發(fā)布時(shí)間：2018-06-25 21:49

  本文選題：視神經(jīng)管 + 顯微外科解剖　； 參考：《吉林大學(xué)》2009年碩士論文

【摘要】： 顱眶交界區(qū)內(nèi)走行的神經(jīng)血管多,是顱底疾病治療中最復(fù)雜的區(qū)域之一,近幾年以來(lái)隨著對(duì)顱底顯微解剖更清晰的認(rèn)識(shí)及顯微技術(shù)的日益發(fā)展成熟,顱眶交界區(qū)疾病的治療研究已成為神經(jīng)外科界重點(diǎn)和熱點(diǎn)課題。隨著交通事故及跌落傷的增多,外傷性視神經(jīng)病的發(fā)病率也有逐年增加趨勢(shì),各家醫(yī)療單位對(duì)外傷性視神經(jīng)病的治療方面進(jìn)行了不少探索與研究,取得了可喜的成就,但治療方法及療效方面仍有很多爭(zhēng)議點(diǎn)和不明之處。因此,為了更好地了解和掌握該區(qū)域顯微解剖關(guān)系,同時(shí)為臨床治療提供有價(jià)值的參考依據(jù),我們對(duì)5例用10%福爾馬林充分固定的國(guó)人成人尸頭濕標(biāo)本及5例國(guó)人成人顱骨干標(biāo)本共10例,進(jìn)行了視神經(jīng)管相關(guān)結(jié)構(gòu)的顯微解剖研究;對(duì)18例視神經(jīng)管骨折病人進(jìn)行視神經(jīng)管三維CT重建行視神經(jīng)管相關(guān)數(shù)據(jù)測(cè)量;同時(shí)對(duì)外傷性視神經(jīng)損傷典型病人進(jìn)行分析及對(duì)一例交通事故死亡病人進(jìn)行尸體解剖,取部分損傷的視神經(jīng)進(jìn)行病理檢查分析,目的在于進(jìn)一步探討外傷性視神經(jīng)病的視神經(jīng)損傷機(jī)制及治療方案。 結(jié)論:1、視神經(jīng)管存在兩個(gè)相對(duì)狹窄部位,即視神經(jīng)管中部及視環(huán)部,而中部最狹窄;視神經(jīng)管越長(zhǎng)其管徑越細(xì),越短則管徑越粗,視神經(jīng)鞘膜與視神經(jīng)管上壁粘連較重,管內(nèi)段視神經(jīng)從眶口到顱口逐漸增粗等特點(diǎn)。2、眼動(dòng)脈走行于視神經(jīng)下方的神經(jīng)鞘膜層內(nèi),并發(fā)出鞘動(dòng)脈供應(yīng)眶內(nèi)神經(jīng),鞘動(dòng)脈分支形成硬膜血管網(wǎng)與軟膜血管網(wǎng),垂直進(jìn)入視神經(jīng);眼動(dòng)脈及分支血管的解剖特點(diǎn)是視神經(jīng)間接損傷的解剖基礎(chǔ)。掌握眼動(dòng)脈及其走行特點(diǎn)為前床突磨除進(jìn)行視神經(jīng)管減壓及巨大眼動(dòng)脈動(dòng)脈瘤夾閉術(shù)中,磨除前床突提供參考依據(jù)。3、由于個(gè)體差異的存在,臨床工作中應(yīng)重視視神經(jīng)管相關(guān)結(jié)構(gòu)的解剖變異。4、前床突尖至頸內(nèi)動(dòng)脈溝上緣中點(diǎn)距離的測(cè)量,為視神經(jīng)管減壓術(shù)中進(jìn)行外側(cè)壁磨除時(shí)避免頸內(nèi)動(dòng)脈損傷提供可靠的參考數(shù)據(jù)。5、對(duì)視神經(jīng)管骨折病人進(jìn)行CT三維重建及視神經(jīng)管各壁進(jìn)行測(cè)量后,提高了診斷率,更加準(zhǔn)確把握視神經(jīng)管減壓的充分性,對(duì)術(shù)者有指導(dǎo)性意義。6、經(jīng)顱入路視神經(jīng)管減壓術(shù)有如下優(yōu)點(diǎn):視野開闊,可以廣泛磨除視神經(jīng)管各壁,達(dá)到視神經(jīng)管進(jìn)行充分減壓的目的;視神經(jīng)鞘切開時(shí)在視神經(jīng)鞘上方進(jìn)行,切開鞘膜時(shí)不易傷及眼動(dòng)脈及分支;對(duì)于合并有腦挫裂傷及顱內(nèi)血腫的病人可進(jìn)行挫裂腦組織及血腫清除,此優(yōu)點(diǎn)是顱外入路的術(shù)式無(wú)法完成的。7、尸檢病人觀察結(jié)論:該患者切開鐮狀韌帶后未見明顯視神經(jīng)被切割性損傷痕跡,因此鐮狀韌帶切割性損傷機(jī)制在今后的臨床工作中需進(jìn)一步觀察;切除前床突后管內(nèi)段視神經(jīng)完全顯露于視野下,證實(shí)了經(jīng)顱視神經(jīng)管減壓術(shù)中充分切除外側(cè)壁減壓的重要性;病理結(jié)果為:視神經(jīng)水腫,神經(jīng)細(xì)胞變性壞死,神經(jīng)纖維消失,雪旺氏細(xì)胞增生性改變等與既往文獻(xiàn)報(bào)告的損傷機(jī)制相似,證實(shí)了視神經(jīng)變性壞死的損傷機(jī)制;該患者視神經(jīng)損傷嚴(yán)重,缺血壞死神經(jīng)纖維消失,提示在臨床工作中,光感消失的特重型視神經(jīng)損傷病人進(jìn)行視神經(jīng)管減壓,是否達(dá)到挽救視力的目的,需進(jìn)一步研究與探索。
[Abstract]:The Craniorbital boundary area is one of the most complex areas in the treatment of skull base diseases. In recent years, with the more clear understanding of the microanatomy of the skull base and the growing maturity of microtechnology, the treatment of the craniofacial junction diseases has become the key and hot topic in the Department of neurosurgery. With traffic accidents and falls The incidence of traumatic optic neuropathy is also increasing year by year. There are many explorations and studies on the treatment of external traumatic optic neuropathy in various medical units, which have made gratifying achievements, but there are still many disputed points and unidentified places in the treatment and curative effect. Therefore, in order to better understand and master the area 5 cases of adult cadaver head wet specimens of 10% formalin and 5 adult cadaver cranial diaphysis specimens from 5 Chinese adult cadavers were given a microanatomical study of the optic canal related structures, and 18 cases of optic canal fractures were performed in 18 cases of optic canal fractures. The data of optic canal related data were measured by T reconstruction. At the same time, the typical patients with traumatic optic nerve injury were analyzed and the autopsy of a case of fatal patients with traffic accidents was dissected and the optic nerve of partial injury was taken for pathological examination. The purpose was to further explore the mechanism and treatment of optic nerve injury of traumatic optic neuropathy.
Conclusions: 1, there are two relatively narrow parts of the optic canal, that is, the central of the optic canal and the optic ring, and the middle of the optic canal, the narrowest in the middle, the longer the diameter of the optic canal, the shorter the diameter of the tube, the thicker the diameter of the tube, the thicker the adhesion of the optic nerve sheath and the superior wall of the optic canal, and the gradual thickening of the optic nerve from the orbital to the cranial mouth, and the ophthalmic artery walks in the optic nerve. The intraorbital nerve is supplied by the sheath artery in the underneath, and the intraorbital nerve is supplied by the sheath artery. The branches of the sheath form the epidural vascular network and the soft membrane network to enter the optic nerve vertically; the anatomical features of the ophthalmic and branch vessels are the anatomical basis of the indirect injury of the optic nerve. In the operation of giant ocular artery aneurysm,.3 is provided for the removal of the anterior bed process. Due to the existence of individual differences, attention should be paid to the measurement of the anatomical variation of the optic canal related structure,.4, the point of the anterior tip of the anterior bed to the middle of the superior neck of the internal carotid artery, and to avoid the internal carotid artery loss during the decompression of the lateral wall during the decompression of the optic canal. The injury provides a reliable reference data.5. After the CT three-dimensional reconstruction of the optic canal fracture and the measurement of the wall of the optic canal, the diagnostic rate is improved, the adequacy of the decompression of the optic canal is more accurately grasped and the operator has the guiding significance.6. The transcranial approach to optic canal decompression has the following advantages: open field of vision and extensive wear and removal. All the walls of the nerve canal can be fully decompressed of the optic canal; the optic nerve sheath is open above the optic nerve sheath over the optic sheath and does not easily hurt the ophthalmic arteries and branches when incision of the sheath; for the patients with cerebral contusion and intracranial hematoma, the brain tissue and hematoma can be removed, and this advantage is the.7 that can not be completed by extracranial approach. The results of autopsy patients: there is no obvious trace of cleavage of optic nerve after the incision of the sickle ligament, so the mechanism of the cleavage of the sickle ligament should be further observed in the future clinical work. The optic nerve in the posterior canal of the anterior bed process is fully exposed to the visual field, which confirms the full excision of the cranial optic canal decompression. The importance of lateral wall decompression, pathological results: optic edema, degeneration and necrosis of nerve cells, disappearance of nerve fibers, the proliferation of Schwann cells, similar to previous reports of damage mechanism, confirmed the mechanism of optic nerve degeneration and necrosis. In clinical work, the patients with severe optic nerve injury with light perception disappeared, and the decompression of optic canal has reached the goal of saving eyesight. Further research and exploration are needed.
【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】：2009
【分類號(hào)】：R322;R651

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