乙状窦优势联合高位颈静脉球与乳突局部解剖的关联：基于颞骨CT三维重建的回顾性研究

Association of Sigmoid Sinus Dominance Combined With a High Jugular Bulb With Local Mastoid Anatomy: A Retrospective Study Based on Three-Dimensional Temporal Bone CT Reconstruction

摘要:

目的 探讨乙状窦优势状态、高位颈静脉球(high jugular bulb,HJB)及二者交互作用与气化型乳突乳突窦入口最小横截面积和乙状窦骨壁厚度的关系。方法 回顾性纳入2021年1月至2024年12月接受颞骨高分辨率CT检查且符合纳入标准的160例患者,共320侧颞骨。采用CT三维重建测量乙状窦相关解剖指标、乳突气房体积、乳突窦入口最小横截面积及乙状窦骨壁平均厚度,并根据双侧乙状窦形态确定乙状窦优势状态,记录HJB。以患者ID作为随机截距,分别以乳突窦入口最小横截面积和乙状窦骨壁平均厚度为主要结局建立线性混合效应模型,分析乙状窦优势状态、HJB及二者交互作用,并调整年龄、性别及侧别。采用估计边际均值进行简单效应分析,多重比较采用Holm法校正。结果 160例患者中右优势型76例(47.5%)、左优势型37例(23.1%)、均衡型47例(29.4%)；320侧颞骨中HJB 72侧(22.5%)。线性混合效应模型显示,乙状窦优势状态与HJB对乳突窦入口最小横截面积和乙状窦骨壁平均厚度均存在显著交互作用(Holm校正后均P<0.001)。优势侧×HJB对乳突窦入口最小横截面积的交互效应为β=-3.381 mm2(95%CI:-5.021～-1.740),对乙状窦骨壁平均厚度的交互效应为β=-0.3217 mm(95%CI:-0.4366～-0.2068),均P<0.001。简单效应分析显示,优势侧存在HJB时乳突窦入口调整后最小横截面积较无HJB时减少6.89 mm2(95%CI:-7.91～-5.88),乙状窦骨壁平均厚度减少0.449 mm(95%CI:-0.520～-0.378),Holm校正后均P<0.001,效应幅度均大于均衡型及非优势侧。结论 乙状窦优势状态与HJB对气化型乳突局部解剖具有明显联合效应。优势侧合并HJB与乳突窦入口缩小及乙状窦骨壁变薄的关联最为突出。基于颞骨HRCT三维重建联合评价乙状窦优势状态与HJB,可为乳突区精细解剖评估及耳科手术术前规划提供影像学参考。

Abstract:

Objective To investigate the associations of sigmoid sinus dominance, high jugular bulb (HJB), and their interaction with the minimum cross-sectional area of the aditus ad antrum and sigmoid sinus bony wall thickness in pneumatized mastoids. Methods A total of 160 patients who underwent temporal bone high-resolution computed tomography (HRCT) between January 2021 and December 2024 and met the eligibility criteria were retrospectively included, comprising 320 temporal bones. Three-dimensional CT reconstruction was used to measure sigmoid sinus-related anatomical parameters, mastoid air-cell volume, minimum cross-sectional area of the aditus ad antrum, and mean sigmoid sinus bony wall thickness. Sigmoid sinus dominance was determined based on bilateral anatomical measurements, and the presence of HJB was recorded. Linear mixed-effects models with patient ID as a random intercept were constructed for the two primary outcomes. Sigmoid sinus dominance, HJB, their interaction, age, sex, and side were included as fixed effects. Estimated marginal means were used for simple-effect analyses, and multiplicity was controlled using the Holm method. Results Among the 160 patients, 76 (47.5%) had right-sided dominance, 37 (23.1%) had left-sided dominance, and 47 (29.4%) had codominant sigmoid sinuses. HJB was identified in 72 of 320 temporal bones (22.5%). Significant interactions between sigmoid sinus dominance and HJB were observed for both the minimum aditus area and mean sigmoid sinus bony wall thickness (Holm-adjusted P<0.001 for both). The interaction effect of a dominant sigmoid sinus with HJB was β=-3.381 mm2 (95%CI: -5.021 to -1.740) for the minimum aditus area and β=-0.3217 mm (95%CI: -0.4366 to -0.2068) for bony wall thickness (both P<0.001). Simple-effect analyses showed that, on the dominant side, the presence of HJB was associated with a 6.89-mm2 reduction in the adjusted minimum aditus area (95%CI: -7.91 to -5.88) and a 0.449-mm reduction in mean sigmoid sinus bony wall thickness (95%CI: -0.520 to -0.378), with both Holm-adjusted P<0.001. These effects were greater than those observed in codominant and non-dominant temporal bones. Conclusion Sigmoid sinus dominance and HJB demonstrate a significant joint association with local mastoid anatomy. The combination of a dominant sigmoid sinus and HJB is particularly associated with a smaller aditus ad antrum and a thinner sigmoid sinus bony wall. Combined assessment of sigmoid sinus dominance and HJB using three-dimensional temporal bone HRCT may provide useful anatomical information for preoperative evaluation and individualized otologic surgical planning.