研究个体化三维数字模型(three-dimension digital manikin,3D-DM)在内镜经颞下锁孔入路岩斜区解剖中的应用,探讨其临床应用价值.方法:10例(20侧)头部标本灌注后行CT扫描,将图像导入3Dview软件重建出个体化3D-DM.定位Day菱形区后测量相关解剖结构距离.在3D-DM辅助下通过颞下入路对岩斜区及其邻近结构进行内镜解剖.并对尸颅解剖与3D-DM相关视野及测量进行比较.结果:3D-DM图像清晰逼真,其入路相关测量与尸颅解剖测量间比较差异无统计学意义.可通过棘孔、卵圆孔、弓状隆起、膝状神经节、锤骨、咽鼓管、岩浅大神经等组合标志准确定位内听道.颞下锁孔入路通过磨除岩尖骨质可以充分暴露中上斜坡结构.结论:3D-DM可以术前模拟岩尖磨除,提高术中岩尖磨除的准确性和安全性.组合解剖标志可提高术中定位内听道口的准确性.内镜颞下锁孔入路可充分显露中上斜坡结构.%Objective To study the application of individual three-dimensional digital manikin(3D-DM) in endoscopic anatomy of petroclival region via subtemporal keyhole approach, and to investigate its value in clinical application. Methods 10 adult cadaveric heads (20 sides) after perfused were scanned by CT. The images were imported to 3Dview software and reconstructed individual 3D-DM. Day rhombus were oriented and then the related anatomic structure distance were measured. The petroclival region and adjacent structures were proceed endoscopic anatomy in 3D-DM-assistance by subtemporal keyhole approach,the visions and data between 3D-DM and endoscopic anatomy were compared. Results The images of 3D-DM were clear and vivid. The data was not significant different between approach related measurement and endoscopic anatomy. The internal auditory canal could be accurately located by combined anatomic landmarks such as the foramen spinosum, foramen ovale, arcuate eminence, geniculate ganglion, malleus, eustachian tube, greater superficial petrosal nerve and so on. The upper-middle clivus structure could be fully exposed through subtemporal keyhole approach, after removal of petrous apex bone. Conclusions 3D-DM can be used to simulate bone window formation of petrous apex preoperatively,which can improve the accuracy and security of the surgery. The combined anatomic landmarks can improve the accuracy of intraoperative localization of the internal auditory canal. Through the endoscopic subtemporal keyhole approach, the structures of the upper-middle clivus can be fully exposed.
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