【作者】 张峰；

【导师】 张瀛；

【作者基本信息】 昆明医学院 ， 耳鼻咽喉科学， 2006， 硕士

【摘要】 目的：探讨切除后半规管的改良迷路下进路，开放内听道的术式，进行解剖学研究和数据测量，为此进路进行内听道手术提供解剖学标志、参数及依据，并探讨该方法的优越性及安全性。 方法：用10％甲醛固定的20具(40侧耳)成人尸头，显微镜下(×6～16)模拟改良迷路下进路进行解剖，暴露内听道。观察乳突导血管的情况。测量乙状窦中段的宽度、乙状窦中段前缘到面神经垂直段的最短距离、颈静脉球的高度、颈静脉球顶到内听道下缘距离、颈静脉球顶到内听道上缘距离、水平半规管曲部后缘到后颅窝硬脑膜的距离、内听道口上下径高度和内听道的长度。对每一个测量结果均重复测量三次，取其平均值。所得数据用SPSS11.5或PEMS软件包统计分析。 结果：乳突导血管的出现率为80％(32／40)，68.75％(22／32)的乳突导血管外口位于枕乳缝之前。乙状窦中段的宽度：(10.63±1.91)mm；乙状窦中段前缘到面神经垂直段的最短距离：(9.84±2.48)mm；颈静脉球的高度：(5.40±1.48)mm；颈静脉球顶到内听道下缘的距离：(3.03±1.93)mm；颈静脉球顶到内听道上缘的距离：(8.24±2.36)mm；水平半规管曲部后缘距后颅窝硬脑膜的距离：(5.60±1.28)mm；内听道口上下径高度：(4.13±0.85)mm；内听道后壁全长：(8.74±1.31)mm；内听道暴露长度(33侧可经改良迷路下进路暴露的内听道)：(5.45±1.04)mm，占全长的(61.52±10.00)％；切除后半规管弓，术中骨窗视野可达(5.60±1.28)mm×(8.24±2.36)mm。颈静脉球的高度与颈静脉球顶到内听道下缘的最短距离呈负相关(r=—0.742，P＜0.01)。 结论： 1．改良迷路下进路开放内听道可明显扩大骨窗视野。 2．颈静脉球的高度与其顶到内听道下缘的距离呈负相关，改良迷路下进更多还原

【Abstract】 Objective To study surgical methods in order to expose the internal auditory canal (IAC) via the modify infralabyrinthine approach resected the posterior semicircular canal (PSC), and to provide anatomic markers, anatomic parameters and evidence for operation on IAC through this approach. And to study the superiority and safety of this approach.Methods Under the microscope (× 6-16), exposure of IAC via the modify infralabyrinthine approach was simulated on 20 adult cadaveric heads (40 sides) fixed with 10% formaldehyde, in each surgery the PSC was removed, Simultaneously, exposed the IAC. Observe mastoid emissary. Measure the following parameters: the width of middle sigmoid sinus, the shortest distance from the anterior border of middle sigmoid sinus to the mastoid segment of facial nerve, the height of jugular bulb, the shortest distance from the top of jugular bulb to the inferior border of IAC, the shortest distance from the top of jugular bulb to the superior border of IAC, the shortest distance from the posterior extremity of horizontal semicircular canal (HSC) to the cerebral dura mater of posterior cranial fossa, the height of internal acoustic porus, the length of the posterior wall of IAC. Measurements were repeated three times and averaged. Acquired data were analysesed by SPSS 11.5 or PEMS software. Results Appearance frequency of mastoid emissary was 80% (32/40), furthermore, 68.75% (22/32) porus of the mastoid emissary were in front of the occipitomastoid suture. The shortest distance from the anterior border of middle sigmoid sinus to the mastoid segment of facial nerve was (9.84±2.48)mm; The height of jugular bulb was (5.40±1.48)mm; The shortest distance from the top of jugular bulb to the inferior border of IAC was (3.03±1.93)mm; The shortest distance from the top of jugular bulb to the superior border of IAC was (8.24±2.36)mm; The shortest distance from the posterior extremity of HSC to the cerebral dura mater of posterior cranial fossa was (5.60± 1.28)mm; The height of internal acoustic porus was (4.13±0.85)mm; The length of the posterior wall of IAC was (8.74±1.31 )mm; The length of the exposed IAC (IAC was exposed successfully in 33/40 sides of specimens via the modify infralabyrinthine approach) was (5.45 ± 1.04)mm, which was (61.52 ± 10.00)% of the更多还原