本文選題：視神經(jīng) + 視網(wǎng)膜中央動(dòng)脈　； 參考：《福建醫(yī)科大學(xué)》2008年碩士論文

【摘要】： 【目的】探討視覺假體微電極芯片植入視神經(jīng)的相對(duì)安全區(qū),為臨床視神經(jīng)手術(shù)提供解剖學(xué)依據(jù)。 【方法】30例成人頭顱標(biāo)本,動(dòng)脈灌注混有紅色染料的乳膠,觀測(cè)視神經(jīng)周圍主要血管、神經(jīng)的行程和外徑等數(shù)據(jù);4例新鮮成人頭顱標(biāo)本(動(dòng)脈灌注墨汁混合液),球后4～8mm視神經(jīng)連續(xù)切片,片厚20μm,顯微鏡觀察和Image Advanced 3.0測(cè)量神經(jīng)橫斷面中各象限血管斷面數(shù)和血管的總面積,并進(jìn)行統(tǒng)計(jì)學(xué)處理。 【結(jié)果】在眶外側(cè)可見外直肌上緣(3.83±1.43)mm處有淚腺動(dòng)脈和神經(jīng)與其伴行向前至淚腺。將外直肌向下牽引,顯露視神經(jīng),兩者之間的間隙稱為外直肌—視神經(jīng)間隙,其深度為(8.14±0.90)mm,主要有睫狀短神經(jīng)和顳側(cè)睫狀后動(dòng)脈等結(jié)構(gòu)穿行。在眶上方,可見眼動(dòng)脈多數(shù)起始于頸內(nèi)動(dòng)脈,視網(wǎng)膜中央動(dòng)脈由眼動(dòng)脈發(fā)出后主要經(jīng)下方穿入視神經(jīng),穿入處距球后(0.85±0.28)cm,其中距離≤4mm者19.2%,≥8mm者76.9%,球后6.5mm處穿入者3.9%。鞘動(dòng)脈穿入鞘膜的方位,內(nèi)側(cè)20%,上方29.3%,外側(cè)6.7%,下方44%。在球后與總腱環(huán)中點(diǎn)處,視神經(jīng)左右徑(3.96±0.35)mm,上下徑(4.18±0.33)mm。 在碳素墨汁混合液灌注的新鮮標(biāo)本上還觀察到,視神經(jīng)鞘上分布著豐富的血管網(wǎng),血管在鞘膜上大致呈前后縱向走行。取球后4～8mm段視神經(jīng)連續(xù)切片,顯微鏡下發(fā)現(xiàn),鞘膜的血管網(wǎng)向神經(jīng)實(shí)質(zhì)內(nèi)以近似直角的方式向中心發(fā)出許多小支,呈向心性走行。調(diào)整、校正后Image Advanced 3.0軟件分析視神經(jīng)實(shí)質(zhì)內(nèi)各象限血管斷面數(shù)和血管的總面積,小血管的斷面數(shù)為( 178.936±8.666 ) ,血管總面積為(0.001280±0.000035)mm2,各象限間無顯著差異。 【結(jié)論】 1、經(jīng)眶外側(cè)壁入路顯露視神經(jīng)的手術(shù)中,要注意保護(hù)外直肌上緣的淚腺動(dòng)脈和神經(jīng),以免影響淚腺的功能。暴露視神經(jīng)時(shí)需經(jīng)過外直肌—視神經(jīng)間隙,手術(shù)顯露視神經(jīng)時(shí)應(yīng)注意保護(hù)該間隙結(jié)構(gòu)。 2、在球后4～8mm間植入微電極芯片或進(jìn)行視神經(jīng)手術(shù)較為安全。 3、經(jīng)外側(cè)植入視覺假體微電極芯片或進(jìn)行其它視神經(jīng)手術(shù)可最大限度的減少對(duì)視神經(jīng)血供的影響。 4、視神經(jīng)外徑約4mm,視網(wǎng)膜中央動(dòng)脈在視神經(jīng)實(shí)質(zhì)中央呈前后縱向走行,微電極芯片最好沿神經(jīng)縱行植入,且植入深度不宜過深,以免影響視網(wǎng)膜血供。 5、因外傷或植入微電極芯片等原因造成視神經(jīng)缺血所致的神經(jīng)纖維受損不存在象限的差異。
[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 鹵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 鹵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 鹵0.28 cm from the posterior bulb. The distance 鈮，

本文編號(hào)：1993325