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目的为幼儿人工耳蜗植入术提供解剖学依据。方法取1-5周岁因故死亡儿童头颅14具,在28例标本上,模拟经乳突后鼓室入路手术。切除乳突,保留外耳道后壁,显露砧骨窝,去除面神经和鼓索神经之间的骨质进入后鼓室,在手术显微镜下(×6)观察并测量与耳蜗植入点相关的解剖学数据。结果圆窗位于圆窗龛前缘上部。锥隆起、镫骨肌腱、砧镫关节、镫骨底板、圆窗龛、鼓岬、外侧半规管突等解剖标志清晰且恒定。镫骨后弓相当于鼓阶的前界。鼓阶位于前庭阶后下的位置。圆窗龛前缘中点到鼓阶下壁、鼓阶后壁、基底膜、锥隆起、外侧半规管突、镫骨底板下缘中点、匙突的距离分别为(1.49±0.42)mm、(0.90±0.31)mm、(1.49±0.41)mm、(3.28±0.55)mm、(7.41±0.9)mm、(3.09±0.53)mm、(4.83±0.65)mm。结论幼儿人工耳蜗植入点应选择在圆窗龛前游离缘中点向前0.90-1.49mm、向下1.49mm以内的位置;在圆窗龛显示困难的病例,植入点应定位于距镫骨底板下缘中点下方约3mm处。
Objective To provide anatomic evidence for cochlear implantation in young children. Methods Fourteen heads of children aged 1-5 years old were killed. On the 28 specimens, we simulated the operation of the posterior tympanic cavity. The excision of the mastoid, retention of the posterior wall of the external auditory canal, exposure of the incus socket, removal of the bone between the facial nerve and the chordoma nerve into the posterior tympanic space were observed under an operating microscope (× 6) and the anatomical data relating to the cochlear implantation site were measured . As a result, the round window is located in the upper part of the leading edge of the round window niche. Conus bumps, stapes tendons, anvils joints, stapes, round niches, promontory promontory promontory promontory promontory promontory, lateral semicircular canal protrusion and other anatomical landmarks clear and constant. Stapelia posterior bow equivalent to the front of the drum. Drum in the vestibule position behind. The distance from the middle point of the round window niche to the inferior wall of the scaphoid, the posterior wall of the scala tympani, the basement membrane, the conical bulge, the lateral semicircular canal protrusion, the midpoint of the lower edge of the stapes base, and the spondylosis were (1.49 ± 0.42) mm, 0.90 ± 0.31 mm, 1.49 ± 0.41 mm, (3.28 ± 0.55) mm, (7.41 ± 0.9) mm, (3.09 ± 0.53) mm and (4.83 ± 0.65) mm, respectively. Conclusion The cochlear implants in children should be selected to move 0.90-1.49 mm forward and 1.49 mm downward in the midpoint of the round window niche. In the case of round window niches, the implantation sites should be located at a distance of 镫About 3mm below the midpoint of the lower edge of the bone floor.