筛动脉管的CT影像解剖学研究及其临床意义

目的研究筛动脉管影像解剖学特点,为功能性鼻腔内镜手术(FESS)提供参考。方法对106例患者行薄层多层CT(MSCT)横轴位螺旋扫描,图像数据传至AW4.2工作站行多层面重建(MPR)、仿真内镜(VE)重建及三维(3D)重建,对筛动脉管的显示率、位置、走行特点、与筛顶的附着关系及上下壁骨质裂缺发生率进行测量和观察。结果筛前、筛中、筛后动脉管的显示率分别为100%、42.9%、99.5%。筛前动脉管大多走行于筛泡隔板及中鼻甲基板内或两者之间的前组筛窦气房内;筛中动脉管较多走行于上鼻甲隔板及后组筛房,分别占26.4%、27.5%;筛后动脉管均走行于中鼻甲基板后,以最后筛房最为多见,占53.5%。筛前动脉管以悬吊型为主,占58.0%;筛中动脉管以隆凸型为主,占62.6%;筛后动脉管以隆凸型及隐匿性为主,分别占49.8%、46.9%。筛动脉管上下壁骨质裂缺存在普遍,并以下壁裂缺更多见。结论MSCT三维重建技术可以满意显示筛动脉管的解剖学特征,对FESS术中避免筛动脉管及其周围筛顶区域的损伤有重要的临床指导意义。

Anatomical study of the ethmoidal canal by multislice CT and its clinical significance

Objective To study the anatomic characteristics of ethmoidal canal on multislice CT (MSCT), and provide instructions for functional endoscopic sinus surgery (FESS). Methods One hundred and six patients underwent consecutive axial scans by GE Lightspeed MSCT and the mutiplanar reformation (MPR), virtual endoscopy (VE) and three-dimensional (3D) reconstruction images were studied and measured to study the anatomic characteristics of the ethmoidal canal, involving its frequency of identification, location, course, relation to the roof of the ethmoid sinus and bony defects with AW 4.2 workstation. The results were analyzed by the statistical software SPSS. Results The detection frequency of anterior, middle and posterior ethmoidal canal (AEC, MEC, PEC) was 100%, 42.9%, 99.5%. Most of AEC was located in the anterior ethmoidal cells (47.2%), or inside the basal lamella of bulla ethmoidalis and the basal lamella of the middle turbinate ( 31.6%, 17.5%). Most of MEC was located in the posterior ethmoidal sinus (27.5%), or inside the basal lamella of the superior turbinate (26.4%). PEC was located behind the basal lamella of the middle turbinate, mostly in the posterior ethmoidal cell (53.5%). The relationship of the ethmoidal canal to the roof of the ethmoid sinus could be divided into three types, the ethmoidal canal attached to the roof of the ethmoid sinus by a bony mesentery, completely attached to the roof of the ethmoid sinus, embedded in the roof of the ethmoid sinus. There were bony defects on the canal's upper or lower wall, and mostly on lower wall. Conclusion MSCT scan could clearly demonstrate the detailed information of ethmoidal canal. It was important to reduce the complications during FESS.