作者：彭露露，刘展，陶胜忠，耿晓腾，马帅

单位：

450014河南省郑州市，郑州大学第二附属医院神经外科

Units：

Neurosugery Department, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China

关键词：

解剖；外科手术；枕下乙状窦后入路手术；“三维象限法”；横窦-乙状窦移行区

Keywords：

Dissection; Surgical procedures, operative; Suboccipital retrosigmoid approach surgery; "Three dimensional quadrant method" ; Transverse-sigmoid sinus junction

CLC：

DOI：

Funds：

河南省医学教育研究项目（Wjlx2020086）

摘要：

　目的　基于“三维象限法”分析横窦-乙状窦移行区（TSSJ）的解剖特点，并分析“三维象限法”的 定位效果。方法　选取2022年在郑州大学第二附属医院神经外科接受颅脑CT检查的患者50例为三维影像重建组，采 用“三维象限法”定位TSSJ，比较三维影像重建组左侧和右侧TSSJ位置、枕外嵴从枕骨粗隆最高点至枕骨大孔后缘的 距离（DE1）、枕外嵴从枕骨粗隆最高点至枕骨大孔后缘的平均曲率（DE2）、星点距离（AA）、星点至二腹肌顶 点距离（AB）、星点至外耳道口距离（AC）、枕骨粗隆中心点与双侧二腹肌顶点夹角角度（∠ADA），并分析三维 影像重建组TSSJ位置与上述指标的相关性。选择2023年1—8月在郑州大学第二附属医院神经外科就诊并拟行枕下乙 状窦后入路手术的患者20例为研究对象，采用随机数字表法将患者分为研究组（10例）和对照组（10例）。研究组 采用“三维象限法”定位TSSJ，对照组采用传统星点定位法定位TSSJ。比较研究组和对照组一般资料、手术指标（切 口长度、开颅时间、骨窗面积、暴露TSSJ者占比、存在静脉窦损伤者占比）。结果　三维影像重建组右侧TSSJ位于第 一、二象限交界处者占比低于左侧，TSSJ位于第二象限者占比高于左侧（P＜0.05）；三维影像重建组右侧AB、AC长 于左侧（P＜0.05）。三维影像重建组TSSJ位置与DE1呈负相关（r s=－0.347，P＜0.001 ），与 AB呈正相关（r s=0.221， P=0.027）。研究组和对照组切口长度、暴露TSSJ者占比比较，差异无统计学意义（ P＞ 0.05）；研究组开颅时间短于 对照组，骨窗面积小于对照组（P＜0.05）。两组无一例患者存在静脉窦损伤。结论　大多数TSSJ位于星点的前下方， 且右侧TSSJ较左侧TSSJ位置稍高，此外，TSSJ位置与枕骨鳞状部形态、AB相关。“三维象限法”定位TSSJ的可靠性较 好，其可缩短开颅时间、减小骨窗面积，且有较好的安全性。

Abstract：

【Abstract】　Objective To analyse the anatomical characteristics of transverse-sigmoid sinus junction (TSSJ) based on "three-dimensional quadrant method" , and to analyse the localization effect of "three-dimensional quadrant method" . Methods A total of 50 patients who did cranial CT examination at the Neurosugery Department of the Second Affiliated Hospital of Zhengzhou University in 2022 were selected as the 3D image reconstruction group. TSSJ was located by "three-dimensional quadrant method" , the position of TSSJ, the distance of the extra-occipital crest from the highest point of the occipital ridge to the posterior margin of the foramen magnum (DE1) , the mean curvature of the external occipital ridge from the highest point of the occipital ramus to the posterior margin of the greater occipital foramen (DE2) , the distance of the asterisk (AA) , the distance of the asterisk to the vertices of digastric groove (AB) , the distance of the asterisk to the external auricular orifice (AC) , and the angle angle of the intersection of the centroid of the occipital ramus and the vertices of digastric groove bilaterally (∠ADA) were compared between the left side and the right side in the 3D image reconstruction group, and the correlation between the position of TSSJ and the above indexes in the 3D image reconstruction group was analyzed. A total of 20 patients who were admitted to the Neurosugery Department of the Second Affiliated Hospital of Zhengzhou University from January to August 2023 and planned to undergo suboccipital retrosigmoid approach surgery were selected as the study objects, and the patients were divided into study group (10 cases) and control group (10 cases) by random number table method. The study group used the "three-dimensional quadrant method" to locate TSSJ, and the control group used traditional asterisk-point localisation method to locate TSSJ. General data and surgical indexes (length of incision, craniotomy time, area of the bone window, the proportion of patients exposed to TSSJ, and the proportion of patients with venous sinus injury) were compared between study group and control group. Results In the 3D image reconstruction group, the proportion of patients with TSSJ located at the junction of the first and second quadrants of the right side was lower than that of the left side, and the proportion of patients with TSSJ located in the second quadrant was higher than that of the left side (P < 0.05) . In the 3D image reconstruction group, AB and AC of the right side were longer than that of the left side (P < 0.05) . In the 3D image reconstruction group, the TSSJ position was negatively correlated with DE1 (r s= －0.347, P < 0.001) and positively correlated with AB (r s=0.221, P=0.027) . There was no significant difference in length of incision and the proportion of patients exposed to TSSJ between study group and control group (P > 0.05) . The craniotomy time of study group was shorter than that of control group, and area of the bone window was smaller than that of control group ( P < 0.05) . None of the patients in the two groups had venous sinus injury. Conclusion Most of the TSSJs are located in the anterior and lower part of asterisk, and the position of the right TSSJ is slightly higher than that of the left TSSJ. In addition, the position of the TSSJ is related to the morphology of the occipital squamous part and AB. "Three-dimensional quadrant method" has good reliability in locating TSSJ, which can shorten the craniotomy time, reduce the bone window area, and has good safety.

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