肌肉解剖、MRI及连续组织切片三维构建上唇肌肉系统

发布时间：2018-05-29 11:56

本文选题：上唇 + 肌肉　；参考：《北京协和医学院》2012年硕士论文

【摘要】：[目的]通过解剖、组织切片、MRI和连续切片三维重建方法,全方位的观察上唇及周围结构,构建更完善、精确、立体的上唇肌肉系统模型。 [方法]选取2具正常成人头颅标本,在唇的外周区由皮肤向深面逐层解剖出放射状排列的口周肌,显示上唇鼻翼提肌、上唇提肌、颧小肌、颧大肌、笑肌、口角提肌、颊肌及口轮匝肌,观察各条肌肉的起止点、纤维方向,显微解剖下重点观察口周肌肉与口轮匝肌的交汇点与连接层次。选取8例正常成人上唇部标本进行轴状面、矢状面、冠状面连续组织石蜡切片,通过HE和masson染色观察人中、唇弓、红唇、鼻槛等处结构,并应用三维重建软件3D-DOCTOR对连续组织切片进行三维重建。选取1例正常成人上唇部标本进行MicroMR(微型磁共振系统)进行三维重建。综合各方面图像提供的信息,构建出上唇肌肉系统模型。 [结果]通过构建出的上唇肌肉系统模型对上唇及周围组织进行观察。可见上唇部的口周相关肌肉由内向外、由浅到深主要有上唇鼻翼提肌、上唇提肌、颧小肌、颧大肌、笑肌、口角提肌、颊肌,这些肌肉与口轮匝肌在鼻翼缘外下方、红唇外翻处及口角等处相互交汇。口轮匝肌深层肌肉除有水平方向环形的肌纤维外,还有口角斜向内上走行的扇形肌纤维,部分终止于鼻小柱下前鼻嵴处,移行为鼻中隔降肌,部分越过中线继续走形,在鼻底移行为鼻肌翼部,在鼻底下方移行为上唇鼻翼提肌,在上唇近唇红缘侧移行为上唇提肌及颧小肌。鼻肌翼部一端移行为口轮匝肌,另一端同鼻翼软骨外侧角相连,鼻中隔降肌一端移行为口轮匝肌,另一端同鼻翼软骨内侧角相连,他们在鼻底处相互交叉重叠,形成鼻槛机构。上唇提肌、颧小肌从鼻翼外缘向近中走行,最后交汇于口轮匝肌深层靠近红唇侧外翻处,对唇弓形成有重要意义。轴状面的口轮匝肌深层发出的到对侧人中嵴外侧的肌纤维,与冠状面的上唇鼻翼提肌、上唇提肌、颧小肌与口轮匝肌浅层共同形成的类似SMAS的浅表肌层发出的到同侧人中嵴内侧的网状肌纤维,两种肌纤维相互交叉,形成人中嵴结构。 [结论]在此基础上构建了更完善、精确、立体的上唇肌肉系统模型,发现了上唇部存在的三个张力平衡结构,提出了上唇主张力带、第一副张力带、第二副张力带理论。
[Abstract]:[objective] to observe the upper lip and its surrounding structures in all directions by dissection, MRI and 3D reconstruction of serial sections, and to construct a more perfect, accurate and stereoscopic upper lip muscle system model. [methods] Radially arranged peroral muscles were dissected from the peripheral area of the lip from the skin to the deep surface in 2 normal adult skull specimens, showing the levator muscle of the upper lip, the zygomaticus minor muscle, the zygomaticus major muscle, the laughing muscle and the horn levator muscle. Buccal muscle and orbicularis oris muscle were observed to observe the starting and ending point of each muscle, the direction of fiber, and the meeting point and connecting level of perioral muscle and orbicularis oris muscle were observed under microdissection. Paraffin sections of axial, sagittal and coronal tissues were taken from 8 normal adult upper lip specimens. The structures of human, labial arch, red lip and nasal sill were observed by HE and masson staining. Three-dimensional reconstruction software 3D-DOCTOR was used to reconstruct the continuous tissue sections. A normal adult upper lip specimen was reconstructed with MicroMRs (Micro Magnetic Resonance system). The model of upper lip muscle system was constructed by synthesizing the information provided by all kinds of images. [results] the upper lip and surrounding tissues were observed by the upper lip muscle system model. It can be seen that the peroral muscles in the upper lip are from inside to out, and from shallow to deep there are mainly levator muscle of upper lip and nose, levator muscle of upper lip, zygomaticus minor muscle, zygomaticus major muscle, laughing muscle, levator oris muscle, buccal muscle. These muscles and orbicularis oris muscle are below the outer edge of the nasal wing. Red lip varus and mouth and so on place intersects mutually. In addition to the circular muscle fibers in the horizontal direction, the deep muscle of the orbicularis oris muscle also has the sector muscle fiber which moves diagonally inward, partly terminates at the anterior nasal crest under the columnar nose, moves the descending muscle of the septum, and partly continues to walk across the midline. At the bottom of the nose, the pterygoid of the nasal muscle, the levator muscle of the upper lip and the zygomaticus minor muscle were shifted at the bottom of the nose, the levator muscle of the upper lip near the red edge of the lip and the zygomaticus minor muscle. One end of the pterygoid part of the nasal muscle moves the orbicularis oris muscle, the other end is connected with the lateral angle of the alar cartilage, one end of the descending muscle of the nasal septum moves the orbicularis oris muscle and the other end is connected with the medial angle of the alar cartilage. The upper labial levator muscle and zygomaticus minor muscle walk from the outer edge of the nasal wing to the near middle, and finally intersect in the deep layer of orbicularis oris muscle near the lateral verticus of the red lip, which is of great significance for the formation of the labial arch. The deep muscle fibers from the orbicularis oris muscle on the axial surface to the lateral crest of the contralateral human crest, and the levator muscle of the upper lip and nose, the levator muscle of the upper lip, and the muscle of the upper lip of the coronal plane. The superficial muscle layer similar to SMAS is formed by zygomaticus minor and orbicularis oris muscle. The two kinds of muscle fibers intersect with each other to form the structure of the human mesoceles from the superficial muscle layer of the zygomaticus minor and the orbicularis oris muscle to the medial side of the human middle crest. [conclusion] on this basis, a more perfect, accurate and stereoscopic model of upper lip muscle system is constructed, and three tension balance structures in upper lip are found, and the theory of upper lip force band, first pair tension band and second pair tension band are put forward.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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