视神经视觉假体微电极植入的应用解剖学研究

发布时间：2018-06-07 23:42

  本文选题：视神经 + 视网膜中央动脉　； 参考：《福建医科大学》2008年硕士论文

【摘要】： 【目的】探讨视觉假体微电极芯片植入视神经的相对安全区,为临床视神经手术提供解剖学依据。 【方法】30例成人头颅标本,动脉灌注混有红色染料的乳胶,观测视神经周围主要血管、神经的行程和外径等数据;4例新鲜成人头颅标本(动脉灌注墨汁混合液),球后4～8mm视神经连续切片,片厚20μm,显微镜观察和Image Advanced 3.0测量神经横断面中各象限血管断面数和血管的总面积,并进行统计学处理。 【结果】在眶外侧可见外直肌上缘(3.83±1.43)mm处有泪腺动脉和神经与其伴行向前至泪腺。将外直肌向下牵引,显露视神经,两者之间的间隙称为外直肌—视神经间隙,其深度为(8.14±0.90)mm,主要有睫状短神经和颞侧睫状后动脉等结构穿行。在眶上方,可见眼动脉多数起始于颈内动脉,视网膜中央动脉由眼动脉发出后主要经下方穿入视神经,穿入处距球后(0.85±0.28)cm,其中距离≤4mm者19.2%,≥8mm者76.9%,球后6.5mm处穿入者3.9%。鞘动脉穿入鞘膜的方位,内侧20%,上方29.3%,外侧6.7%,下方44%。在球后与总腱环中点处,视神经左右径(3.96±0.35)mm,上下径(4.18±0.33)mm。 在碳素墨汁混合液灌注的新鲜标本上还观察到,视神经鞘上分布着丰富的血管网,血管在鞘膜上大致呈前后纵向走行。取球后4～8mm段视神经连续切片,显微镜下发现,鞘膜的血管网向神经实质内以近似直角的方式向中心发出许多小支,呈向心性走行。调整、校正后Image Advanced 3.0软件分析视神经实质内各象限血管断面数和血管的总面积,小血管的断面数为( 178.936±8.666 ) ,血管总面积为(0.001280±0.000035)mm2,各象限间无显著差异。 【结论】 1、经眶外侧壁入路显露视神经的手术中,要注意保护外直肌上缘的泪腺动脉和神经,以免影响泪腺的功能。暴露视神经时需经过外直肌—视神经间隙,手术显露视神经时应注意保护该间隙结构。 2、在球后4～8mm间植入微电极芯片或进行视神经手术较为安全。 3、经外侧植入视觉假体微电极芯片或进行其它视神经手术可最大限度的减少对视神经血供的影响。 4、视神经外径约4mm,视网膜中央动脉在视神经实质中央呈前后纵向走行,微电极芯片最好沿神经纵行植入,且植入深度不宜过深,以免影响视网膜血供。 5、因外伤或植入微电极芯片等原因造成视神经缺血所致的神经纤维受损不存在象限的差异。
[Abstract]:[objective] to explore the relative safety zone of optic nerve implanted with microelectrode chip of visual prosthesis, and to provide anatomic basis for clinical optic nerve operation. [methods] 30 adult head specimens were perfused with red dye latex. The main vessels around the optic nerve, the distance and the external diameter of the nerve were observed. 4 fresh adult head specimens were collected (arterial infusion of ink mixture, Retrobulbar 4~8mm continuous section of optic nerve, etc.) The slice thickness was 20 渭 m and the number of quadrant blood vessels and the total area of blood vessels were measured by microscope and Image Advanced 3.0. [results] there were lacrimal gland arteries and nerves in the superior edge of the lateral rectus muscle at 3.83 卤1.43)mm. [results] the lacrimal gland was accompanied by the lacrimal gland. The outer rectus muscle was pulled down to expose the optic nerve. The space between them was called the space between the external rectus muscle and the optic nerve. The depth of the space was 8.14 卤0.90 mm. The main structures were the short ciliary nerve and the posterior temporal ciliary artery. Above the orbit, most of the ophthalmic arteries originated from the internal carotid artery, and the central retinal artery was mainly perforated through the optic nerve through the lower part of the ophthalmic artery, with a distance of 0.85 卤0.28 cm from the posterior bulb. The distance 鈮，

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