根据计算机断层扫描分析 3-5 岁儿童颅窝的大小和形状
- 作者: Prokofiev A.S.1, Makeeva E.A.1, Mitrokhina E.О.1, Chukbar A.V.1
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隶属关系:
- Russian University of Medicine
- 期: 卷 162, 编号 2 (2024)
- 页面: 189-199
- 栏目: Original Study Articles
- URL: https://journals.rcsi.science/1026-3543/article/view/272642
- DOI: https://doi.org/10.17816/morph.633388
- ID: 272642
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详细
论证。利用内窥镜显微外科技术，可以进行轻柔的手术，清除窝内的异物和长入或长出窝内的肿瘤。此类手术不仅适用于成人，也适用于 1 个月以上的儿童。对于外科医生来说，了解耳窝结构和形态特征的细节非常重要。然而，文献中并没有关于儿童耳窝的详细描述。
研究目的 以计算机断层扫描数据为基础，研究 3-5 岁儿童（乳牙形成期）腭窝的大小和形状，以及腭窝神经穿孔的相互位置。
材料与方法。为了研究腭窝的大小和形状，我们分析了 12 名 3-5 岁儿童（24 个腭窝）的匿名档案正面和轴向计算机断层扫描图像，这些图像是在主要疾病（脑部病变）检查计划中进行的。所有 CT 扫描都是在 Evdokimov Moscow State Medical and Dental University 大学医院使用螺旋 CT 扫描仪（Somatom Sensation 64，德国西门子公司）获得的，扫描仪的有效电流为 63、120 千伏，切片厚度为 0.5 毫米，重建步长为 0.7 毫米，准直度为 12×0.6 毫米，内核 U 为 70，窗口宽度为 450 HU，窗口中心为 50 HU。
在初步测量确定了断层扫描中窝轮廓上足够恒定的点后，在 Cdviewer 程序中进行了测量。在通过腭叶管的轴向切片上研究了腭窝的最大宽度（腭窝前开口与腭骨眼突之间的距离）、内侧壁的宽度以及楔形腭孔和腭骨楔形突的宽度，因为它们的数值最大。此外，还对内侧壁偏离矢状面的角度、前壁的宽度（上颌窝前壁最向后突出点到腭骨眼下颌突之间的距离）、上颌窝的最大深度（后壁的宽度）以及上颌裂的宽度进行了评估。在正面切片上，测量了从大腭管口到翼管前口和圆口的距离。利用轴向断层图像计算大腭管口、圆口和翼管前口之间的空间关系，以及这些口与楔形腭管、圆口和翼管前口之间的关系。
结果。上颌窝的形状不同于金字塔形，它由四个部分组成：邻近楔形腭孔的主要部分和漏斗状收缩部分（翼管前庭、大腭管前庭和上颌翼裂前庭）。所获得的数据表明，3-5 岁儿童上颌窝的大小及其形状的均匀性方面的个体差异并不明显。确定了大腭管口、叶管前口、圆口和楔形腭管口的空间关系，它们决定了神经在叶窝中的位置。根据获得的数据，构建了腭窝的三维重建图。
结论。3-5 岁儿童（在乳牙形成期）的牙窝具有复杂的腔隙结构，这表明牙窝在牙窝中的位置与通常认为的不同。这种情况，以及我们首次确定的窝洞尺寸，在制定手术进入窝洞和窝洞-下颌交界处的方法时应加以考虑。
作者简介
Aleksandr S. Prokofiev
Russian University of Medicine
Email: prokofev_aleksandr83@mail.ru
ORCID iD: 0009-0008-9620-7810
SPIN 代码: 2756-9756
俄罗斯联邦, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow
Ekaterina A. Makeeva
Russian University of Medicine
Email: makeevi@inbox.ru
ORCID iD: 0009-0005-1689-8518
SPIN 代码: 9106-6445
MD, Cand. Sci. (Medicine), Assistant Professor
俄罗斯联邦, 23 bldg. 1 Boris Zhigulenkov street, 105275 MoscowEugenia О. Mitrokhina
Russian University of Medicine
Email: Jony.Mitrokhina@yandex.ru
ORCID iD: 0009-0003-9697-3383
俄罗斯联邦, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow
Aleksandr V. Chukbar
Russian University of Medicine
编辑信件的主要联系方式.
Email: achukbar@yandex.ru
ORCID iD: 0009-0002-3243-878X
SPIN 代码: 8463-2948
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow参考
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Fig. 1. Pterygopalatine fossa of a child 3 years 4 months old. Fragments of computed tomography scans in the axial plane: a — at the level of 3 mm above the mouth of the large palatine canal; b — in the plane of the pterygoid canal; c — 1 mm higher; d — at the level of the round hole. 1 — maxillary sinus; 2 — front wall of pterygopalatine ganglion; 3 — orbital process of the palatine bone; 4 — medial wall of pterygopalatine ganglion; 5 — anterior edge of the pterygoid process; 6 — pterygomaxillary fissure; 7 — sphenopalatine foramen; 8 — sphenoid process of the palatine bone; 9 — vestibule of the pterygoid canal; 10 — pterygoid canal; 11 — central part of pterygopalatine ganglion; 12 — vestibule of the pterygomaxillary fissure; 13 — fragment of the pterygoid sinus; 14 — palatovaginal canal; 15 — orbit; 16 — posterior ethmoidal cells; 17 — wall of the sphenoid sinus; 18 — body of the sphenoid bone; 19 — round foramen; 20 — inferior orbital fissure.
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Fig. 2. Pterygopalatine fossa of a child 4 years 2 months old. Fragments of CT scans in the frontal plane: a — at the level of the orifice of the greater palatine canal; b — 3 mm posteriorly from the plane of the orifice of the greater palatine canal; c — 2 mm posteriorly from the previous section; d — at the level of the anterior foramen of the pterygoid canal. 1 — central part of pterygopalatine fossa 2 — bottom of the sphenoid sinus; 3 — sphenopalatine foramen; 4 — medial wall of pterygopalatine fossa; 5 — nasal cavity; 6 — orifice of the greater palatine canal; 7 — maxillary sinus; 8 — vestibule of the greater palatine canal; 9 — vestibule of the pterygomaxillary fissure; 10 — lower orbital fissure; 11 — vestibule of the pterygoid canal; 12 — sphenoid sinus; 13 — pterygoid process; 14 — base of the pterygoid process; 15 — greater wing of the sphenoid bone; 16 — round foramen; 17 — medial plate of the pterygoid process; 18 — lateral plate of the pterygoid process; 19 — pterygoid canal; 20 — body of the sphenoid bone; 21 — throat; 22 — middle cranial fossa.
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Fig. 3. Three-dimensional reconstruction of the pterygopalatine fossa of a child 3 years 8 months old: 1 — sphenopalatine foramen; 2 — round foramen; 3 — bottom of the sphenoid sinus; 4 — sphenoid process of the palatine bone; 5 — vestibule of the pterygoid canal; 6 — anterior opening of the pterygoid canal; 7 — pterygoid canal; 8 — central part of the pterygopalatine fossa; 9 — vestibule of the greater palatine canal; 10 — pterygomaxillary fissure; 11 — vestibule of the pterygomaxillary fissure.
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