额肌瓣的相关解剖学研究

发布时间：2018-02-03 12:20

本文关键词： 额肌瓣上睑下垂面神经眶上动脉解剖学　出处：《吉林大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：研究眶上神经血管束、面神经颞支的直径、行程、走行层次及临床上利用额肌瓣悬吊治疗上睑下垂的方式、方法、效果、注意事项等。以此来验证临床上常见的以眉中三分之一为标志作为切口的安全性，且通过对比试验，观察不同手术方式治疗中重度上睑下垂的临床疗效及并发症，为临床更合理地选择术式提供依据。材料与方法：解剖清理20具（共40例）尸体标本，年龄不详。其中男性10具，女性10具，额部完好无缺损。暴露研究区域，并对眶上神经血管束和面神经颞支走行相关参数进行测量，并使用统计软件对数据进行处理。临床资料：采集从2010年7月到2012年10月，吉林大学中日联谊医院的中、重度上睑下垂患者男28例，女12例，行额肌瓣悬吊矫正上睑下垂手术，统计术后治愈情况及并发症。结果： 1.眉毛的长度，眉毛严格三等分以后以靠近正中线的为起始点A、两个等分点B、C,以及终点D分别距离正中线的直线距离男女分别为A点10.06±2.08mm和9.58±2.16mm，B点32.36±5.88mm和30.42±6.24mm，C点57.28±8.50mm和55.76±8.64mm，，D点80.22±12.72mm和76.46±11.36mm，眉毛的总长度为68.26±10.52mm和60.84±11.66mm。 2.左侧额肌的内侧缘长度的平均值为65.78±0.85mm，右侧内侧缘长度的平均值分别为65.49±0.88mm，左侧外侧缘长度的平均值为70.48±0.95mm，右侧外侧缘长度的平均值为70.55±0.94mm，左侧前端宽度的平均值为56.14±0.75mm，右侧前端宽度的平均值为55.93±0.74mm，左侧后端的宽度平均值为61.09±0.82mm，右侧后端的宽度平均值为60.40±0.83mm，左侧中份厚度平均值为1.43±0.06mm，右侧中份厚度平均值为1.46±0.06mm。 3.眶上神经在出眶上孔以后并不是完全垂直向上走行的，而是以一定角度由内下向外上走行，主干走行在额肌筋膜的深面及帽状腱膜下隙中，眶上神经本干出眶上孔直径为1.44±0.3mm，入肌点至眶上孔直线距离40.3±9.0mm，入肌点至眶上孔垂直距离33.7±8.5mm，入肌点至眶上孔水平距离30.5±8.6mm，本干与眶上孔切线的夹角52.7±7.4度；眶上动脉本干与眶上神经伴行出眶上孔。 4.眶上动脉为眼动脉的分支，与眶上神经同出眶上孔，其主干倾斜一定角度行向外上方，大约在额部中点的水平穿过额肌及帽状腱膜的后鞘。眶上动脉在眶上缘水平线和额部中点水平线上距正中线的距离分别为22.5±4.1mm和33.3±5.9mm。 5.面神经颞支进入额肌点的最低点和最高点距离眶上缘的上方分别为7.6±1.5mm和26.4±3.0mm，而它们距正中线的距离分别为50.0±1.9mm和51.3±2.1mm。结论： 1.眉毛的长度与我们选定的眉毛严格三等分的中央部分有一定的差异性，即眉毛稍长的个体，切口可稍微偏向内一点； 2.眉中三分之一的部分很少有神经的主干进入，因此该区域剥离额肌是比较安全的。
[Abstract]:Objective: to study the method, method and effect of frontal muscle flap suspension in the treatment of blepharoptosis by using frontalis muscle flap in the treatment of blepharoptosis by the diameter, itinerary and route of the superior orbital nerve and the temporal branch of the facial nerve. To verify the clinical safety of the common eyebrow 1/3 as the mark of incision, and through a comparative trial. To observe the clinical efficacy and complications of different surgical methods in the treatment of moderate and severe ptosis, and to provide evidence for more rational selection of operative methods. Materials and methods: 20 cadaver specimens (40 cases) with unknown age were dissected, including 10 males and 10 females. The parameters related to the superior orbital nerve bundle and the temporal branch of facial nerve were measured and the data were processed by statistical software. Clinical data were collected from July 2010 to October 2012. There were 28 male and 12 female patients with severe blepharoptosis in Sino-Japanese Friendship Hospital of Jilin University. Frontalis muscle flap suspension was performed to correct blepharoptosis. Results: 1. The length of the eyebrow, after the eyebrow is strictly divided into three equal points, the starting point A is near the median line, and the two equipartition points are BFU C. The distance between male and female was 10.06 卤2.08 mm and 9.58 卤2.16 mm, respectively. B point 32.36 卤5.88 mm and 30.42 卤6.24 mm C point 57.28 卤8.50 mm and 55.76 卤8.64 mm. The total length of eyebrow was 68.26 卤10.52 mm and 60.84 卤11.66 mm respectively at D point 80.22 卤12.72 mm and 76.46 卤11.36 mm. 2. The average length of the medial margin of the left frontal muscle was 65.78 卤0.85 mm, and the average length of the right medial margin was 65.49 卤0.88 mm. The average length of left lateral margin was 70.48 卤0.95mm, and that of right lateral margin was 70.55 卤0.94mm. The average width of the left front end was 56.14 卤0.75 mm, and the right front end width was 55.93 卤0.74 mm. The average width of the left end was 61.09 卤0.82mm, the width of the right end was 60.40 卤0.83mm, the average thickness of the left middle portion was 1.43 卤0.06mm. The mean thickness of the right median portion was 1.46 卤0.06mm. 3. The supraorbital nerve does not walk vertically and upward after the supraorbital foramen, but at a certain angle from the inner to the outer, and the main trunk runs in the deep surface of the fascia of the frontal muscle and in the subaponeurotic space of the capsiform aponeurosis. The diameter of supraorbital foramen was 1.44 卤0.3mm, the distance between muscle entry point and supraorbital foramen was 40.3 卤9.0mm, and the vertical distance between muscle entry point and supraorbital foramen was 33.7 卤8.5mm. The distance between the muscle entry point and the supraorbital foramen was 30.5 卤8.6mm, and the angle between the trunk and the subeorbital foramen was 52.7 卤7.4 degrees. The primary trunk of the supraorbital artery and the supraorbital nerve accompanied by the supraorbital foramen. 4. The supraorbital artery is a branch of the ophthalmic artery, with the supraorbital nerve coming out of the supraorbital foramen. The distance between the supraorbital artery and the median line is 22.5 卤4.1 mm and 33.3 卤5, respectively. .9mm. 5. The lowest point and the highest point of the temporal branch of the facial nerve entering the frontal muscle were 7.6 卤1.5 mm and 26.4 卤3.0 mm above the superior orbital margin, respectively. The distance from the median line was 50.0 卤1.9 mm and 51.3 卤2.1 mm, respectively. Conclusion: 1. The length of the eyebrow is different from that of the central part of the eyebrow which is strictly divided into three equal parts, that is, the individual with slightly longer eyebrow, the incision may be slightly inward; 2. In the 1/3 part of the eyebrow, the nerve trunk rarely enters, so it is safe to exfoliate the frontal muscle in this area.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R322

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