改良Hartel入路在卵圆孔穿刺中的应用效果

目的利用计算机辅助设计技术模拟卵圆孔穿刺,评估改良定位方法(口角外2 cm,下1 cm)的临床应用价值。方法收集100例原发性三叉神经痛患者的头颅CT薄层扫描数据,进行三维重建,使用计算机辅助设计技术模拟卵圆孔穿刺,每例进行3种方法模拟穿刺,分别为改良进针点(方法O)、传统进针点A(方法A)和传统进针点B(方法B)。方法O选取口角外2 cm、下1 cm作为进针点;方法A选取口角外2.5 cm为进针点;方法B选取口角外延线与外侧眼角垂线交点为进针点。每组均在三维影像上沿进针点与卵圆孔中心点连线方向模拟穿刺。观察穿刺路径骨质遮挡情况并测量穿刺方向上可获得的卵圆孔面积及短径。结果方法O、A、B分别有15、28、31例穿刺路径有遮挡,方法O被遮挡率明显低于方法A和B(P0.01或P0.05)。方法O、A、B在穿刺方向上可获得卵圆孔面积分别为(9.45±6.57)mm~2、(6.91±5.96)mm~2、(6.59±5.86)mm~2,方法O明显大于方法A和B(P0.01或P0.05);卵圆孔短径分别为(2.25±1.04)mm、(1.81±0.97)mm、(1.71±0.92)mm,方法O明显长于方法A和B(P0.01或P0.05)。结论与传统的定位方法比较,改良定位法可为Hartel前入路卵圆孔穿刺提供更佳的穿刺条件。

Effect of modified Hartel approach for foramen ovale cannulation

Ojective Based oncomputer-aided design (CAD) technology, we compared the optimized method of locating inserting point (2 cm lateral to and 1 cm below angulus oris) with traditional ones and assessed its clinical value by simulating foramen ovale (FO) cannulation.
Methods Skull CT data of 100 primary trigeminal neuralgia patients were used in this study and three-dimensional reconstruction with FO cannulation simulation were conducted. With self-control test method, each patient was divided into three groups: group of optimized insertion point (method O): point 2 cm lateral to and 1 cm below angulus oris as the insertion point; group of traditional entry point A (method A): 2.5 cm lateral the angulus oris as the insertion point; group of traditional entry point B (method B): intersecting the external extension of angulus oris and the vertical line of the lateral eye angle as the entry point. Puncture simulation was performed along connecting line of insertion point and the central point of the FO. We recorded results of simulation and measured the available area and short diameter of FO in the direction of puncture.
Results The cases that the puncture route was obstructed of methods O, A and B were 15, 28 and 31, respectively. The occlusion rate of method O was significantly lower than those of methods A and B (P < 0.01 or P < 0.05). The available area of methods O, A and of B were (9.45 ± 6.57) mm², (6.91 ± 5.96) mm², (6.59 ± 5.86) mm², respectively. The available area of method O was significantly larger than those of methods A and B (P < 0.01 or P < 0.05). The short diameters of methods O, A and B were (2.25 ± 1.04) mm, (1.81 ± 0.97) mm, (1.71 ± 0.92) mm, respectivtly. Short diameters of method O was significantly longer than those of methods A and B (P < 0.01 or P < 0.05).
Conclusion compared with the traditional positioning method, the optimized method can provide better condition for puncture through Hartel approach.