摘要： 目的  对比分析尸头标本和虚拟现实系统经颞下入路磨除岩骨解剖显露特征，探讨虚拟现实技术在岩骨显微解剖中的应用价值。方法  将15 例成人尸头标本CT 影像数据输入Dextroscope 虚拟现实系统，构建岩骨三维解剖模型，分别于尸头标本和虚拟现实系统中模拟经颞下入路磨除岩骨手术方法，逐步显露解剖结构，选择标志点进行距离和角度测量。采用Bland-Altman 方法进行一致性检验。结果  虚拟现实系统模拟经颞下入路磨除岩骨可视性效果良好，岩骨内面神经、岩浅大神经、耳蜗、半规管、颈内动脉、颈静脉球等解剖结构显示清晰。分别于尸头标本和虚拟现实系统中测量并获得膝状神经节-半规管总骨脚起始点、膝状神经节-耳蜗顶点和耳蜗顶点-岩骨内颈内动脉水平段起始点连线距离，经Bland-Altman 检验，偏倚分别为0.020、0.020 和-0.010，95%可信区间分别为-0.240 ~ 0.270、-0.190 ~ 0.220和-0.170 ~ 0.150，相关分析显示一致性良好。尸头标本因角度限制无法测量半规管总骨脚起始点-颈静脉球上缘连线距离和内耳道与岩浅大神经沟夹角角度，而虚拟现实系统岩骨解剖模型数据测量方便快捷，无测量角度限制，测得半规管总骨脚起始点与颈静脉球上缘连线距离为（4.74 ± 0.20）mm、内耳道与岩浅大神经沟夹角角度为（51.34 ± 3.29）°。结论  利用虚拟现实技术模拟经颞下入路磨除岩骨的手术方法，方便快捷，所获数据准确、直观并可量化，可为指导岩斜区病变神经外科手术提供依据。

关键词: 颞骨岩部, 计算机模拟, 神经解剖学, 显微外科手术

Abstract: Objective To evaluate the utilizing value of virtual reality technique for microanatomy of petrous bone by comparing the anatomic characteristics and data measurement between virtual reality and cadaveric head specimens in subtemporal approach. Methods CT scan data of 15 adult cadaveric heads were inputted into the Dextroscope virtual reality system to build three-dimensional model of petrous bone. Petrous bone drilling was performed on cadaveric heads and virtual reality models respectively to expose anatomic structures step by step, and the distance and angle was measured based on selected mark points. Bland-Altman method was used for the uniformity of checking. Results Visibility effect of simulation of petrous bone drilling in virtual reality system was good. The anatomical structure of facial nerve in petrous bone, greater superficial petrosal nerve, cochlea, semicircular canal, internal carotid artery and glomus jugulare, were displayed clearly. Comparative analysis between cadaveric head and virtual reality by Bland-Altman method showed that bias for distance between geniculate ganglion and start point of common osseus crus of semicircular canal bony, geniculate ganglion and vertex of cochlea, and vertex of cochlea and start point of horizontal segment of internal carotid artery in petrous bone, were 0.020, 0.020, and -0.010 respectively, and 95% confidence intervals were -0.240-0.270, -0.190-0.220, and -0.170-0.150, respectively. Good consistency was demonstrated in scatter diagram. For the limitation of visual angle in cadaveric head, the angle between internal acoustic meatus and groove of great superficial petrosal nerve and the distance between start point of common osseus crus of semicircular canal and superior margin of glomus jugulare could not be measured, while data measurement of petrous bone model in virtual reality system was convenient and quick, without limitation of visual angle. The distance between start point of common osseus crus of semicircular canal and superior margin of glomus jugulare was measured as (4.74 ± 0.20) mm, and the angle between internal acoustic meatus and groove of greater superficial petrosal nerve was (51.34 ± 3.29)° . Conclusion Accurate, objective and measurable results can be obtained in the simulation of petrous bone drilling in subtemporal approach utilizing virtual reality system, and could guide surgical practice in dealing with petroclival lesions．

Key words: Petrous bones, Computer simulation, Neuroanatomy, Microsurgery