本文選題：上頜骨 + 顱底��； 參考：《安徽醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 目的: 為獲得準確的顱底手術(shù)相關(guān)解剖學(xué)資料,進一步提高手術(shù)的安全性。 方法: 首先將10%福爾馬林浸泡過的10例20側(cè)成人尸頭,用紅、藍色乳膠分別進行頸總動脈和頸內(nèi)靜脈灌注;其次去除頂骨和腦組織暴露顱底內(nèi)面、再行上頜骨外旋后進一步解剖依次暴露前、中以及側(cè)顱底,并測量相關(guān)的顱底解剖學(xué)數(shù)據(jù)。1、對前顱底的暴露:1.1將眶下壁和內(nèi)壁骨膜剝離并使眶內(nèi)容物向外翻并去除,暴露Dacryon點、眶額顴點以及眶尖,測量Dacryon點與眶上裂的外側(cè)端、內(nèi)側(cè)端的距離;測量眶額顴點與眶上裂的外側(cè)端、內(nèi)側(cè)端的距離。1.2將上頜骨鼻突及紙樣板切除暴露額竇后壁及篩竇,將篩竇輪廓化,暴露篩板,從顱底上下測量雞冠前緣-篩板后緣連線中點的距離;測量雞冠后部兩側(cè)篩板最大水平距離。2、對中顱底的暴露:2.1解剖眶下神經(jīng)至園孔外口,再于其內(nèi)下方解剖翼管出口,測量二孔距離;2.2去除翼突保留翼突根部,解剖下頜神經(jīng)至卵園孔,再于翼突根部后解剖破裂孔,分別測量翼突根部內(nèi)側(cè)前緣與破裂孔前緣的距離和翼突根部外側(cè)前緣與卵園孔前緣的距離;2.3在顱底內(nèi)面,解剖園孔和卵園孔,測量二孔的距離,并觀察二孔連線與海綿竇的關(guān)系從而了解翼突根部與海綿竇的關(guān)系;2.4打開蝶竇,觀察頸內(nèi)動脈和視神經(jīng)在后篩或/和蝶竇外側(cè)壁的解剖特點,解剖頸內(nèi)動脈和視神經(jīng),測量前鼻嵴至海綿竇頸內(nèi)動脈前曲部的距離、視神經(jīng)眶口至顱口的距離;解剖視神經(jīng)—頸內(nèi)動脈隱窩,觀察其毗鄰關(guān)系。3、對側(cè)顱底的暴露:去除下頜骨升支,暴露下頜窩;解剖頸內(nèi)動脈和頸內(nèi)靜脈分別至顱底頸動脈外口和頸靜脈孔;解剖莖突至顱底。測量卵園孔后緣與頸動脈管外口前緣的距離、測量下頜窩內(nèi)緣與頸動脈管外口外緣的距離;從前向后觀察頸內(nèi)動脈、頸內(nèi)靜脈與下頜窩、莖突在近顱底和顱底的位置關(guān)系。 結(jié)果: 1、1.1 Dacryon點與眶上裂的外側(cè)端、內(nèi)側(cè)端的距離分別是42.5±3.52mm、37.2±2.52mm(左)和42.8±3.90 mm、37.8±2.57 mm(右);眶額顴點與眶上裂的外側(cè)端、內(nèi)側(cè)端的距離分別是34.0±2.76mm、49.3±3.02mm(左)和35.0±4.30 mm、49.5±3.54mm(右)。1.2雞冠前緣-篩板后緣連線中點的距離為21.6±2.28 mm;量雞冠后部兩側(cè)篩板最大水平距離8.8±2.32 mm。 2、2.1翼突根部內(nèi)側(cè)緣后為破裂孔,翼突根部外側(cè)緣后為卵園孔;翼突根部內(nèi)側(cè)前緣與破裂孔前緣的距離為11.9±2.35mm(左)、12±1.85 mm(右),翼突根部外側(cè)前緣與卵園孔前緣的距離14.4±1.87mm(左)、14.8±2.34 mm(右)。2.2前鼻嵴至海綿竇頸內(nèi)動脈前曲部的距離66.9±2.91 mm(左)、67.6±2.23 mm(右)、視神經(jīng)眶口至顱口的距離分別是8. 1±1.82 mm(左)、8.24±1.70 mm(右)。2.3圓孔外口與其內(nèi)下方的翼管出口的距離為5.08±2.04 mm(左)、5.6±1.41 mm (右);顱底內(nèi)面園孔和卵園孔的距離為7.43±1.49 mm (左)、8.85±2.60 mm(右),二者的連線相當于海綿竇的外界,并近似與翼突外側(cè)板在同一平面上;2.4頸內(nèi)動脈和視神經(jīng)在后篩或/和蝶竇外側(cè)壁不論是否形成隆起,二者交叉的外側(cè)形成隱窩,即“視神經(jīng)-頸內(nèi)動脈隱窩”,該隱窩可作為尋找頸內(nèi)動脈和視神經(jīng)的標志。 3、3.1卵園孔后緣與頸動脈管外口前緣的距離為9.6±1.85mm(左)、9.1±2.0 mm(右);3.2下頜窩內(nèi)側(cè)緣與頸動脈管外口外緣的距離為12.3±2.95mm(左)、11.5±3.12mm(右);3.3頸內(nèi)靜脈在頸內(nèi)動脈后外側(cè),頸內(nèi)動脈于下頜窩內(nèi)側(cè)緣最遠點冠狀平面之后;頸內(nèi)靜脈于莖突內(nèi)側(cè)出頸內(nèi)靜脈孔。 結(jié)論: 上頜骨外旋后,可對前、中以及側(cè)顱底充分暴露;正確認識顱底雞冠、篩板、翼突、視神經(jīng)-頸內(nèi)動脈隱窩、圓孔、卵圓孔、頸內(nèi)動脈、視神經(jīng)及其各自的毗鄰解剖結(jié)構(gòu)這些臨床標志,為顱底手術(shù)安全性提供保證。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R322

【參考文獻】

相關(guān)期刊論文 前10條

1 劉業(yè)海,張琨齡,沙群,楊克林,楊見明,方平,童步升;改良面部正中翻揭術(shù)在鼻腔鼻竇腫瘤手術(shù)中的應(yīng)用探討[J];耳鼻咽喉頭頸外科;2002年06期

2 朱儉,王保安,朱正兵,楊波;篩板和篩頂高度解剖變異的CT觀察[J];廣東醫(yī)學(xué);2003年12期

3 蔣健,劉寧,朱風(fēng)儀,趙春生,陳新成,駱慧;顳下經(jīng)下頜入路顯露側(cè)顱底區(qū)的應(yīng)用解剖學(xué)研究[J];解剖學(xué)研究;2005年02期

4 尹金淑;;鼻內(nèi)鏡徑路對顱底病變的手術(shù)治療[J];國際耳鼻咽喉頭頸外科雜志;2006年02期

5 廖建春,胡國漢,盧亦成,朱杭軍,王海青;后篩竇氣化發(fā)育對蝶鞍區(qū)手術(shù)的影響[J];中國解剖與臨床;2001年Z1期

6 汪吉寶,劉邦華,楊成章,余青松,孔維佳,畢勝斌,項濟生;擴大唇下徑路面中部掀翻術(shù)及其改良術(shù)式治療鼻部疾病[J];臨床耳鼻咽喉科雜志;1992年02期

7 吳躍煌,祁永發(fā),唐平章,徐振剛;鼻咽癌殘留或復(fù)發(fā)外科挽救治療的術(shù)式選擇[J];臨床耳鼻咽喉科雜志;2002年02期

8 張紅萍,張大良,張輝;上頜骨外旋入路切除顱底及咽旁間隙腫瘤[J];臨床耳鼻咽喉科雜志;2004年12期

9 唐敏峰,王鶴鳴,姜平;蝶竇氣化程度與相鄰結(jié)構(gòu)關(guān)系的研究[J];江蘇臨床醫(yī)學(xué)雜志;2001年01期

10 黃安煬;顳下窩入路和改良入路的應(yīng)用進展[J];中國耳鼻咽喉顱底外科雜志;2002年03期

，

本文編號：1844973