山东大学耳鼻喉眼学报 ›› 2015, Vol. 29 ›› Issue (6): 22-25.doi: 10.6040/j.issn.1673-3770.0.2015.209

• 论著 • 上一篇    下一篇

中颅窝盖板低位的高分辨率CT“分度标准”构想

孙晓卫1, 李东梅1, 窦芬芬1, 张子和1, 张建基1, 丁元萍2, 史丽2   

  1. 1. 济南市儿童医院耳鼻喉科, 山东 济南 250022;
    2. 山东大学齐鲁医院耳鼻咽喉头颈外科, 山东 济南 250012
  • 收稿日期:2015-05-30 出版日期:2015-12-16 发布日期:2015-12-16
  • 通讯作者: 史丽. E-mail:shili126@sina.com E-mail:shili126@sina.com
  • 作者简介:孙晓卫. E-mail:sunxiaowei2000@163.com

Clinical significance of grading low middle fossa tegmen plate with high-resolution computed tomography

SUN Xiaowei1, LI Dongmei1, DOU Fenfen1, ZHANG Zihe1, ZHANG Jianji1, DING Yuanping2, SHI Li2   

  1. 1. Department of Otolaryngology, Jinan Children's Hospital, Jinan 250022, Shandong, China;
    2. Department of Otolaryngology & Head and Neck Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2015-05-30 Online:2015-12-16 Published:2015-12-16

摘要: 目的 观察中颅窝盖板低位对耳后进路清除上鼓室病变的影响,探讨中颅窝盖板低位的分度标准.方法 对87例影像科报告中颅窝盖板低位的慢性化脓性中耳炎患者的CT图像进行冠状位重建,沿外耳道上壁最高点作水平切线L1,自该层面出现上半规管结构的最高点作水平切线L2,沿该层面的中颅窝盖板最低点作水平切线L3,测量L1~L2距离 a和L1~L3距离b,计算b/a值r,依据r值将中颅窝盖板低位分为正常、轻、中、重及绝对低位,与3位手术医生术前评估及手术记录结果进行比较.结果 手术医生根据不同的r值,不同观点如下:①当r<1/4时,不认同影像科提示的中颅窝盖板低位;②当1/4≤r<1/3时,认同中颅窝盖板低位,但手术记录中未提及;③当1/33/4时,清除上鼓室病变时非常困难,中颅窝盖板低位导致的耳后进路已不可避免的要磨除外耳道后壁.结论 可依据r值可将中颅窝盖板低位分无、轻、中、重及绝对低位"5度",轻度对耳后进路清除上鼓室病变无影响,中度耳后进路清除上鼓室病变存在困难,重度经耳后进路清除上鼓室病变部分需要磨除外耳道后壁,绝对低位时磨除外耳道后壁已不可避免.

关键词: 中颅窝, 体层摄影术, X线计算机, 鼓室病变, 颞骨, 颅底

Abstract: Objective To observe the effect of high-resolution computed tomography (HRCT) grading of low middle fossa tegmen plate on the elimination of diseased tissue in epitympanum and to investigate the grading standard of low middle fossa tegmen plate. Methods The CT images obtained from 87 chronic otitis media (COM) cases were subjected to coronal reconstruction. A horizontal tangent L1 at the highest point along the upper wall of external auditory canal, a horizontal tangent L2 at the highest point of the semicircular canal structure, and a horizontal tangent L3 at the lowest point along the middle fossa tegmen plate were created to measure the distance between L1 and L2, L1 and L3, and to calculate the r value (b/a). The r value was used to divide the low middle fossa tegmen plate into five grades: non-low, mild, moderate, severe, and absolute low. Pre-operative evaluation and postoperative results were compared. Results Surgeons had different opinions on the r value: (1) If r < 1/4, the low middle cranial fossa cover identified by the Radiation Department could not be accepted. (2) If 1/4 ≤ r < 1/3, the low middle cranial fossa cover identified by the Radiation Department could be accepted, but it was not mentioned in the operation record. (2) If 1/3 < r ≤ 1/2, wearing was found at the bottom wall of the middle fossa tegmen plate upon clearing the diseased tissue, and the operation would be affected because of bleeding. (4) If 1/2 < r ≤3/4, the surgeons were able to identify the low middle fossa tegmen plate before operation; but some cases' back wall of the external auditory canals could be preserved after the diseased tissue in the epitympanum was cleared. (5) If r > 3/4, the surgeons experienced difficulty in finding the trum tympanicum and pathway behind the ear because the low middle fossa tegmen plate wore down the back wall of external auditory canal. Conclusion The r value can be used to divide the low middle fossa tegmen plate into five grades: non, mild, moderate, severe, and absolute low. Mild grade has no effect on the removal of lesions,moderate grade makes the removal of lesions difficult, severe grade requires destruction of the back wall of external auditory canal, and absolute low grade means wearing down of the back wall of external auditory canal is inevitable.

Key words: Middle cranial fossa, Tympanic cavity lesions, Basis Cranii, X-ray computed, Tomography, Temporal Bone

中图分类号: 

  • R764.4
[1] 李希平, 夏寅, 韩德民. 侧颅底冠状位组织学与CT断层的对照[J]. 解剖学报, 2013, 44(4):514-518. LI Xiping, XIA Yin, HAN Demin. Comparison of observations between coronal histological and CT images of the lateral skull base[J]. Acta Anatomica Sinica, 2013, 44(4):514-518
[2] Alzoubi F Q, Odat H A, Al-Balas H A, et al. The role of preoperative CT scan in patients with chronic otitis media[J]. Eur Arch Otorhinolaryngol, 2009, 266(6):807-809.
[3] Boyraz E, Erdogğan N, Boyraz I, et al. The importance of computed tomography examination of temporal bone in detecting tympanosclerosis[J]. Kulak Burun Bogaz Ihtis Derg, 2009, 19(6):294-298.
[4] Karatag O, Guclu O, Kosar S, et al. Tegmen height: preoperative value of CT on preventing dural complications in chronic otitis media surgery[J]. Clin Imaging, 2014, 38(3):246-248.
[5] 刘兆会, 王振常, 鲜军舫, 等. 颞骨解剖变异的高分辨率CT研究[J]. 中国耳鼻咽喉头颈外科, 2006, 13(2):97-101. LIU Zhaohui, WANG Zhenchang, XIAN Junfang, et al. HRCT study of anatomic variations of temporal bone[J]. Chin Otolaryngol Otolaryngol Head Neck Surg, 2006, 13(2):97-101.
[6] 孙晓卫, 张建基, 丁元萍, 等. 高分辨率CT对慢性化脓性中耳炎和胆脂瘤中耳炎软组织分型的诊断价值[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(5):388-392. SUN Xiaowei, ZHANG Jianji, DING Yuanping, et al. Efficacy of high-resolution CT in differential diagnosis of chronic suppurative otitis media and cholesteatoma otitis media by soft-tissue shadows[J]. Chin J Otorhinolarynol Head Neck Surg, 2011, 46(5):388-392.
[7] Makki F M, Amoodi H A, van Wijhe R G, et al. Anatomic analysis of the mastoid tegmen: slopes and tegmen shape variances[J]. Otol Neurotol, 2011, 32(4):581-588.
[8] Tatlipinar A, Tuncel A, Öğredik E A, et al. The role of computed tomography scanning in chronic otitis media[J]. Eur Arch Otorhinolaryngol, 2012, 269(1):33-38.
[9] Vlastarakos P V, Kiprouli C, Pappas S, et al. CT scan versus surgery: how reliable is the preoperative radiological assessment in patients with chronic otitis media?[J]. Eur Arch Otorhinolaryngol, 2012, 269(1):81-86.
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