动眼神经的显微解剖学研究及临床意义

发布时间：2019-06-20 20:09

【摘要】：目的研究动眼神经的走形、长度、外径、毗邻结构及血液供应，进行测量及分析，分段研究了动眼神经各区域的解剖结构，以期对临床手术提供解剖学资料。方法取10例福尔马林固定的成人完整头颅湿标本(男8,女2例)，常规灌注四根动脉，所有标本均颈内动脉、椎动脉灌注红色乳胶，颈内静脉灌注蓝色乳胶。沿眉弓至耳缘连线剥除头皮,锯开颅骨,除去颅盖开颅去除大脑半球,保留脑干大脑脚以下结构,在显微镜下仔细解剖岩斜区、海绵窦及眶顶，显露动眼神经的全程。在10-40倍手术显微镜下进行仔细测量，并结合解剖学资料对比分析，所得的数据采用SPSS10.0进行数据处理,数据以x±s表示,行t检验。结果动眼神经距离后床突5.13±1.26mm，动眼神经与后交通动脉距离为9.72±2.13mm，动眼神经小脑幕入口与滑车神经入口距离为10.20±2.71mm，动眼神经在小脑幕缘下方距滑车神经距离为2.84±0.22mm，动眼神经小脑幕入口与滑车神经入口距离为10.20±2.71mm，动眼神经三角入口中点距前床突距离为7.47±0.32mm，距离后床突距离为6.25±0.30mm，距岩尖距离为9.32±0.33mm。动眼神经从起始部运行至后岩床皱襞距离为15.2±2.2mm，经后岩床皱襞至入海绵窦距离为5.12±0.80mm，动眼神经池长度为7.20±1.62mm，动眼神经距离前床突为2.42±0.43mm，动眼神经经海绵窦距离为15.2±1.14mm。动眼神经上支横径1.23±0.57mm，下支横径1.60±0.23mm，动眼神经起始部至上下支平均直径为2.4±0.3mm。结论动眼神经在颅内行程长，走形复杂，颅内多种病变时动眼神经均可受累。临床神经外科医生在处理这些区域病变时，应仔细分离，，小心牵拉以免损伤动眼神经供血动脉，熟悉的显微解剖知识以及娴熟的显微神经外科技术与手术技巧是减少动眼神经损伤的必要条件。
[Abstract]:Objective to study the shape, length, outer diameter, adjacent structure and blood supply of oculomotor nerve, to measure and analyze the anatomical structure of oculomotor nerve, and to study the anatomical structure of oculomotor nerve in order to provide anatomical data for clinical operation. Methods Ten complete adult head wet specimens (male 8, female 2) fixed with formalin were routinely perfused with four arteries. All specimens were perfused with red latex into vertebral artery and blue latex in internal jugular vein. The scalp was removed from the eyebrow arch to the ear margin, the skull was sawed, the skull cover was removed, the cerebral hemisphere was removed, the structure below the foot of the brain stem was preserved, and the petroclival area, cavernous sinus and orbital apex were carefully dissected under microscope to reveal the whole course of oculomotor nerve. The data were carefully measured under 10 脳 40 times operation microscope and compared with anatomical data. The data were processed by SPSS10.0, and the data were expressed by x 卤s and t test. Results the distance of oculomotor nerve from posterior clinoid process was 5.13 卤1.26mm, the distance between oculomotor nerve and posterior communicating artery was 9.72 卤2.13mm, the distance between the entrance of oculomotor nerve cerebellar nerve and the entrance of pulley nerve was 10.20 卤2.71mm, the distance between oculomotor nerve below the tentorial margin of cerebellum was 2.84 卤0.22mm, and the distance between the entrance of oculomotor nerve and the entrance of troute nerve was 10.20 卤2.71mm. The distance from the middle point of oculomotor nerve triangle to the anterior clinoid process was 7.47 卤0.32 mm, to the posterior clinoid process was 6.25 卤0.30 mm, and to the petrosal tip was 9.32 卤0.33 mm. The distance from the origin of oculomotor nerve to posterior petrous bed fold was 15.2 卤2.2 mm, the distance from posterior petrous bed fold to cavernous sinus was 5.12 卤0.80 mm, the length of oculomotor nerve pool was 7.20 卤1.62 mm, the distance of oculomotor nerve from anterior clinoid process was 2.42 卤0.43 mm, and the distance of oculomotor nerve via cavernous sinus was 15.2 卤1.14 mm. The transverse diameter of the superior branch of the oculomotor nerve was 1.23 卤0.57 mm, and the transverse diameter of the lower branch was 1.60 卤0.23 mm. The average diameter from the origin of the oculomotor nerve to the upper and lower branches of the oculomotor nerve was 2.4 卤0.3 mm. Conclusion the oculomotor nerve can be involved in all kinds of intracranial lesions because of its long stroke and complex appearance. When dealing with these regional lesions, clinical neurosurgeons should carefully separate, carefully pull to avoid injury of oculomotor nerve blood supply artery, familiar microanatomy knowledge and skilled microsurgical techniques and surgical skills are the necessary conditions to reduce oculomotor nerve injury.
【学位授予单位】：辽宁医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322.85

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