改良圆形尸检锯设计与标准化技术用于死后人类颞骨获取及外淋巴采集。

文献信息

中文摘要

背景： 死后人类颞骨为研究天然解剖背景下的耳蜗和前庭迷路提供了不可替代的资源，因为这些器官的组织无法进行非破坏性活检。然而，使用颅内圆形锯片获取颞骨在技术上仍具挑战性，尽管对锯片材料和设计进行了迭代优化，仍存在间歇性锯片断裂。由于标本稀有，高效收集生物材料（包括外淋巴）进一步增加了每次尸检的价值。方法：我们定性评估了在三次操作者进行的五次死后颞骨采集中导致锯片断裂风险的可改变和不可改变因素，并评估了外淋巴采集的改进措施。基于直接观察和操作者报告的经验，潜在因素包括不规则的中颅窝（MCF）地形、锯片与骨骼的接合角度、皮质划痕技术以及操作者身体力学。可改变因素包括保持锯轴相对于MCF垂直、在完全截骨前进行皮质划痕以及重新定位操作者以改善与锯轴的人体工学对齐。不可改变因素包括MCF的不规则表面、颞骨不对称以及限制垂直锯对齐的物理约束。结果：这些观察结果指导了改良锯片设计，旨在适应不可改变的解剖和人体工学约束。外淋巴工作流程的改进使得在颞骨固定前及时回收低体积样本。优化后，受训者获取时间在连续五次会话中平均为8.0 ± 2.5分钟，而有经验的操作者回顾性自我报告每颞骨约5分钟。结论：这些改进旨在提高死后颞骨采集的稳健性、可重复性、速度和可及性，以用于人类耳病理学研究。

英文摘要

Postmortem human temporal bones provide an irreplaceable resource for studying the cochlea and vestibular labyrinth in their native anatomic context, as the tissues of these organs cannot be non-destructively biopsied. However, temporal bone procurement using an intracranial circular saw blade remains technically challenging, with intermittent blade fractures despite iterative optimization of blade materials and design. Because specimens are rare, efficient collection of biologic materials, including perilymph, further increases the value of each autopsy. We qualitatively assessed modifiable and non-modifiable factors contributing to blade fracture risk during five postmortem temporal bone collections by three operators and evaluated refinements for perilymph collection. Potential contributors, based on direct observation and operator-reported experience, included irregular middle cranial fossa (MCF) topography, angle of saw blade engagement with bone, cortical scoring technique, and operator body mechanics. Modifiable factors included maintaining an orthogonal saw axis relative to the MCF, performing cortical scoring before complete osteotomy, and repositioning of the operator to improve ergonomic alignment with the saw axis. Non-modifiable factors included the irregular surface of the MCF, temporal bone asymmetry, and physical constraints limiting orthogonal saw alignment. These observations informed a refined saw blade design intended to accommodate non-modifiable anatomic and ergonomic constraints. Perilymph workflow refinements enabled timely recovery of low-volume samples before temporal bone fixation. After optimization, trainee procurement duration averaged 8.0 ± 2.5 min across five serial sessions, whereas experienced operators retrospectively self-reported ~5 min per temporal bone. These refinements are intended to improve the robustness, reproducibility, speed, and accessibility of postmortem temporal bone collection for human otopathology studies.