侧颅底手术中乙状窦应用解剖学研究
Applied anatomy of the sigmoid sinus in lateral skull base surgery
目的 探讨侧颅底手术中乙状窦相关解剖标志的位置，为进一步提高侧颅底手术安全性提供解剖学基础。 方法 选取成人头颅标本40个，采用耳后切口行标准乳突根治术。充分暴露颅中窝及颅后窝硬脑膜、外半规管、面神经膝部、乙状窦、颈静脉球、乳突、茎乳孔、二腹肌嵴、外耳道后壁等重要解剖结构。使用双脚规测径器或电子数显游标卡尺分别测量相关解剖结构之间的距离。 结果 乙状窦前缘至外耳道后壁的距离是(1.41±0.32)cm，乙状窦外侧壁至乳突外侧壁的距离是(1.02±0.38)cm，面神经乳突段的长度是(1.28±0.13)cm，面神经乳突段起点（即面神经膝部）到乙状窦的距离是(0.56±0.20)cm，面神经乳突段终点（即茎乳孔部）到乙状窦的距离是(0.62±0.22)cm，二腹肌嵴至乙状窦的距离是(0.52±0.18) cm，茎乳孔至乙状窦的距离是(1.02±0.24)cm。 结论 面神经乳突段起点和终点至乙状窦的距离及乙状窦至二腹肌嵴和茎乳孔之间的距离均呈正相关；乙状沟的深浅、宽窄及骨壁的厚薄因乳突气化程度不同而各异。
Objective To investigate the quantitative relationships between sigmoid sinus(SS) and anatomic landmarks correlated with SS, and provide anatomic basis for safety in lateral skull base surgery. Methods 40 human temporal bones were obtained and dissected with typical radical mastoidectomy so that the dura mater of middle and posterior cranial fossa, lateral semicircular canal, genu of facial nerve, SS, jugular bulb(JB), mastoid process, stylomastoid foramen, digastric ridge, the posterior wall of external auditory canal(EAC) can be exposed. The distances from SS to neighbouring structures were measured with caliper or electron sliding caliper. Results The distance from EAC to anterior border of SS was (1.41±0.32)cm, the distance from lateral wall of SS to lateral wall of mastoid process was (1.02±0.38)cm, the length of the mastoid portion of facial nerve was (1.28±0.13)cm, the distance from the beginning of the mastoid portion of facial nerve to SS was (0.56±0.20)cm, the distance from the end-point of the mastoid portion of facial nerve to SS was (0.62±0.22)cm, the distance from digastric ridge to SS was (0.52±0.18)cm, the distance from stylomastoid foramen to SS was (1.02±0.24)cm. Conclusion A statistically significant correlation was found between the distance of the SS to the beginning and the SS to the end-point of the mastoid portion of facial nerve; Comparing the distance of the stylomastoid foramen and the digastric ridge compared to the SS, a proportional and direct relation was found; A significant relationship between the degree of mastoid pneumatization and the morphology of SS was found.
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