中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (20): 3117-3122.doi: 10.12307/2023.148

• 骨组织构建 bone tissue construction •    下一篇

枕骨大孔和枕髁数字化形态的三维重建

王  建1，王  星1，2，李  琨1，2，高  尚1，王超群3，张少杰1，2，李志军1，2   

  1. 内蒙古医科大学，1人体解剖学教研室，2数字医学中心，3附属医院影像中心，内蒙古自治区呼和浩特市  010110
  • 收稿日期:2021-12-08 接受日期:2022-05-21 出版日期:2023-07-18 发布日期:2022-11-18
  • 通讯作者: 李志军，教授，博士生导师，内蒙古医科大学人体解剖学教研室，数字医学中心，内蒙古自治区呼和浩特市 010110 张少杰，教授，硕士生导师，内蒙古医科大学人体解剖学教研室，数字医学中心，内蒙古自治区呼和浩特市 010110
  • 作者简介:王建，男，1986年生，内蒙古自治区呼和浩特市人，汉族，内蒙古医科大学法医学在读硕士，主要从事脊柱脊髓损伤方面的研究。 王星，男，1979年生，内蒙古自治区呼和浩特市人，汉族，博士，主要从事脊柱与脊髓的数字化研究。
  • 基金资助:
    国家自然科学基金资助项目(81860383)，项目负责人：李志军；内蒙古自治区自然科学基金资助项目(2020LH08021)，项目负责人：李志军；国家自然科学基金资助项目(81860382)，项目负责人：王星；内蒙古自治区自然科学基金资助项目(2020MS03061)，项目负责人：王星；内蒙古自治区高等学校青年科技英才支持计划资助(NJYT22009)，项目负责人：王星；内蒙古自治区科技计划项目(2019GG158)，项目负责人：王星；内蒙古医科大学科研重点项目(YKD2021ZD011)，项目负责人：王星；内蒙古自治区卫生健康委医疗卫生科技计划项目(202201217)，项目负责人：王星；内蒙古自治区自然科学基金资助项目(2019MS08017)，项目负责人：张少杰，内蒙古医科大学青年基金项目(YKD2020QNCX055)，项目负责人：李琨

Digital morphology of foramen magnum and occipital condyle: an observation based on three-dimensional reconstruction

Wang Jian1, Wang Xing1, 2, Li Kun1, 2, Gao Shang1, Wang Chaoqun3, Zhang Shaojie1, 2, Li Zhijun1, 2   

  1. 1Human Anatomy Teaching and Research Section, 2Digital Medicine Center, 3Imaging Center of Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
  • Received:2021-12-08 Accepted:2022-05-21 Online:2023-07-18 Published:2022-11-18
  • Contact: Li Zhijun, Professor, Doctoral supervisor, Human Anatomy Teaching and Research Section, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China; Digital Medicine Center, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China Zhang Shaojie, Professor, Master’s supervisor, Human Anatomy Teaching and Research Section, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China; Digital Medicine Center, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
  • About author:Wang Jian, Master candidate, Human Anatomy Teaching and Research Section, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China Wang Xing, MD, Human Anatomy Teaching and Research Section, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China; Digital Medicine Center, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
  • Supported by:
    the National Natural Science Foundation of China, Nos. 81860383 (to LZJ) and 81860382 (to WX); the Natural Science Foundation of Inner Mongolia Autonomous Region, Nos. 2020LH08021 (to LZJ), 2020MS03061 (to WX), and 2019MS08017 (to ZSJ); the College Youth Science and Technology Talent Support Program in Inner Mongolia Autonomous Region, No. NJYT22009 (to WX); Inner Mongolia Autonomous Region Science and Technology Plan Project, No. 2019GG158 (to WX); Inner Mongolia Medical University Key Research Project, No. YKD2021ZD011 (to WX); Medical and Health Science and Technology Plan Project of Inner Mongolia Autonomous Region Health Commission, No. 202201217 (to WX); Inner Mongolia Medical University Youth Fund Project, No. YKD2020QNCX055 (to LK)

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摘要：


文题释义：

枕骨大孔：位于颅底后部，容纳和毗邻脑干、椎动脉、脑神经、脑被膜等重要结构，了解此区域的形态特征及解剖结构对临床治疗脑干腹侧病变具有重要意义。
枕骨大孔前、后缘中点连线与枕骨大孔前缘中点和舌下神经管内口后壁中点连线的夹角(F-H 角)：为从枕髁后内侧磨除枕髁至舌下神经管内口时所显露的手术视野，可避免损伤舌下神经，即经髁入路所暴露最大范围。

背景：脑干腹侧面周围结构的病变位于颅颈交界处深面，周围毗邻重要结构，远外侧入路是基本术式，但入路时要考虑性别、侧别间的差异。
目的：通过三维重建测量手段对枕骨大孔和枕髁进行形态特征分析，为临床颅底远外侧手术入路提供解剖学参数。
方法：选择拍摄头颈部电子计算机断层扫描图像的成年人共673 例，男 448 例，女225 例，年龄20-87岁。经软件三维重建颅底，测量枕骨大孔长度和宽度，利用公式计算枕骨大孔面积和指数，测量枕髁长度、宽度，枕髁长轴与矢状轴的夹角，枕骨大孔前、后缘中点连线与枕髁后缘和枕骨大孔交点连线的夹角，枕骨大孔前、后缘连线中点与舌下神经管后壁中点连线的夹角。对各指标进行性别和侧别差异分析。
结果与结论：①枕骨大孔指标中除枕骨大孔指数不存在性别间统计学差异外，其余指标均存在性别间的差异(P < 0.05)；枕髁指标中，除男性左枕髁宽小于女性外(P > 0.05)，左枕髁长、右枕髁长、右枕髁宽男性均大于女性(P < 0.05)；②男性枕髁长轴与矢状轴的夹角小于女性，且左枕髁长轴与矢状轴的夹角在性别间差异有显著性意义(P < 0.05)；③枕骨大孔前、后缘连线中点与枕骨大孔前缘中点和舌下神经管内口后壁中点连线的夹角在侧别间无统计学差异；枕髁长、枕髁宽、枕髁长轴与矢状轴的夹角、枕骨大孔前、后缘中点连线与枕髁和枕骨大孔交点连线的夹角在侧别间差异均有显著性意义(P < 0.05)；④提示枕骨大孔和枕髁的相关参数在性别和侧别间存有差异，临床远外侧髁后及经髁入路中，右侧入路暴露范围较大；男性枕骨大孔长、宽、面积均大于女性，男性枕髁长、枕骨大孔前缘中点和枕髁后缘连线与矢状面夹角大于女性，远外侧入路时应考虑性别间差异。

https://orcid.org/0000-0001-8064-0320(王建)；https://orcid.org/0000-0003-0059-4921 (王星)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 枕骨大孔, 枕髁, 电子计算机断层扫描图像, 三维重建, 远外侧入路

Abstract: BACKGROUND:  Lesions of structures around the ventral side of the brainstem are located in the deep surface of the craniocervical junction, surrounded by important structures. The far lateral approach is the basic surgical method, but sex and lateral differences should be considered in the approach.
OBJECTIVE: To analyze the morphological characteristics of the foramen magnum and occipital condyle by three-dimensional reconstruction measurements, thereby providing anatomical parameters for the far lateral approach to the skull base in clinical practice. 
METHODS: A total of 673 adult patients (448 males and 225 females) with head and neck CT scans were selected. The age ranged from 20 to 87. The length and width of the foramen magnum were measured. The area and index of the foramen magnum were then calculated by formulas. The length and width of the occipital condyle were measured, as well as the angle between the long and sagittal axis of the occipital condyle (O-S angle), the angle between the line connecting the midpoints of anterior and posterior foramen magnum and the line connecting the midpoint of anterior foramen magnum and the intersection of posterior occipital condyle and lateral foramen magnum (F-O angle), and the angle between the line connecting the midpoints of anterior and posterior foramen magnum and the line connecting the midpoint of anterior foramen magnum and the midpoint of the posterior wall of the hypoglossal canal (F-H angle). The sex and lateral differences of each index were analyzed.
RESULTS AND CONCLUSION: There were statistical differences in foramen magnum indexes except between sexes (P > 0.05). The indexes of occipital condyle were significantly higher in males than in females (P < 0.05) except that the left occipital condyle width in males was lower than that in females (P > 0.05). The O-S angle in males was smaller than that in females, and there was a significant difference in the left O-S angle between sexes (P < 0.05). There was no statistical difference between right and left F-H angles. Significant differences were observed in occipital condyle length, occipital condyle width, O-S angle, and F-O angle (P < 0.05). These findings indicate that the parameters of the foramen magnum and occipital condyle were different in sex and on both sides. For the far lateral and transcondylar approaches, the right approach was relatively safe and exposed to a larger range. The length, width, and area of the foramen magnum, the length of the occipital condyle, and O-S angle in males were larger than those in females. Therefore, the sex difference should be considered in the far lateral approach.

Key words: foramen magnum, occipital condyle, computed tomography, three-dimensional reconstruction, far lateral approach

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