经额颧角蝶腭神经节穿刺解剖影响因素的分析*

ANATOMIC FACTORS AFFECTING PTERYGOPALATINE GANGLION PUNCTURE VIA THE FRONTOZYGOMATIC ANGLE APPROACH*

摘要:

目的 CT影像下对额颧角途径蝶腭神经节穿刺的成功率进行统计,并分析影响穿刺成败的解剖影响因素。方法 在6例患者的MRI影像图像下定位蝶腭神经节并确定相关骨性标志后,在颅骨标本进行试穿刺并观察影响穿刺成败的因素,最后在142例(284侧)患者的CT影像资料中模拟穿刺,记录模拟穿刺是否成功并观察分析影响成败的因素。结果 颅骨标本下额颧角途径蝶腭神经节试穿刺时成功率为14/20,CT影像下模拟穿刺时成功率为53.9%。成败影响因素主要为突出明显的蝶骨翼颞下嵴、狭窄的翼上颌裂以及额颧角后上方偏移。结论 蝶骨翼颞下嵴及翼上颌裂形态有可能影响经额颧角蝶腭神经节阻滞,穿刺前行影像学检查可为临床选择穿刺路径提供有价值的信息。

Abstract:

Objective To calculate the success rate of pterygopalatine ganglion puncture via the frontozygomatic angle approach by CT scans, and to analyze the anatomical factors affecting the success of puncture. Methods The pterygopalatine ganglions under the MRI images of 6 patients and the relevant bone markers were identified, then skull specimens were punctured to observe the factors that influencing the success rate. Finally, the puncture was simulated in the CT images of 142 patients (284 sides). The success of the puncture was recorded and the influencing factors were observed and analyzed. Results: The success rate of the pterygopalatine ganglion puncture via the frontozygomatic angle approach in the cranial specimens was 14/20, and that in the CT imaging was 53.9%. The influencing factors are mainly the enlarged sphenoidal spine, stenotic pterygomaxillary fissure and the posterior-superior displacement of the frontozygomatic angle. Conclusion: The sphenoidal spine and the width pterygomaxillary fissure may affect the pterygopalatine ganglion puncture via the frontozygomatic angle. Imaging examination before puncture may provide valuable information for clinical selection of puncture pathway.