本文選題：鼻再造術 + 滑車上動脈��； 參考：《南京醫(yī)科大學》2008年碩士論文

【摘要】： 目的 通過對滑車上動脈的解剖研究,觀察該血管的走行特點明確其與皮膚和額肌的層次關系。據(jù)此設計少攜帶額肌的改良前額旁正中皮瓣,并行鼻再造術。 方法 對7具成人尸體前額部標本(12側(cè)滑車上動脈)進行解剖,以眶上緣和前正中線為參考點分別記錄滑車上動脈的發(fā)出點位置、管徑、長度、走行過程中與額肌及皮膚的層次關系、分支情況以及與眶上動脈、顳淺動脈額支的吻合情況。根據(jù)解剖結果,在臨床上設計僅蒂部帶少量額肌的改良前額旁正中皮瓣行鼻再造術,術中觀察滑車上動脈走行層次、皮瓣存活情況,術后隨訪再造鼻色澤、外形,鼻翼、鼻尖、鼻小柱等情況及患者對再造鼻的滿意度。 結果 12側(cè)滑車上動脈均由滑車上切跡發(fā)出,發(fā)出點距前正中線(1.33±0.14)cm,發(fā)出點血管外徑為(1.28±0.22)mm,主干與眶上緣水平成角約82度向內(nèi)上方行走,全長(5.98±0.64)cm。以眶上緣水平和眶上緣水平上(0.93±0.23)cm為界限,自發(fā)出點至血管終點,其主干走行可分為三段:第一段自發(fā)出點至眶上緣水平,滑車上動脈行于眼輪匝肌與皺眉肌之間;第二段自眶上緣水平至眶上緣水平上(0.93±0.23)cm,滑車上動脈在距前正中線(1.21±0.15)cm的眶上緣水平,穿越額肌,緊貼額肌表面走行;第三段自眶上緣水平上(0.93±0.23)cm至終點,滑車上動脈淺行于淺層皮下,并逐漸淺出至皮內(nèi)。5具尸體(8側(cè))滑車上動脈于眶上緣水平上(1.26±0.20)cm向外上發(fā)出分支行于皮下水平。兩側(cè)滑車上動脈之間及滑車上動脈與同側(cè)眶上動脈、顳淺動脈額支有廣泛交通吻合。額肌內(nèi)沒有發(fā)現(xiàn)明顯軸形走行的滑車上動脈肌支血管。臨床運用改良前額旁正中皮瓣行鼻再造術3例,術中發(fā)現(xiàn)前額皮下存在軸形走向的滑車上動脈屬支,皮瓣色澤皮溫正常無血運障礙,術后皮瓣全部存活2例,有1例出現(xiàn)皮瓣周邊少量壞死,換藥后自愈。術后隨訪6-9月皮瓣無攣縮,色澤正常,鼻背、鼻翼、鼻尖、鼻小柱形態(tài)厚度接近正常,鼻側(cè)壁不臃腫,患者對手術效果滿意。 結論 滑車上動脈自眶上緣水平穿出額肌,以主干形式走行于皮下組織與額肌層之間,漸行漸淺,沿途發(fā)出短小肌支和皮支分別營養(yǎng)額肌與前額皮膚。因而可以設計僅蒂部帶少量額肌的前額旁正中皮瓣行鼻再造術以達到使再造鼻更符合美學標準,前額供區(qū)損傷更小的目的。
[Abstract]:Objective to observe the characteristics of superior trochlear artery (SCA) and its relationship with skin and frontal muscle. Based on this, a modified paraphalar median flap with little frontal muscle was designed and nasal reconstruction was performed. Methods Seven adult cadavers were dissected from the frontal part (12 superior trochlear arteries). The location, diameter and length of the superior trochlear artery were recorded with the superior orbital margin and the anterior median line as reference points. The hierarchical relationship with the frontal muscle and skin, the branches and the anastomosis with the superior orbital artery and the frontal branch of the superficial temporal artery. According to the anatomical results, a modified paraphalar median flap with only a small amount of frontal muscle pedicle was designed in clinic to perform nasal reconstruction. The level of superior trochlear artery, the survival of the flap, and the color, shape, alar, tip of the nose were observed during the operation. Nasal column and patients' satisfaction with reconstructed nose. Results all the superior trochlear arteries were generated from the superior notch of the trochlear, and the point was (1.33 鹵0.14) cm from the anterior median line. The external diameter of the issuing point was (1.28 鹵0.22) mm. The lateral angle between the main trunk and the superior orbital margin was 82 degrees and the total length was (5.98 鹵0.64) cm. At the level of (0.93 鹵0.23) cm above the supraorbital margin and the level of the supraorbital margin, the main trunk can be divided into three sections: the first spontaneous exiting point to the supraorbital margin, the superior trochlear artery between the orbicularis oculi muscle and the frowning muscle; The second segment was from the supraorbital margin to the supraorbital margin (0.93 鹵0.23) cm. The superior trochlear artery traverses the frontalis muscle at the level of (1.21 鹵0.15) cm from the anterior median line to the surface of the frontalis, and the third segment runs from (0.93 鹵0.23) cm above the superior orbital margin to the end point. The superior trochlear artery was shallowly located in the superficial subcutaneous layer, and gradually shallowened to the level of (1.26 鹵0.20) cm above the supraorbital margin of the superior trochlear artery in 5 cadavers (8 sides). Bilateral superior trochlear artery and superior trochlear artery were anastomosed with ipsilateral superior orbital artery and frontal branch of superficial temporal artery. There were no obvious axial-shaped superior trochlear artery branches found in the frontal muscle. Three cases of nasal reconstruction were performed with the modified paraphalar median flap. It was found that there was a branch of superior trochlear artery in the subcutaneous region of the forehead. The skin temperature of the flap was normal and the skin temperature of the flap was normal, and the flap survived in 2 cases. There was a small amount of necrosis around the flap in 1 case, and self-healing after dressing change. After 6-9 months follow up, the skin flap had no contracture, normal color, nasal dorsal, nasal wing, nasal tip, nasal column shape thickness close to normal, nasal lateral wall is not bloated, patients are satisfied with the operation results. Conclusion the superior trochlear artery passes through the frontal muscle from the supraorbital margin horizontally and runs in the form of trunk between the subcutaneous tissue and the frontal muscle layer, and gradually shrunk. Along the way, the frontalis muscle branch and the cutaneous branch of the trochlear artery are fed with the frontal muscle and the forehead skin, respectively. Therefore, we can design a paraphoral median flap with only a small number of frontal muscles in pedicle to perform nasal reconstruction to make the reconstructed nose more in line with the aesthetic standard and to reduce the injury of the prefrontal donor area.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R322;R765.9

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