發(fā)布時(shí)間：2018-04-05 16:35

  本文選題：顳淺動(dòng)脈　切入點(diǎn)：面動(dòng)脈　出處：《中南大學(xué)》2010年碩士論文

【摘要】： 研究目的： 通過血管灌注,顯微解剖的方法,研究顳淺動(dòng)脈(superficial temporal artery, STA)、面動(dòng)脈(facial artery, FA)主要走行、分支和其分支的大致供養(yǎng)范圍,并解剖面部淺層結(jié)構(gòu),為同種異體顏面移植術(shù)的臨床應(yīng)用提供解剖學(xué)依據(jù)。同時(shí),模擬以顳淺動(dòng)脈為蒂的換臉術(shù)供體皮瓣的切取過程并施以灌注,借以驗(yàn)證在換臉術(shù)中以STA主干為蒂的可行性。 研究方法： 1.采用以紅色乳膠灌注的成人頭部標(biāo)本3個(gè)共6側(cè),解剖STA主干及主要分支并用游標(biāo)卡尺、直尺、量角器等觀測(cè)STA的走行、起始、分支及與周圍神經(jīng)血管的相互關(guān)系。對(duì)STA的起源、行程、分支等進(jìn)行觀測(cè)和必要的拍照。測(cè)量的指標(biāo)主要有：STA淺出點(diǎn)至發(fā)出額支處的距離,STA淺出點(diǎn)處外徑,STA發(fā)出額支處到腮腺上緣的距離,額支到眼外角點(diǎn)的距離,額支與STA主干所成角度,從額支起點(diǎn)至外眥上方轉(zhuǎn)折處之間的直線距離及實(shí)際血管長(zhǎng)度,顳淺動(dòng)脈頂支與主干所成的角度以及STA主干、額支、頂支的起始處外徑。同時(shí)從頜下緣開始顯露面動(dòng)脈到內(nèi)眥的全過程,展示它的走行、分支和終末部分以及面橫動(dòng)脈、眶下動(dòng)脈和眼動(dòng)脈的吻合關(guān)系。 2.模擬在同種異體顏面移植術(shù)中以STA主干為主要供養(yǎng)動(dòng)脈的供體復(fù)合瓣切取的手術(shù)過程,切取“供體”全面部皮瓣,并向其一側(cè)顳淺動(dòng)脈主干灌注亞甲藍(lán)注射液,觀察亞甲藍(lán)灌注范圍。3.采用經(jīng)福爾馬林固定的一個(gè)頭部標(biāo)本進(jìn)行面部淺層結(jié)構(gòu)的解剖,觀察面淺層血管、神經(jīng)、肌肉的分布、走行及其支配范圍。 研究結(jié)果： 1.STA主干淺出顳淺筋膜后分出額、頂二支。其中額支與STA主干向前上方走行。至外毗上方折向內(nèi)上走行。在額部,額支又分為額眶支和額頂支。額眶支行向前下方,分布于前額部皮膚,額頂支行向后上方。頂支從顳淺動(dòng)脈發(fā)出后與額支主干后行向后上方。面動(dòng)脈在嚼肌的前緣繞下頜骨下緣向上進(jìn)入面部,迂曲向上行進(jìn)至距口角外,然后上升至鼻翼基底,在沿鼻外側(cè)到達(dá)內(nèi)眥,延續(xù)為內(nèi)眥動(dòng)脈。面動(dòng)脈位于笑肌、顴大肌、顴小肌、提上唇肌、提上唇鼻翼肌的外側(cè)束的深面和下頜骨、頰肌、提口角肌的淺面。雙側(cè)面動(dòng)脈和顳淺動(dòng)脈在面部有廣泛的交通支。 2.從一側(cè)顳淺動(dòng)脈灌注亞甲藍(lán)后,發(fā)現(xiàn)亞甲藍(lán)從對(duì)側(cè)顳淺動(dòng)脈可以流出,切開對(duì)側(cè)皮膚后可見皮下組織出現(xiàn)點(diǎn)狀染色。被亞甲藍(lán)灌注的范圍包括灌注側(cè)顳部、顴部、頰部以及眶周以及對(duì)側(cè)顴部、顳部等。 研究結(jié)論： STA主干解剖位置恒定、粗大,并有足夠長(zhǎng)的血管蒂。其分支與面動(dòng)脈等血管有廣泛的吻合,吻合單側(cè)STA主干可保證大部分面部血供。用STA主干為蒂切取同種異體全面部皮瓣,具有操作簡(jiǎn)潔、迅速、安全、血供可靠的優(yōu)點(diǎn),值得在臨床應(yīng)用中推廣。
[Abstract]:Objectives of the study:By means of blood vessel perfusion and microdissection, we studied the main route of superficial temporal artery, Stella, facial artery of facial artery, the general range of branches and their branches, and dissected the superficial structure of the face.To provide anatomic basis for the clinical application of facial allograft transplantation.At the same time, the procedure of transposition of donor flap pedicled with superficial temporal artery was simulated and perfused to verify the feasibility of using STA trunk as pedicle during facial replacement.Research methods:1.The main STA trunk and its main branches were dissected from 3 adult head specimens infused with red latex, and the walking, starting, branching and interrelation with peripheral nerve and blood vessels were observed by Vernier caliper, straight ruler and protractor.Observe the origin, itinerary and branch of STA and take necessary photos.The main indexes measured were the distance from the point from the superficial to the frontal branch of the STA and the distance between the external diameter of the superficial point of the STA and the superior parotid gland, the distance between the frontal branch and the outer corner of the eye, and the angle between the frontal branch and the main STA trunk, the distance between the frontal branch and the upper parotid gland, the distance between the frontal branch and the outer corner of the eye.The distance between the frontal branch and the turning point of the lateral canthus and the actual vascular length, the angle between the parietal branch and the trunk of the superficial temporal artery, and the outer diameter of the starting point of the STA trunk, the frontal branch and the parietal branch.At the same time, the whole process of facial artery to inner canthus was exposed from the lower margin of the jaw, and the anastomosis of the transverse facial artery, the infraorbital artery and the ophthalmic artery was demonstrated.2.In facial allograft transplantation, the STA trunk was used as the main supporting artery of the donor complex flap. The "donor" total facial flap was removed, and methylene blue injection was infused into one side of the main trunk of the superficial temporal artery.The range of methylene blue perfusion was observed.A head specimen fixed by formalin was used to dissect the superficial facial structure and to observe the distribution of the superficial blood vessels, nerves and muscles, the movement and the innervation area of the facial superficial blood vessels, nerves and muscles.Results of the study:1.STA trunk shallowly emerged from the superficial temporal fascia and divided into forehead and parietal branches.The frontal branch and the STA trunk go forward and upward.Go up to the outer side.In the frontal part, the frontal branch is divided into the frontal orbital branch and the frontal parietal branch.The frontoorbital branch is located forward and lower in the skin of the forehead, and the frontopietal branch is located at the top of the forehead.The parietal branch from the superficial temporal artery and the frontal branch from the back to the top.The facial artery enters the face at the anterior edge of the masseter muscle around the lower margin of the mandible, detours up to the angle of mouth, then rises to the base of the nasal wing and reaches the medial canthus along the lateral side of the nose, and continues to be the medial canthus artery.The facial artery is located on the deep side of the lateral bundle of the muscle of laugh, zygomaticus major, zygomaticus minor, levator labialis, the lateral bundle of the muscle of levator nasi and the superficial surface of the mandibular, buccal and levator muscles.Bilateral arteries and superficial temporal arteries have extensive communicating branches on the face.2.After perfusing methylene blue from one side of superficial temporal artery, it was found that methylene blue could flow out from the contralateral superficial temporal artery.The range of methylene blue perfusion includes the temporal, zygomatic, buccal, periorbital and contralateral zygomatic and temporal regions.The study concluded that:The anatomical position of STA trunk is constant, thick, and has long enough vascular pedicle.Its branches are widely anastomosed with facial artery and other vessels. Anastomosis of unilateral STA trunk can guarantee the majority of facial blood supply.Using STA trunk as pedicle to cut allogeneic total facial flap has the advantages of simple operation, rapid operation, safety and reliable blood supply, which is worth popularizing in clinical application.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R622;R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳江萍;宋建星;邢新;張明利;;應(yīng)用改良菱形皮瓣修復(fù)面部皮膚缺損[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2006年12期

2 魯開化,郭樹忠,艾玉峰,韓巖,馬顯杰,潘寶華,周智,雷永紅;皮膚擴(kuò)張術(shù)20年臨床應(yīng)用的回顧[J];中國實(shí)用美容整形外科雜志;2005年04期

3 張恒術(shù);任海濤;沈?yàn)槊?果磊;;鼻端缺損的四種修復(fù)方法比較[J];中國實(shí)用美容整形外科雜志;2005年06期

4 陶革方;黃衛(wèi)平;阮晨曦;李偉紅;;鼻唇溝皮瓣的臨床應(yīng)用——附56例報(bào)告[J];中國美容整形外科雜志;2006年04期

5 于立新,裴國獻(xiàn),顧立強(qiáng),朱立軍;異體手移植的免疫抑制治療[J];中國創(chuàng)傷骨科雜志;2000年02期

6 宋業(yè)光;謝洋春;嚴(yán)義坪;;現(xiàn)代面部除皺術(shù)的面神經(jīng)解剖學(xué)研究[J];中華整形燒傷外科雜志;1999年01期

7 賀友生;李朝暉;潘乃j;李耀峰;鄭守練;;全頭皮撕脫成功再植一例[J];中華顯微外科雜志;2006年01期

8 姜會(huì)慶,胡心寶,李幼生,汪涌,李元新,汪軍,洪志堅(jiān),解偉光,陳一飛,黎介壽;同種異體頭皮、面頸部和雙耳廓復(fù)合組織移植術(shù)[J];中華整形外科雜志;2003年06期

9 潘寶華,艾玉峰,魯開化,郭樹忠,夏煒,韓巖,馬顯杰,張琳西;顳頰部擴(kuò)張皮瓣的手術(shù)設(shè)計(jì)[J];中華整形外科雜志;2004年04期

10 鄭勝武;李青峰;姜浩;顧斌;王會(huì)勇;鄭丹寧;劉琴秀;昝濤;湯璐佳;李玉萍;謝蕓;陳瑜;張滌生;;犬頭面部復(fù)合組織同種異體移植模型的建立[J];中華整形外科雜志;2006年04期

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