【摘要】： 目的 通過對支配皺眉肌神經(jīng)的解剖學(xué)研究，確認(rèn)皺眉肌肌內(nèi)外神經(jīng)的來源、走行和分布。消除皺眉肌運(yùn)動(dòng)所導(dǎo)致的眉間皺紋是目前整形美容外科的一項(xiàng)難題，本研究旨在明確皺眉肌的神經(jīng)解剖，從而為處理和治療其產(chǎn)生的皺紋尋找適合的方法，并盡可能地減少皺眉肌功能喪失提供解剖學(xué)依據(jù)。(1)通過對尸頭標(biāo)本皺眉肌神經(jīng)分布的解剖和肌內(nèi)神經(jīng)染色的研究，建立皺眉肌的神經(jīng)支配模型。(2)為改善眉間紋的衰老形態(tài)的手術(shù)方式或其他治療方法提供解剖學(xué)依據(jù)。 實(shí)驗(yàn)方法 對10％福爾馬林溶液浸泡5個(gè)月至2年的成人尸頭5具，10側(cè)面部進(jìn)行解剖學(xué)研究，包括大體解剖和顯微解剖。解剖時(shí)逐層銳性鈍性結(jié)合剝離，注意尋找面神經(jīng)皺眉肌支配支走行及分布，必要時(shí)在3.5倍手術(shù)顯微鏡下使用顯微器械對尸體標(biāo)本進(jìn)行顯微解剖，利用改良的Sihler's肌內(nèi)神經(jīng)染色顯示皺眉肌內(nèi)神經(jīng)，采取游標(biāo)卡尺測量，精度為0.02m，并做文字和圖象記錄。 實(shí)驗(yàn)結(jié)果 面神經(jīng)出莖乳孔后，各分支相互吻合，形成立體網(wǎng)狀結(jié)構(gòu)。皺眉肌受面神經(jīng)多重分支支配。顳支分出外側(cè)及內(nèi)側(cè)額支，外側(cè)額支進(jìn)入額肌，內(nèi)側(cè)額支進(jìn)入眼輪匝肌，，兩分支于皺眉肌中段進(jìn)入皺眉肌。顴支上部分支進(jìn)入眼輪匝肌，在內(nèi)眥部與淺支匯合，一同進(jìn)入降眉間肌后上行進(jìn)入皺眉肌。淺頰支上行穿“三角窗”(眼輪匝肌、顴小肌、提上唇鼻翼肌)，與上顴支及淺顴支匯合成“角支”，跨越瞼內(nèi)側(cè)韌帶到達(dá)皺眉肌和降眉間肌。利用肌內(nèi)神經(jīng)染色可以清楚顯示皺眉肌內(nèi)神經(jīng)，皺眉肌內(nèi)神經(jīng)呈水平節(jié)段性分布。 結(jié)論 面神經(jīng)各分支間交錯(cuò)吻合成神經(jīng)網(wǎng)，通過形成的神經(jīng)網(wǎng)支配面部諸表情肌。皺眉肌受面神經(jīng)顳支、顴支和頰支多重神經(jīng)分支支配，同時(shí)亦與臨近解剖區(qū)域表情肌相關(guān)聯(lián)。皺眉肌肌內(nèi)神經(jīng)與皺眉肌走行大致垂直，呈水平節(jié)段性分布。因而面部年輕化手術(shù)中，去除眉間皺紋必須徹底切斷皺眉肌所有支配神經(jīng)。在最大限度的保留皺眉肌形態(tài)和功能的情況下，通過高選擇性神經(jīng)離斷術(shù)可以安全有效的解決眉間皺紋。
[Abstract]:Objective to identify the origin, movement and distribution of the internal and external nerves of the frowning muscles by anatomic study of the innervation of the frowning muscles. It is a difficult problem for cosmetic surgery to eliminate the wrinkles caused by the frowning muscle movement. The purpose of this study is to clarify the neuroanatomy of the frowning muscles and to find suitable methods for the treatment and treatment of the wrinkles produced by them. As far as possible to reduce the loss of the function of frowning muscles to provide anatomical basis. (1) by studying the distribution of frowning nerve and the staining of intramuscular nerve in cadaveric head specimens, The innervation model of the frowning muscles was established. (2) the anatomical basis was provided for the operation or other treatment methods to improve the aging morphology of the intereyebrow striae. Methods Anatomy of 10 sides of adult cadaveric heads soaked in 10% formalin solution for 5 months to 2 years was studied, including gross anatomy and microanatomy. In dissection, the facial nerve frowning muscle was dissected layer by layer, and the innervation branches of the facial nerve frowning muscle were searched for walking and distribution. When necessary, the cadaver specimens were dissected with microinstruments under 3.5 times operation microscope. The improved Sihler's intramuscular nerve staining was used to display the intramuscular nerve of frown. The Vernier caliper was used to measure the intramuscular nerve. The accuracy was 0.02m.The written and image records were also made. The results showed that the branches of the facial nerve anastomosed with each other and formed a three-dimensional reticular structure after the caulomastoid foramen. The frowning muscle is innervated by multiple branches of the facial nerve. The temporal branch was divided into lateral and medial frontalis, lateral frontal branch into frontal muscle, medial frontal branch into orbicularis oculi muscle, and two branches into frowning muscle. The upper branch of zygomatic branch enters the orbicularis oculi muscle, and the medial canthus converges with the superficial branch. The superficial buccal branch goes up through the "triangle window" (orbicularis oculi muscle, zygomaticus minor muscle, upper lip and nasal alar muscle), converges with the superior zygomatic branch and the superficial zygomatic branch to form the "angle branch", and crosses the medial ligaments of the eyelid to the frowning muscle and the lower interfacial muscle. The intramuscular nerve of frown can be clearly displayed by intramuscular nerve staining, and the intramuscular nerve of frown is distributed horizontally. Conclusion the nerve network is formed by interlaced anastomosis between the branches of the facial nerve, and the facial expression muscles are innervated by the neural network formed. The frowning muscle is innervated by the temporal branch, zygomatic branch and buccal branch of facial nerve. The intramuscular nerve was approximately vertical to the frowning muscle and distributed horizontally. Therefore, facial rejuvenation surgery, the removal of wrinkles must be completely cut off all the innervation of the frown muscle. Under the condition of preserving the shape and function of the frowning muscle to the maximum extent, it is safe and effective to solve the intereyebrow wrinkles by high selective neurotomy.
【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R322

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