摘要
目的探讨一种术中横窦、乙状窦简易定位方法的临床应用价值,并总结经验教训。方法选择拟经乙状窦后入路手术的患者31例。利用三维重建技术制作颅骨三维虚拟模型,以二腹肌沟及其颅骨表面延长线为 y 轴,二腹肌沟顶点为原点O,构建直角坐标体系,确定横窦-乙状窦交角(transverse sigmoid sinus junction,TSSJ)的坐标值,指导术中横窦、乙状窦定位和骨瓣成形。最后,分析TSSJ在坐标系中的分布,总结其定位误差值及损伤发生率。结果在虚拟模型坐标系中,右侧16例患者(88.9%)TSSJ分布于右上象限,坐标平均值为(6.24±4.14,17.28±4.64),左侧11例患者(84.6%)位于左上象限,坐标平均值为(-4.1 ± 5.41 ,20.69±6.13)。所有患者术中均准确定位TSSJ,其定位误差值为(0.2~0.5)cm,平均为(0.37± 0.11)cm 。形成骨瓣过程中,2例患者(6.5%)出现横窦、乙状窦损伤,术后均无发生脑脊液漏、皮下积液、感染等相关并发症。结论 通过寻找有效解剖标志,构建直角坐标系,利用三维重建技术确定TSSJ的坐标,这种简易的定位方法有助于术中静脉窦准确定位,减少骨瓣缺损,操作简便有效,值得临床推广应用。
Objective To analyze the clinical value of a simple localization method for transverse sinus and sigmoid sinus during operation, and summarize the experience and lessons. Methods 31 patients with retrosigmoid craniotomy were selected. The 3D virtual model of skull was made by using 3D reconstruction technology. The digastric groove and its surface extension line were designed as the Y-axis, and the vertex of the digastric groove was designed as the origin O. The coordinate system was designed to determine the coordinate value of the transverse sigmoid sinus junction(TSSJ), guiding the intraoperative localization of transverse sinus and sigmoid sinus and bone flap shaping. Finally, the distribution of TSSJ in the coordinate system was analyzed, and its positioning error and damage incidence are summarized. Results In the coordinate system of virtual model, TSSJ of 16 cases(88.9%) on the right lateral were distributed in the upper right quadrant, with the mean value of coordinates(6.24± 4.14, 17.28±4.64). 11 cases(84.6%) on the other side were located in the upper left quadrant, with the mean value of coordinates(-4.1±5.41, 20.69±6.13). Although TSSJ was accurately located in all patients during the operation,a positioning error about 0.2-0.5 cm(average: 0.37±0.11 cm) was made. In the process of bone flap formation, transverse sinus and sigmoid sinus injuries occurred in 2 patients(6.5%). However no cerebrospinal fluid leakage, subcutaneous hydrops, infection or other related complications occurred postoperatively. Conclusions After cartesian coordinate system is constructed on the base of effective anatomical markers, the coordinates of TSSJ are determined on the virtual model with 3D reconstruction technology. This localization method is helpful for accurate intraoperative positioning of sinus, and reducing bone flap defect. It is simple and convenient, effective and worth popularizing.
作者
洪文瑶
刘宇清
王健红
张文清
廖正俭
郑诗豪
黄绳跃
HONG Wen-yao;LIU Yu-qing;WANG Jian-hong(Department of Nuerosurgery,Fujian Provincial Hospital,Fujian Medical University Provincial Clinical Medical College,Fuzhou 350001,China)
出处
《临床神经外科杂志》
CAS
2019年第5期415-419,共5页
Journal of Clinical Neurosurgery
基金
福建省自然科学基金资助引导性项目(2019H0042)
福建省自然科学基金资助对外合作项目(2019I0023)
福建省医科大学启航基金项目(2017-XQ-1135)
福建医科大学教育教学改革研究基金资助项目(J18011)
关键词
横窦-乙状窦交角
定位
直角坐标系
三维虚拟模型
transverse sigmoid sinus junction
localization
cartesian coordinate system
3D virtual model
