颞骨内部结构的显微解剖与计算机三维重建图像的解剖学研究
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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。⑥
MPR、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。
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 nerve
canal 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 first
time, the MRI measurement's criterion of inner structures is established.(8)All structures reconstructed can be represented indi
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。⑥
MPR、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。
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 nerve
canal 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 first
time, the MRI measurement's criterion of inner structures is established.(8)All structures reconstructed can be represented indi
引文
1．杨智云，黄兆民，许达生，等．中耳疾病的CT诊断及传统X线的比较．临床放射学杂志，2000；19(6)：339～341
2. Polacin A, Kalender WA, Marchal G..Evaluation of section sensitivity profiles and image noise in spiral CT. Radiology, 1992; 185 (1): 29～35
3．姜泗长 主编．耳解剖学与颞骨组织病理学(第一版)．北京：人民军医出版社，1999；25～26，162～164，354
4. Lutz C, Takagi A, Janecka IP, et al.Three-dimensional computer reconstruction of a temporal bone. Otolaryngol Head Neck Surg,1989; 101 (5): 522～526
5．戴朴，姜泗长，顾瑞，等．听骨链的计算机三维重建及力学模型建立．中华耳鼻咽喉科杂志，1991；26(5)：272～274
6. Hirsch BE,Weissman JL,Curtin HD,et al.Magnetic Resonance Imaging of the large vestibular aqueduct.Arch Otolaryngol Head Neck Surg,1992; 118(10):1124～1127
7．孔祥泉，刘定西，徐海波，等．国人内听道及内耳膜迷路的正常MRI解剖研究．临床放射学杂志，1999；18(1)：11～13
8．何利平，贺飞，李永新，等．人工耳蜗植入相关的解剖学研究．耳鼻咽喉．头颈外科，2002；9(3)：168～170
9．张绍祥，刘正津，何光篪，等．生物塑化薄层连续断面的计算机三维重建．解剖学报，1996；27(2)：113～118
10．李文明，李明，王爱莲，等．前庭窗区域的应用解剖．中华耳鼻咽喉科杂志，1989；24(1)：22～23
11．王启荣，韩飞，李国华，等．经迷路下开放内耳道的应用解剖研究．山东医大基础医学院学报，2000；14(1)：4～6
12．梁树立，漆松涛，彭林，等．经迷路后入路岩骨磨除范围的解剖学研究．中华耳鼻咽喉颅底外科杂志，2001，7(1)：30～32
13．刘清明，赵华盛，朱世杰，等．颅中窝径路内耳道手术有关的应用解剖．中国临
床解剖学杂志，1990；8(4)：217～219
14. Parlier-Cuau C, Champsaur P, Perrin E, et al.High-reconstruction computed tomographic study of the retrotympanum-Anatomic correlations.Surgical and Radiologic Anatomy, 1998; 20 (3): 215～220
15．王卫，卢厚祯，高秀来，等．迷路下手术入路的研究．首都医科大学学报，1997；18(4)：305～309
16．李忠华，王兴海主编．解剖学技术．北京：人民卫生出版社，1997：53-60
17．张为龙，钟世镇 主编．临床解剖学丛书—头颈部分册．(第一版)．北京：人民卫生出版社，1988；341
18. Fatterpekar GM, Mukherji SK, Lin Y, et al.Normal canals at the fundus of the internal auditory canal: CT evaluation.J Assist Tomogr, 1999; 23 (5): 776～780
19. Christina S, Cathrina M.Dimensions of cochlear nerve canal: radioanatomic investigation,Acta Otolaryngol, 2002; 122 (1): 43～48
20. Fisch U.Surgery for bells palsy.Arch Otolaryngol, 1981 ; 107 (1): 1～11
21. Nakashima S,Sando I,Takahashi H,et al.Computer-aided 3-D reconstruction and measurement of the facial canal and facial nerve.I.Cross-sectional area and diameter:preliminary report.Laryngoscope, 1993,103(9): 1150～1156
22. Fowler Jr EP, York N, Variations in the temporal bone course of the facial nerve.J Neursurg, 1965; 25:891～921
23．陈义蔚，陈瑞华．面神经管及其毗邻结构的观察．中华耳鼻咽喉科杂志，1981；16(1)：7～13
24．雷晓寰，卢范，韩文江，等．面神经和位听神经在脑桥小脑角及内听道的显微外科解剖．解剖学报，1988；19(1)：1～5
25．周荣康．螺旋CT(第一版)．上海：上海医科大学出版社，1998，12～33
26．牛玉军，闫晓红，武克俭，等．成人中耳、内耳解剖结构螺旋CT三维重建技术．放射学实践，2002；17(1)：28～31
27．宦怡，伏晓，郭男晋．颞骨螺旋CT的后处理功能．第四军医大学学报，2001；
22 (11): 1051～1053
28. Levy RA,Edwards MT, Meyer JR, et al.Facial trauma and 3-D reconstructive imaging:insufficiencies and correctives. AJNR Am J Neuroradiol, 1992;13(3):885～892
29. Maw JL,Kartush JM,Bouchard K,et al.Octylcyanoacrylate:a new medical-grade adhesive for otologic surgery.Am J Otol,2000,21 (3):310～314
30. Tanioka H, Shirakawa T, Machida T, et al.Three-dimensional reconstructed MR imaging of the inner ear.Radiology, 1991,178(1): 141～144
31．李书玲，刘怀军，秦瑞平，等．正常人内耳前庭、半规管及耳蜗的MRI测量．中华放射学杂志-头颈部放射学，2003；37(1)：55～58
32. Mitsuoka H, Arai H, Tsunoda A, et al.Microanatomy of the cerebellopontine angle and inter auditory canal: study with new magnetic resonance imaging technique using three-dimensional fast spin echo.Neurosurgery, 1999; 44(3): 561～567
33. Yang D, Kodama T, Tamura S, et al.Evaluation of the inner ear by 3D fast asymmetric spin echo MR imaging: phantom and volunteer studies.Magnetic resonance imaging, 1999; 17(2): 171～182
2. Polacin A, Kalender WA, Marchal G..Evaluation of section sensitivity profiles and image noise in spiral CT. Radiology, 1992; 185 (1): 29～35
3．姜泗长 主编．耳解剖学与颞骨组织病理学(第一版)．北京：人民军医出版社，1999；25～26，162～164，354
4. Lutz C, Takagi A, Janecka IP, et al.Three-dimensional computer reconstruction of a temporal bone. Otolaryngol Head Neck Surg,1989; 101 (5): 522～526
5．戴朴，姜泗长，顾瑞，等．听骨链的计算机三维重建及力学模型建立．中华耳鼻咽喉科杂志，1991；26(5)：272～274
6. Hirsch BE,Weissman JL,Curtin HD,et al.Magnetic Resonance Imaging of the large vestibular aqueduct.Arch Otolaryngol Head Neck Surg,1992; 118(10):1124～1127
7．孔祥泉，刘定西，徐海波，等．国人内听道及内耳膜迷路的正常MRI解剖研究．临床放射学杂志，1999；18(1)：11～13
8．何利平，贺飞，李永新，等．人工耳蜗植入相关的解剖学研究．耳鼻咽喉．头颈外科，2002；9(3)：168～170
9．张绍祥，刘正津，何光篪，等．生物塑化薄层连续断面的计算机三维重建．解剖学报，1996；27(2)：113～118
10．李文明，李明，王爱莲，等．前庭窗区域的应用解剖．中华耳鼻咽喉科杂志，1989；24(1)：22～23
11．王启荣，韩飞，李国华，等．经迷路下开放内耳道的应用解剖研究．山东医大基础医学院学报，2000；14(1)：4～6
12．梁树立，漆松涛，彭林，等．经迷路后入路岩骨磨除范围的解剖学研究．中华耳鼻咽喉颅底外科杂志，2001，7(1)：30～32
13．刘清明，赵华盛，朱世杰，等．颅中窝径路内耳道手术有关的应用解剖．中国临
床解剖学杂志，1990；8(4)：217～219
14. Parlier-Cuau C, Champsaur P, Perrin E, et al.High-reconstruction computed tomographic study of the retrotympanum-Anatomic correlations.Surgical and Radiologic Anatomy, 1998; 20 (3): 215～220
15．王卫，卢厚祯，高秀来，等．迷路下手术入路的研究．首都医科大学学报，1997；18(4)：305～309
16．李忠华，王兴海主编．解剖学技术．北京：人民卫生出版社，1997：53-60
17．张为龙，钟世镇 主编．临床解剖学丛书—头颈部分册．(第一版)．北京：人民卫生出版社，1988；341
18. Fatterpekar GM, Mukherji SK, Lin Y, et al.Normal canals at the fundus of the internal auditory canal: CT evaluation.J Assist Tomogr, 1999; 23 (5): 776～780
19. Christina S, Cathrina M.Dimensions of cochlear nerve canal: radioanatomic investigation,Acta Otolaryngol, 2002; 122 (1): 43～48
20. Fisch U.Surgery for bells palsy.Arch Otolaryngol, 1981 ; 107 (1): 1～11
21. Nakashima S,Sando I,Takahashi H,et al.Computer-aided 3-D reconstruction and measurement of the facial canal and facial nerve.I.Cross-sectional area and diameter:preliminary report.Laryngoscope, 1993,103(9): 1150～1156
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