上颌骨外旋颅底临床解剖学研究

发布时间：2018-05-04 22:31

本文选题：上颌骨 + 颅底　；参考：《安徽医科大学》2007年硕士论文

【摘要】： 目的: 为获得准确的颅底手术相关解剖学资料,进一步提高手术的安全性。方法: 首先将10%福尔马林浸泡过的10例20侧成人尸头,用红、蓝色乳胶分别进行颈总动脉和颈内静脉灌注;其次去除顶骨和脑组织暴露颅底内面、再行上颌骨外旋后进一步解剖依次暴露前、中以及侧颅底,并测量相关的颅底解剖学数据。1、对前颅底的暴露:1.1将眶下壁和内壁骨膜剥离并使眶内容物向外翻并去除,暴露Dacryon点、眶额颧点以及眶尖,测量Dacryon点与眶上裂的外侧端、内侧端的距离;测量眶额颧点与眶上裂的外侧端、内侧端的距离。1.2将上颌骨鼻突及纸样板切除暴露额窦后壁及筛窦,将筛窦轮廓化,暴露筛板,从颅底上下测量鸡冠前缘-筛板后缘连线中点的距离;测量鸡冠后部两侧筛板最大水平距离。2、对中颅底的暴露:2.1解剖眶下神经至园孔外口,再于其内下方解剖翼管出口,测量二孔距离;2.2去除翼突保留翼突根部,解剖下颌神经至卵园孔,再于翼突根部后解剖破裂孔,分别测量翼突根部内侧前缘与破裂孔前缘的距离和翼突根部外侧前缘与卵园孔前缘的距离;2.3在颅底内面,解剖园孔和卵园孔,测量二孔的距离,并观察二孔连线与海绵窦的关系从而了解翼突根部与海绵窦的关系;2.4打开蝶窦,观察颈内动脉和视神经在后筛或/和蝶窦外侧壁的解剖特点,解剖颈内动脉和视神经,测量前鼻嵴至海绵窦颈内动脉前曲部的距离、视神经眶口至颅口的距离;解剖视神经—颈内动脉隐窝,观察其毗邻关系。3、对侧颅底的暴露:去除下颌骨升支,暴露下颌窝;解剖颈内动脉和颈内静脉分别至颅底颈动脉外口和颈静脉孔;解剖茎突至颅底。测量卵园孔后缘与颈动脉管外口前缘的距离、测量下颌窝内缘与颈动脉管外口外缘的距离;从前向后观察颈内动脉、颈内静脉与下颌窝、茎突在近颅底和颅底的位置关系。结果: 1、1.1 Dacryon点与眶上裂的外侧端、内侧端的距离分别是42.5±3.52mm、37.2±2.52mm(左)和42.8±3.90 mm、37.8±2.57 mm(右);眶额颧点与眶上裂的外侧端、内侧端的距离分别是34.0±2.76mm、49.3±3.02mm(左)和35.0±4.30 mm、49.5±3.54mm(右)。1.2鸡冠前缘-筛板后缘连线中点的距离为21.6±2.28 mm;量鸡冠后部两侧筛板最大水平距离8.8±2.32 mm。 2、2.1翼突根部内侧缘后为破裂孔,翼突根部外侧缘后为卵园孔;翼突根部内侧前缘与破裂孔前缘的距离为11.9±2.35mm(左)、12±1.85 mm(右),翼突根部外侧前缘与卵园孔前缘的距离14.4±1.87mm(左)、14.8±2.34 mm(右)。2.2前鼻嵴至海绵窦颈内动脉前曲部的距离66.9±2.91 mm(左)、67.6±2.23 mm(右)、视神经眶口至颅口的距离分别是8. 1±1.82 mm(左)、8.24±1.70 mm(右)。2.3圆孔外口与其内下方的翼管出口的距离为5.08±2.04 mm(左)、5.6±1.41 mm (右);颅底内面园孔和卵园孔的距离为7.43±1.49 mm (左)、8.85±2.60 mm(右),二者的连线相当于海绵窦的外界,并近似与翼突外侧板在同一平面上;2.4颈内动脉和视神经在后筛或/和蝶窦外侧壁不论是否形成隆起,二者交叉的外侧形成隐窝,即“视神经-颈内动脉隐窝”,该隐窝可作为寻找颈内动脉和视神经的标志。 3、3.1卵园孔后缘与颈动脉管外口前缘的距离为9.6±1.85mm(左)、9.1±2.0 mm(右);3.2下颌窝内侧缘与颈动脉管外口外缘的距离为12.3±2.95mm(左)、11.5±3.12mm(右);3.3颈内静脉在颈内动脉后外侧,颈内动脉于下颌窝内侧缘最远点冠状平面之后;颈内静脉于茎突内侧出颈内静脉孔。结论: 上颌骨外旋后,可对前、中以及侧颅底充分暴露;正确认识颅底鸡冠、筛板、翼突、视神经-颈内动脉隐窝、圆孔、卵圆孔、颈内动脉、视神经及其各自的毗邻解剖结构这些临床标志,为颅底手术安全性提供保证。
[Abstract]:Objective:
In order to get accurate anatomical data of skull base surgery, we can further improve the safety of operation.
Method:
First, 10 cases of 20 adult cadaver heads soaked in 10% formalin were perfused with red and blue latex. Then the skull and brain tissues were removed and the inner surface of the skull was exposed, and the anterior, middle and lateral cranial base were exposed after the external rotation of the maxilla, and the related cranial anatomical data,.1, were measured, and the anterior cranium was measured. Bottom exposure: 1.1 peel off the suborbital wall and the periosteum and remove the orbital contents, expose the Dacryon points, the orbital frontal zygomatic points and the orbital apex, measure the distance between the Dacryon point and the lateral and medial end of the orbital fissure, and measure the orbital frontal and zygomatic points with the lateral orbital fissure, and the distance.1.2 from the medial end to the maxilla naso process and paper samples to excision exposure. The posterior sinus and ethmoid sinus were used to outline the ethmoid sinus, to expose the sieve plate, to measure the distance from the skull base to the midpoint of the trailing edge of the sieve plate from the base of the skull; to measure the maximum horizontal distance of the sieve plate at the posterior part of the cockscomb.2, to expose the middle skull base, to dissect the orbital nerve to the orifice, and to dissect the wing tube exit, and to measure the distance of the two holes; 2.2 removal of the wing. 2.2 removal of the wing. At the root of the pterygwing process, the mandibular nerve was dissected to the oval orifice, and then the rupture hole was dissected after the root of the pterygoid process. The distance between the medial front of the root of the pterygw and the front of the ruptured hole and the distance between the lateral front of the root of the pterygw and the front of the oval orifice were measured. 2.3 the distance between the orchards and the orchards was measured in the inner surface of the skull, and the distance between the two holes was measured and the two hole connection was observed and observed. The relationship between the cavernous sinus and the cavernous sinus; 2.4 open the sphenoid sinus and observe the anatomical characteristics of the internal carotid and optic nerve at the posterior sieves or / and the lateral wall of the sphenoid sinus, the internal carotid artery and the optic nerve, the distance of the anterior nasal ridge to the cavernous sinus of the internal carotid artery, the distance of the optic orbit to the cranial mouth, and the dissection of the optic nerve. Internal carotid recess, observing its adjacent relationship.3, exposure to the lateral skull base: removal of the ascending branch of the mandible, exposing the mandibular fossa, the anatomy of the internal carotid artery and the internal jugular vein to the external orifice of the skull base and the jugular vein, and the anatomy of the styloid process to the skull base. Measuring the distance between the posterior margin of the orifice of the oval orifice and the anterior border of the carotid canal, and measuring the inner margin of the mandibular fossa and the carotid canal The distance between the external margin of the external orifice and the position of the internal carotid artery, the internal jugular vein and the mandibular fossa and the styloid process in the proximal skull base and the skull base were observed from the back to the back.
Result:
The distance between the 1,1.1 Dacryon point and the lateral and medial end of the orbital fissure was 42.5 + 3.52mm, 37.2 + 2.52mm (left) and 42.8 + 3.90 mm, 37.8 + 2.57 mm (right), and the distance between the orbital frontal zygomatic point and the upper part of the orbital fissure was 34 + 2.76mm, 49.3 + 3.02mm (left) and 35 + 4.30 mm, 49.5 + 3.54mm (right).1.2 cocktail of the cocktail - the posterior border of the ethmoid plate. The distance from the midpoint is 21.6 + 2.28 mm; the maximum horizontal distance between the two sides of the comb is 8.8 + 2.32 mm..
The medial margin of the root of the 2,2.1 pterygus is the rupture hole and the oval orifice in the lateral margin of the root of the pterygoid process. The distance between the medial anterior margin of the root of the pterygwing and the anterior margin of the rupture hole is 11.9 + 2.35mm (left), 12 + 1.85 mm (right), the distance between the lateral anterior margin of the root of the pterygw and the front of the oval orifice is 14.4 + (left), 14.8 + 2.34 mm (right).2.2 anterior nasal ridge to the internal carotid artery of cavernous sinus. The distance was 66.9 + 2.91 mm (left) and 67.6 + 2.23 mm (right). The distance from the orbital orbitum to the cranial mouth of the optic nerve was 8.1 + 1.82 mm (left). The distance between the outer mouth of the 8.24 + 1.70 mm (right).2.3 circular hole and the outlet of the wing tube was 5.08 + 2.04 mm (left) and 5.6 + 1.41 mm (right), and the distance between the inner garden hole and the oval hole in the skull base was 7.43 + mm (left), + + m m M (right), the connection between the two is equivalent to the outside of the cavernous sinus and approximately on the same plane with the lateral pterygoid lateral plate; the 2.4 internal carotid artery and the optic nerve in the posterior sieves or / and the lateral wall of the sphenoid sinus may form a protruding, the two intersecting lateral fossa, namely the "optic nerve internal carotid recess", which can be used as the internal carotid artery and optic nerve for the search of the internal carotid artery and the optic nerve. Sign.
The distance between the posterior margin of the 3,3.1 oval orchards and the anterior border of the carotid canal was 9.6 + 1.85mm (left) and 9.1 + 2 mm (right), and the distance between the medial margin of the 3.2 mandibular fossa and the outer edge of the carotid canal was 12.3 + 2.95mm (left) and 11.5 + 3.12mm (right); the 3.3 internal jugular vein was behind the internal carotid artery, and the internal carotid artery was at the farthest point in the medial margin of the mandibular fossa; the internal neck was static. The vein has the internal jugular hole in the medial styloid process.
Conclusion:
The anterior, middle, and lateral cranial base of the maxilla can be fully exposed, and the correct understanding of the skull base, the sieve plate, the pterygus, the optic nerve - the internal carotid artery recess, the round hole, the oval hole, the internal carotid artery, the optic nerve and its adjacent anatomical structures provide a guarantee for the safety of the operation of the skull base.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

【参考文献】