 sides of volunteers including MPR,SSD and CTVE, 3D images of inner ear by using maximum intensity projection and 3D images of intratemporal structures by using the Chinese visible human data set were performed and measured under computer working station.Results (1)The configuration of internal auditory pore was oval shape in 83.3% of all and there were suprameatal tubercle in 25.0%. The distances from internal auditory pore to the external aperture of the vestibular aqueduct and to posterior semicircular canal were 9.71 1.38mm and 15.62 2.40mm.(2)The distance between hiatus of facial nerve canal and the projecting point of fundus of internal auditory meatus was 8.04+ 2.01mm.(3)The satisfactory plastic models of bony labyrinth were obtained. Among them, the span of anterior bony semicircular canal was the longest, and the internal diameter of lateral bony semicircular canal was the boldest; and the height and the arc length of posterior bony semicircular canal were the longest.(4)The cochlea nerve canal was scanned by spiral CT and the reference value of the diameter of cochlea nervecanal was in the range from 2.08mm to 2.23mm.(5)The labyrinthine portion of facial nerve canal was the narrowest. (6)The satisfactory MPR images of cochlea, bony semicircular canals, internal auditory meatus and other intratemporal structures might be obtained by different slices. The SSD images could show the important bony marks of temporal bone and the spatial relationships between them perspicuously. The coronal dissected images of SSD can vividly demonstrate the shape and the spatial relationships of malleus and incus. A series images were obtained as the virtual endoscope moved from the external auditory canal to the middle ear cavity. Vritual endoscopy could well demonstrate the surface of medial wall and ossicles.(7)Anatomic structures of internal auditory meatus and membraneous labyrinth were well demonstrated in all volunteers. With T2 weighted 3D-FSE sequence, all three semicircular ducts, utricle, saccule, cochlea duct and internal auditoruy meatus produced high singal intensity.(8)The 3D images of intratemporal structures could be obtained on SGI working station. All structures reconstructed could be represented individually or jointly and rotated continuously in various planes. Conclusions (1)Internal auditory pore can be served as landmark for otolosurgery and neurosurgery.(2)The hiatus of facial nerve canal was important landmark to define internal auditory meatus. (3) Three bony semicircular canals were not same in appearance and size.(4)The number range of CT diameter of cochlea nerve canal was helpful for choosing the method in cochlea implantation.(5)To be familiar with the microanatomy of the facial nerve in internal auditory meatus, cerebellopontine angles and the facial canal is helpful for localizing the facial nerve and improving its preservation in otolosurgery and neurosurgery.(6)The images of spiral CT including SSD, MPR and CTVE can enrich the diagnostic information for observer. The reconstructed images can be used to design tactics for otolosurgery and be applied in medical education.(7)MIP images might document, stereoscopically and directly, the minute structures of internal auditory meatus and membraneous labyrinth. For the firsttime, the MRI measurement’s criterion of inner structures is established.(8)All structures reconstructed can be represented indi更多还原