颈静脉球的分型及其临床意义

目的 研究颈静脉球的解剖与影像学形态及其与周围结构之间的关系,探讨颈静脉球的分型及其临床意义.方法 对120例颈静脉球部位的多层螺旋CT扫描图像进行分析,结合30例颞骨标本及6例血管铸型标本,观察其形态特点及其与周围结构的关系.以鼓室内壁作一虚拟矢状平面,在该平面上分别以鼓室后壁、底壁的切线为坐标轴(X轴、Y轴),在该矢状面上将该部位划分为4个象限,根据颈静脉球顶在该平面上的投影所在象限进行统计分型,分别为Ⅰ、Ⅱ、Ⅲ、Ⅳ 4型,再根据每型在该平面的内侧或外侧分成亚型.在标本上模拟经乳突部位的手术人路.观察各型颈静脉球对手术人路的影响.结果 颈静脉球分类:CT影像组Ⅰ型11例(9%)、Ⅱ型63例(53%)、Ⅲ型25例(21%)、Ⅳ型21例(17%);标本组Ⅰ型1例(3%)、Ⅱ型11例(37%)、Ⅲ型8例(27%)、Ⅳ型10例(33%).每型都可以分成亚型,不同类型可以影响不同的手术人路.结论 本文提供的象限法分型,对颈静脉球位置的描述更简单明确,有立体感,方便影像学描述和术前设计手术方案.

Classification and morphology of jugular bulb and its clinical significance

Objective To observe the anatomic and imaging morphology ofjugnlar bulb and its relationship with the surrounding structures, and to investigate the classification ofjugnlar bulb and its clinical significance. Methods We dissected 30 human temporal bones and studied multi-slice spiral CT imaging data of temporal bone of 120 cases and blood vessel cast mould specimen of the jugular bulb of 6 cases, to observe the morphology of jugnlar bulb and its spatial relationship with the surrounding structures. We made an imagined sagittal plane on the medial well of the tympanic cavity, with a horizontal tangent line of the proximal wall of the tympanic cavity and a vertical tangent line of the posterior wall of the tympanic cavity as coordinate axes (X axis and Y axis), respectively, so the 4 quadrants ( Ⅰ , Ⅱ, Ⅳ, Ⅳ) were formed. The jugular bulb was classified intro 4 types according to the quadrant where its top was projected and subtyped according to its position on the inner or outer side of the plane. The operation via mastoid approach was simulated on specimen to observe the effect of jugnlar bulb on the operation route. Results Some jugular bulbs were flat type and others were prominent types. The classification in the group of CT image: type Ⅰ , 11 case (9%);type Ⅱ, 63 cases (53%);type Ⅲ, 25 cases (21%);type Ⅳ, 21cases (17%). The classification in the group of specimen: type Ⅰ, 1 case (3%);type Ⅱ, 11 cases (37%);type Ⅲ, 8 cases (27%);type Ⅳ, 10 cases (33%). Each type of the jugular bulb had different effects on the operative approach. Conclusions The classification method with the 4 quadrants is a simple and three-dimensional way to describe the position of the jugular bulb for imaging diagnosis or operative scheme design.