眶外侧锁孔入路与常规锁孔入路对于鞍区手术显露的量化对比研究

摘要

目的 量化对比眶外侧锁孔与常规锁孔入路包括翼点锁孔、眶上锁孔入路对于鞍区各部区域显露面积和操作能力的研究,为临床提供理论和实践依据.方法 从2017年1月至2018年2月,15例(30侧)经福尔马林固定的成人尸体头颅标本,随机分3组,分别模拟眶上锁孔、眶外侧锁孔、翼点锁孔开颅.应用无框神经导航系统,以视交叉和终板前方相交处作为中心基点,选取6个不同参照点以辐射状方式向颅底鞍区外方延伸,相邻2个参照点方向与基点连接成一个三角形,所构成的6个三角形为鞍区显露总面积.通过组合叠加三角形计算幕上区、同侧区、幕下区、对侧区的显露面积并进行组间比较.为进一步应用于临床,引入Salma手术显露操作评分表,模拟鞍区常见部位的操作并进行量化评分.结果 眶上锁孔入路、眶外侧锁孔入路、翼点锁孔入路对鞍旁区显露的总面积分别为(1641.6±295.6)mm2、(1782.3±294.6)mm2、(1552.5±307.4)mm2,彼此间差异无统计学意义(P>0.05).其中对比幕上区显露面积时,眶外侧锁孔入路和眶上锁孔入路都大于翼点锁孔入路,差异有统计学意义(P<0.05);对于同侧区和幕下区的显露面积,翼点锁孔入路和眶外侧锁孔入路都大于眶上锁孔入路,差异有统计学意义(P<0.05);对比对侧区显露面积时,眶上锁孔入路大于眶外侧锁孔入路大于翼点锁孔入路,且彼此间差异有统计学意义(P<0.05).应用Salma手术显露操作评分表所得评分:眶上锁孔入路评分29.7分(39.08％)、眶外侧锁孔入路37.0分(48.68％)、翼点锁孔入路36.1分(47.50％).结论 3种锁孔入路对于鞍旁区各部的显露程度不尽相同,眶外侧锁孔入路对鞍旁区的显露程度较好,可操作性较高.但临床应用时应综合分析,注重具体病变.%Objective To compare lateral orbital keyhole approach(LOK) with conventional keyhole approach including supraorbital keyhole approach (SOK) and pterional approach(PTK) for exposuring the sellar region and oper-ation ability, to provide theoretical and practical basis for the clinic. Methods From January, 2017 to Feburary, 2018, 15 cadaver head specimens of Chinese (30 sides) fixed by formalin were randomly divided into 3 groups, simu-lating SOK, LOK and PTK, application of frameless neuronavigation system, intersection of the posterior margin of the optic chiasma and the lamina terminalis served as the base point. Six different reference points were selected to radi-ate into the parasellar region of the skull base. The direction of the 2 adjacent reference points were connected to the base point to form a triangle. Six triangles constituted the sellar region to represent the total area. The supratentorial area, ipsilateral area, inferior area and contralateral area were calculated by stacking triangle. The comparison was made between groups. The Salma operation exposure scale was used to simulate the aneurysms of the common parts in the brain and the quantitative scores were performed. Results The total parasellar regions by SOK, LOK and PTK respectively were:(1641.6±295.6)mm2, (1782.3±294.6)mm2 and (1552.5±307.4)mm2. There was no statistical differ-ence(P>0.05); To compare the supratentorial region, SOK and LOK were both bigger than PTK ( P<0.05); To compare the ipsilateral and infratentorial area, LOK and PTK were both bigger than SOK respectively ( P<0.05);To compare the contralateral area, SOK, LOK and PTK were increased in turn (P<0.05). Salma operation exposure scale was used to get the scores:the score of SOK was 29.7 (39.08％), LOK was 37.0 (48.68％), and PTK was 36.1 (47.50％). Conclusion Anatomical analysis displayed that the 3 keyhole approaches showed different exposure of each part the parasellar re-gions, the LOK had a good exposure to the parasellar region and so as the higher maneuverability. But the clinical appli-cation should be comprehensive analysis, pay attention to specific lesions and make an appropriate choice. It has impor-tant clinical significance to improve the prognosis of patients.