摘要
目的在构建虚拟现实模型的基础上探讨经枕髁入路显露颈静脉结节的不同手术路径中包含结构的显微解剖特征。方法15例尸体头颅行头颅CT和MRI扫描，影像数据输入虚拟现实系统构建颈静脉孔区三维解剖模型，在颅盖和颅底中选择骨性标志点设计经枕髁入路显露颈静脉结节的手术路径，观察和测量路径方向改变后解剖结构显露情况，采用方差分析和配对￡检验进行数据分析比较。结果模拟手术路径有效体现随操作方向和角度变化所包含的神经、血管等解剖结构变化，仅路径b包含外展神经，仅路径c包含脑干。路径中骨性结构体积：路径a〉路径c〉路径b；静脉体积：路径b〉路径a〉路径C；小脑前下动脉体积：路径b〉路径c〉路径a；后组颅神经（不包括舌下神经）和舌下神经体积：路径c〉路径a〉路径b；椎动脉体积：路径c〉路径a；小脑体积：路径b〉路径C；差异均有统计学意义。结论在限定靶点的情况下，围绕枕髁的手术路径方向和角度变化，路径中显露解剖结构随之改变；量化结果可为手术微创化提供信息。
Objective To discuss microanatomy features of different surgical roads in transcondyle approach for exposure of jugular tubercle based on virtual reality model. Methods CT and MRI scans were performed to fifteen adult cadaver heads, and then, image data was inputted into Vitrea virtual reality system to establish three--dimensional anatomy model of jugular foramen region, transcondyle ap- proach for exposure of jugular tubercle was simulated by selecting osseous landmark points on the calvar- ia and skull base. Anatomic structure appeared was observed and measured following change of surgical trajectory. Statistical comparison was launched by variance analysis and paired t test. Results Changes of in the anatomy of nerves, blood vessels were reflected by alternation of directions and angle of surgical routes. Abducens nerve and brainstem was exposed only in route b and c respectively. Path of the bony structure volume： a〉c〉b; Intravenous volume： b〉a〉c; anterior inferior cerebellar artery volume： b〉c〉a; Cranial nerve （not including the hypoglossal nerve ） and hypoglossal volume： c〉a〉b; verte- bral artery volume： c〉a; and cerebellar volume： b〉c. The differences of above items were statistically significant. Conclusions In the case of a limited target, anatomical structures involved will alter follow- ing directions and angles change of surgical route. The quantitative results are helpful to guiding mini- mally invasive surgery.
出处
《神经疾病与精神卫生》
2014年第6期552-554,F0003,共4页
Journal of Neuroscience and Mental Health
基金
首都卫生发展科研专项基金（首发2014-4-5073）
关键词
虚拟现实
三维解剖
远外侧入路
颈静脉结节
微创
Virtual reality
Three--dimensional anatomy
Far lateral approach
Jugular tubercle
Minimal invasion
