内镜下后、下鼓室精细解剖及变异观察

目的 探讨国人后、下鼓室各骨嵴及隐窝之间的毗邻关系及存在形态,为临床提供解剖学数据。 方法 遴选80例中耳(成人灌注新鲜冰冻尸头20具和耳内镜手术40例),在0°和30°耳内镜下经外耳道进入中耳,对后、下鼓室相关区域进行解剖和观察,记录后、下鼓室各骨嵴及隐窝形态并制成图表。 结果 (1)岬小桥出现率为62.50%(50/80),实性骨嵴、桥状骨嵴占比分别为52.50%、10.00%;(2)岬下脚出现率为52.50%(42/80),实性骨嵴、桥状骨嵴占比分别为41.25%、11.25%;(3)岬末脚出现率为52.50%(42/80),实性骨嵴、桥状骨嵴占比分别为46.25%、6.25%;(4)上述结构变异使后鼓室窦及鼓室窦毗邻关系分为经典型(50.00%)、融合型(47.50%)、分隔型(1.25%)、限制型(1.25%);(5)鼓索嵴、椎体嵴、茎突嵴三者出现占比分别为67.50%(54/80)、75.00%(60/80)、57.50%(46/80)。 结论 耳内镜可以清晰地显露显微镜难以观察的解剖结构,国人后、下鼓室部分骨嵴及隐窝呈现不同的形态。

Endoscopic anatomy and variation observation of the retrotympanum and hypotympanum

Objective To explore the relationship between bone crest and crypt of the retrotympanum and hypotympanum and to provide anatomical data for clinical use. Methods Eighty sides of the middle ears were selected(20 adult patients with fresh frozen caddies and 40 cases of endoscopic surgery). The middle ears were accessed through the external auditory canal using 0° and 30° endoscopes, and the relevant areas of the retrotympanum and hypotympanum were dissected and observed. The morphology of bone crest and crypt in the retrotympanum and hypotympanum were recorded and made into charts. Results (1)The incidence of ponticulus was 62.50%(50/80; solid bone ridge, 52.50%; bridge-like bone ridge, 10.00%); (2)Subiculum was 52.50%(42/80; solid bone ridge, 41.25%; bridge-like bone ridge, 11.25%); (3)Funiculus was 52.50%(42/80; solid bone ridge, 46.25%; bridge-like bone ridge, 6.25%); (4) Based on structural variation, the position of posterior sinus and sinus tympanic was classified as classical shape(50%), confluent shape(47.50%), partitioned shape(1.25%), and restricted shape(1.25%); (5) The proportion of chordal, vertebral, and styloid crests was 67.50%(54/80), 75.00%(60/80), and 57.50%(46/80), respectively. Conclusion The endoscopic vision of the ear could provide a full range of visual field to observe these hidden anatomical regions, bone crests, and sinus of the retrotympanum and hypotympanum varied.