云南地区青少年额隐窝气房三维CT研究
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摘要
目的通过多层螺旋CT对41例青少年鼻窦进行扫描,使用三维重建软件将额隐窝区域气房进行冠状位与矢状位重建,研究青少年额隐窝区域的三维CT影像解剖学特征,探寻青少年额窦炎发病与额隐窝解剖结构变异之间的关系。
方法收集41例(82侧)2010年1月-2011年11月于本院耳鼻喉科住院的14-18岁青少年,男性24例,女性17例,平均年龄(15.97±1.49)岁,依据其是否患额窦炎分为正常组25例(47侧),其中3侧额窦未发育,患病组16例(32侧)。采用16层螺旋CT扫描,层距0.7mm,层厚1mm,获得轴位CT影像学资料后再使用Simplant14.01软件对其进行冠状位及矢状位三维重建。将重建的冠状位、矢状位结合轴位CT影像,观察额隐窝区域各气房分布、钩突上端附着情况及测量额窦口径线。
结果患病组Ⅰ-Ⅱ型额气房出现率为56.25%,鼻丘气房出现率为84.38%,眶上筛房的出现率为0%,筛泡上气房出现率为40.63%,额窦中隔气房的出现率为9.38%,终末隐窝出现率为18.75%,额泡气房出现率为0%；正常组Ⅰ-Ⅱ型额气房出现率为53.19%,鼻丘气房出现率为74.47%,筛泡上气房出现率为38.30%,眶上筛房出现率为6.38%,额窦中隔气房出现率为6.38%,额泡气房出现率为2.38%,终末隐窝出现率为14.89%,患病组与正常组额隐窝区域各气房的出现率差异无明显统计学意义；钩突上端附着率正常组钩突附着于眶纸板65.96%,中鼻甲23.40%,颅底10.64%；患病组钩突附着于眶纸板75.00%,中鼻甲15.63%,颅底9.38%,患病组与正常组间钩突上端附着率无明显统计学意义；除右侧额窦口前后径差异无统计学意义外,其余额窦口各径线的差异均有统计学意义。
结论初步推断青少年额隐窝区域气房尚未发展到成人稳定阶段,额隐窝气房并不是青少年额窦炎发病的主要致病因素；提示额窦口的狭窄,尤其是实验结果显示双侧额窦口左右径的狭窄可能是造成青少年额窦引流通道狭窄,引流不畅,进而引起额窦炎的致病因素；通过Simplant软件重建冠状位和矢状位CT有助于青少年额隐窝气房的一一辨认,从而使术者在掌握复杂的额隐窝区域解剂的基础上制寂完整精确的手术方案。
Objective:the paper focuses on the anatomical characteristics of3D CT images of frontal recess area of ordinary adolescents, and explores the relationship between the adolescents frontal sinusitis cases and the anatomical structure variation of frontal recess.
Methodology:There are41cases (82sides) collected in the first affiliated hospital of Kunming Medical University from January2010to November2011. The cases cover young people of14--18years old, average age (15.97±1.49) years old, and are divided into normal group and patient group according to whether they are affected by frontal sinusitis. There were25cases(47side) in nomal group, excepting3sides of the frontal sinus which are not developed; the group of patients includes16cases (32sides). The gender composition of them was24males and17females.
Results:The patient group's frontal cell (type Ⅰ-Ⅱ) is56.25%, agger nasi cell is84.38%, supra-ethmoidal bulla recess is0%, suprabullar cell is40.63%, interfrontal sinus septal cell is9.38%, terminal recess is18.75%, frontal bullar cell is0%; The normal group's frontal cell (type Ⅰ-Ⅱ) is53.19%, agger nasi cell is74.47%, supra-ethmoidal bulla recess is6.38%, suprabullar cell is38.30%, interfrontal sinus septal cell is6.38%, terminal recess is14.89%, frontal bullar cell is0%; The uncinate process single superior attachment into the surrounding structures was identified to have the following distribution:65.96%to the lamina papyracea,23.40%to the middle turbinate,10.64%to the skull base of normal group;75.00%to the lamina papyracea,15.63%to the middle turbinate,9.38%to the skull base of patient group; There are no statistical significances in frequency differences between the normal group and the patient group. There are statistical significances in transverse diameters of the frontal sinus ostium except the transverse diameters of right frontal sinus ostium between front-back side.
Conclusion:To identify the anatomical structure of frontal recess area of adolescents aged from14-18based on three-dimensional imaging anatomy, helps surgeons to correctly choose treatment of adolescents'frontal sinusitis, and enables them to choose personalized intranasal endoscopic frontal sinus surgery methods, and promotes the success rate of the surgery. It also identified that the occurrence rate of all cells in frontal recess has no clear relevance to the occurrence rate of adolescents'frontal sinusitis, whereas the front-back and right-left side of frontal sinus ostium may be the cause of adolescents' frontal sinusitis, and suggests that mucosal inflammatory lesions may also be the cause of adolescents'frontal sinusitis.
方法收集41例(82侧)2010年1月-2011年11月于本院耳鼻喉科住院的14-18岁青少年,男性24例,女性17例,平均年龄(15.97±1.49)岁,依据其是否患额窦炎分为正常组25例(47侧),其中3侧额窦未发育,患病组16例(32侧)。采用16层螺旋CT扫描,层距0.7mm,层厚1mm,获得轴位CT影像学资料后再使用Simplant14.01软件对其进行冠状位及矢状位三维重建。将重建的冠状位、矢状位结合轴位CT影像,观察额隐窝区域各气房分布、钩突上端附着情况及测量额窦口径线。
结果患病组Ⅰ-Ⅱ型额气房出现率为56.25%,鼻丘气房出现率为84.38%,眶上筛房的出现率为0%,筛泡上气房出现率为40.63%,额窦中隔气房的出现率为9.38%,终末隐窝出现率为18.75%,额泡气房出现率为0%；正常组Ⅰ-Ⅱ型额气房出现率为53.19%,鼻丘气房出现率为74.47%,筛泡上气房出现率为38.30%,眶上筛房出现率为6.38%,额窦中隔气房出现率为6.38%,额泡气房出现率为2.38%,终末隐窝出现率为14.89%,患病组与正常组额隐窝区域各气房的出现率差异无明显统计学意义；钩突上端附着率正常组钩突附着于眶纸板65.96%,中鼻甲23.40%,颅底10.64%；患病组钩突附着于眶纸板75.00%,中鼻甲15.63%,颅底9.38%,患病组与正常组间钩突上端附着率无明显统计学意义；除右侧额窦口前后径差异无统计学意义外,其余额窦口各径线的差异均有统计学意义。
结论初步推断青少年额隐窝区域气房尚未发展到成人稳定阶段,额隐窝气房并不是青少年额窦炎发病的主要致病因素；提示额窦口的狭窄,尤其是实验结果显示双侧额窦口左右径的狭窄可能是造成青少年额窦引流通道狭窄,引流不畅,进而引起额窦炎的致病因素；通过Simplant软件重建冠状位和矢状位CT有助于青少年额隐窝气房的一一辨认,从而使术者在掌握复杂的额隐窝区域解剂的基础上制寂完整精确的手术方案。
Objective:the paper focuses on the anatomical characteristics of3D CT images of frontal recess area of ordinary adolescents, and explores the relationship between the adolescents frontal sinusitis cases and the anatomical structure variation of frontal recess.
Methodology:There are41cases (82sides) collected in the first affiliated hospital of Kunming Medical University from January2010to November2011. The cases cover young people of14--18years old, average age (15.97±1.49) years old, and are divided into normal group and patient group according to whether they are affected by frontal sinusitis. There were25cases(47side) in nomal group, excepting3sides of the frontal sinus which are not developed; the group of patients includes16cases (32sides). The gender composition of them was24males and17females.
Results:The patient group's frontal cell (type Ⅰ-Ⅱ) is56.25%, agger nasi cell is84.38%, supra-ethmoidal bulla recess is0%, suprabullar cell is40.63%, interfrontal sinus septal cell is9.38%, terminal recess is18.75%, frontal bullar cell is0%; The normal group's frontal cell (type Ⅰ-Ⅱ) is53.19%, agger nasi cell is74.47%, supra-ethmoidal bulla recess is6.38%, suprabullar cell is38.30%, interfrontal sinus septal cell is6.38%, terminal recess is14.89%, frontal bullar cell is0%; The uncinate process single superior attachment into the surrounding structures was identified to have the following distribution:65.96%to the lamina papyracea,23.40%to the middle turbinate,10.64%to the skull base of normal group;75.00%to the lamina papyracea,15.63%to the middle turbinate,9.38%to the skull base of patient group; There are no statistical significances in frequency differences between the normal group and the patient group. There are statistical significances in transverse diameters of the frontal sinus ostium except the transverse diameters of right frontal sinus ostium between front-back side.
Conclusion:To identify the anatomical structure of frontal recess area of adolescents aged from14-18based on three-dimensional imaging anatomy, helps surgeons to correctly choose treatment of adolescents'frontal sinusitis, and enables them to choose personalized intranasal endoscopic frontal sinus surgery methods, and promotes the success rate of the surgery. It also identified that the occurrence rate of all cells in frontal recess has no clear relevance to the occurrence rate of adolescents'frontal sinusitis, whereas the front-back and right-left side of frontal sinus ostium may be the cause of adolescents' frontal sinusitis, and suggests that mucosal inflammatory lesions may also be the cause of adolescents'frontal sinusitis.
引文
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[20]Friedman M, Bliznikas D, Vidyasagar R,etal. Frontal sinus surgery 2004:Update of clinicalanatomy and surgical techniques. Operative Techniques in Otolaryngology-Head and Neck Surgery.2004,15:23-31.
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