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目的应用锁孔理念,对部分迷路切除岩骨尖入路进行改良,并对改良后的入路进行显微解剖学研究。方法对15例30侧成人尸头采用改良部分迷路切除岩骨尖入路暴露岩斜区,测量磨除部分迷路和岩骨尖后增加的手术视野和视角,观察岩斜区解剖结构的暴露情况。结果在4cm×3cm大小的骨窗范围内可以完成所有的手术操作。磨除部分迷路和岩骨尖后,手术水平视野平均增加14·2mm,垂直视野平均增加12·5mm,手术水平视角平均增加58°,垂直视角平均增加46°,该入路可充分暴露岩斜区各解剖结构,与原入路相比无明显差别。结论改良部分迷路切除岩骨尖入路暴露充分,较原入路创伤小,脑牵拉轻,不容易损伤颈静脉球和面神经颅外段等重要结构,是一种良好的处理岩斜区病变的手术入路。
Objective To improve the method of partial removal of petrous apex with the concept of keyhole, and to study the microsurgical anatomy of the improved approach. Methods Fifteen patients with 30 adult cadaver heads were enrolled in this study. A modified partial labyrinthine excision of the petrous apex was performed to reveal the rock slope. The surgical field and visual angle were measured after the partial removal of the dermabrasion and the petrous apex were measured. The anatomic exposure was observed . Results All surgical procedures were completed within a bone window of 4 cm × 3 cm. After grinding away some of the lost and petrous apex, the average visual field of operation increased by 14.2 mm, the vertical field of vision increased by 12.5 mm, the average horizontal angle of operation increased by 58 °, and the average vertical angle increased by 46 °. This approach can fully expose the rock slope District anatomical structure, compared with the original approach no significant difference. Conclusion It is a good way to treat petroclival lesions with improved partial labyrinthine excision of petrous apexes and adequate exposure compared with the original approach with less trauma and lighter brain traction, less damage to the jugular bulb and facial nerve extracranial segments, The surgical approach.