本文關(guān)鍵詞： 額肌瓣 上瞼下垂 面神經(jīng) 眶上動(dòng)脈 解剖學(xué)　出處：《吉林大學(xué)》2013年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：研究眶上神經(jīng)血管束、面神經(jīng)顳支的直徑、行程、走行層次及臨床上利用額肌瓣懸吊治療上瞼下垂的方式、方法、效果、注意事項(xiàng)等。以此來(lái)驗(yàn)證臨床上常見(jiàn)的以眉中三分之一為標(biāo)志作為切口的安全性，且通過(guò)對(duì)比試驗(yàn)，觀察不同手術(shù)方式治療中重度上瞼下垂的臨床療效及并發(fā)癥，為臨床更合理地選擇術(shù)式提供依據(jù)。 材料與方法：解剖清理20具（共40例）尸體標(biāo)本，年齡不詳。其中男性10具，女性10具，額部完好無(wú)缺損。暴露研究區(qū)域，并對(duì)眶上神經(jīng)血管束和面神經(jīng)顳支走行相關(guān)參數(shù)進(jìn)行測(cè)量，并使用統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行處理。臨床資料：采集從2010年7月到2012年10月，吉林大學(xué)中日聯(lián)誼醫(yī)院的中、重度上瞼下垂患者男28例，女12例，行額肌瓣懸吊矯正上瞼下垂手術(shù)，統(tǒng)計(jì)術(shù)后治愈情況及并發(fā)癥。 結(jié)果： 1.眉毛的長(zhǎng)度，眉毛嚴(yán)格三等分以后以靠近正中線(xiàn)的為起始點(diǎn)A、兩個(gè)等分點(diǎn)B、C,以及終點(diǎn)D分別距離正中線(xiàn)的直線(xiàn)距離男女分別為A點(diǎn)10.06±2.08mm和9.58±2.16mm，B點(diǎn)32.36±5.88mm和30.42±6.24mm，C點(diǎn)57.28±8.50mm和55.76±8.64mm，，D點(diǎn)80.22±12.72mm和76.46±11.36mm，眉毛的總長(zhǎng)度為68.26±10.52mm和60.84±11.66mm。 2.左側(cè)額肌的內(nèi)側(cè)緣長(zhǎng)度的平均值為65.78±0.85mm，右側(cè)內(nèi)側(cè)緣長(zhǎng)度的平均值分別為65.49±0.88mm，左側(cè)外側(cè)緣長(zhǎng)度的平均值為70.48±0.95mm，右側(cè)外側(cè)緣長(zhǎng)度的平均值為70.55±0.94mm，左側(cè)前端寬度的平均值為56.14±0.75mm，右側(cè)前端寬度的平均值為55.93±0.74mm，左側(cè)后端的寬度平均值為61.09±0.82mm，右側(cè)后端的寬度平均值為60.40±0.83mm，左側(cè)中份厚度平均值為1.43±0.06mm，右側(cè)中份厚度平均值為1.46±0.06mm。 3.眶上神經(jīng)在出眶上孔以后并不是完全垂直向上走行的，而是以一定角度由內(nèi)下向外上走行，主干走行在額肌筋膜的深面及帽狀腱膜下隙中，眶上神經(jīng)本干出眶上孔直徑為1.44±0.3mm，入肌點(diǎn)至眶上孔直線(xiàn)距離40.3±9.0mm，入肌點(diǎn)至眶上孔垂直距離33.7±8.5mm，入肌點(diǎn)至眶上孔水平距離30.5±8.6mm，本干與眶上孔切線(xiàn)的夾角52.7±7.4度；眶上動(dòng)脈本干與眶上神經(jīng)伴行出眶上孔。 4.眶上動(dòng)脈為眼動(dòng)脈的分支，與眶上神經(jīng)同出眶上孔，其主干傾斜一定角度行向外上方，大約在額部中點(diǎn)的水平穿過(guò)額肌及帽狀腱膜的后鞘�？羯蟿�(dòng)脈在眶上緣水平線(xiàn)和額部中點(diǎn)水平線(xiàn)上距正中線(xiàn)的距離分別為22.5±4.1mm和33.3±5.9mm。 5.面神經(jīng)顳支進(jìn)入額肌點(diǎn)的最低點(diǎn)和最高點(diǎn)距離眶上緣的上方分別為7.6±1.5mm和26.4±3.0mm，而它們距正中線(xiàn)的距離分別為50.0±1.9mm和51.3±2.1mm。 結(jié)論： 1.眉毛的長(zhǎng)度與我們選定的眉毛嚴(yán)格三等分的中央部分有一定的差異性，即眉毛稍長(zhǎng)的個(gè)體，切口可稍微偏向內(nèi)一點(diǎn)； 2.眉中三分之一的部分很少有神經(jīng)的主干進(jìn)入，因此該區(qū)域剝離額肌是比較安全的。
[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 鹵2.08 mm and 9.58 鹵2.16 mm, respectively. B point 32.36 鹵5.88 mm and 30.42 鹵6.24 mm C point 57.28 鹵8.50 mm and 55.76 鹵8.64 mm. The total length of eyebrow was 68.26 鹵10.52 mm and 60.84 鹵11.66 mm respectively at D point 80.22 鹵12.72 mm and 76.46 鹵11.36 mm. 2. The average length of the medial margin of the left frontal muscle was 65.78 鹵0.85 mm, and the average length of the right medial margin was 65.49 鹵0.88 mm. The average length of left lateral margin was 70.48 鹵0.95mm, and that of right lateral margin was 70.55 鹵0.94mm. The average width of the left front end was 56.14 鹵0.75 mm, and the right front end width was 55.93 鹵0.74 mm. The average width of the left end was 61.09 鹵0.82mm, the width of the right end was 60.40 鹵0.83mm, the average thickness of the left middle portion was 1.43 鹵0.06mm. The mean thickness of the right median portion was 1.46 鹵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 鹵0.3mm, the distance between muscle entry point and supraorbital foramen was 40.3 鹵9.0mm, and the vertical distance between muscle entry point and supraorbital foramen was 33.7 鹵8.5mm. The distance between the muscle entry point and the supraorbital foramen was 30.5 鹵8.6mm, and the angle between the trunk and the subeorbital foramen was 52.7 鹵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 鹵4.1 mm and 33.3 鹵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 鹵1.5 mm and 26.4 鹵3.0 mm above the superior orbital margin, respectively. The distance from the median line was 50.0 鹵1.9 mm and 51.3 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 黃海輝,陳春鵬,謝義德;眶上神經(jīng)的走行層次及其臨床意義[J];福建醫(yī)科大學(xué)學(xué)報(bào);1999年01期

2 李葉揚(yáng),梁岷,汪錦倫,童仁聯(lián),黃峻,矯立仁;梯形額肌瓣轉(zhuǎn)移治療上瞼下垂[J];中華醫(yī)學(xué)美學(xué)美容雜志;2002年03期

3 林茂昌;;上瞼下垂術(shù)式選擇及其評(píng)價(jià)[J];中國(guó)美容醫(yī)學(xué);2006年01期

4 謝義德,黃海輝,黃拔瑞,郭志輝,周亞寬,周政,謝云;結(jié)合尸解淺談?lì)~肌解剖及額肌瓣治療重度上瞼下垂的體會(huì)[J];實(shí)用美容整形外科雜志;1997年02期

5 黃發(fā)明;額肌瓣矯正重度上瞼下垂手術(shù)的若干臨床問(wèn)題[J];中國(guó)美容醫(yī)學(xué);2003年06期

6 封必釗,盧學(xué)軍,王光軍,程宏宇;改良的額肌瓣懸吊治療上瞼下垂[J];中華醫(yī)學(xué)美容雜志;2001年01期

7 李超英,李耀峰,楊旭梅;改良式額肌腱膜懸吊術(shù)治療重度上瞼下垂[J];中國(guó)實(shí)用眼科雜志;2005年10期

8 孫金閣,張軍和;眼輪匝肌提吊術(shù)治療完全性上瞼下垂[J];中國(guó)實(shí)用眼科雜志;1987年10期

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