眼外肌Pulley結(jié)構(gòu)的解剖學(xué)和影像學(xué)觀察
發(fā)布時(shí)間：2018-08-09 07:26
【摘要】： 目的意義:探討眼外肌Pulley結(jié)構(gòu)解剖學(xué)基礎(chǔ)及pulley理論在臨床眼肌疾病診治中的應(yīng)用。 實(shí)驗(yàn)方法:Pulley結(jié)構(gòu)的解剖學(xué)觀察:用骨剪打開眶壁,分離并除去眶內(nèi)骨膜和脂肪,仔細(xì)解剖出眼外肌,小心沿每條眼外肌肌腹向前分離至眼球及眼外肌表面的Tenon氏囊游離緣。仔細(xì)剝離和清除Pulley結(jié)構(gòu)周圍的結(jié)締組織,測(cè)量Pulley結(jié)構(gòu)從鞏膜附著點(diǎn)至Pulley的長(zhǎng)度并記錄。將pulley組織塊取下放入4%多聚甲醛液中固定2小時(shí),作石蠟切片,HE染色,Masson三色染色和F-actin染色,證實(shí)pulley組織結(jié)構(gòu)。Pulley結(jié)構(gòu)的影像學(xué)觀察:健康志愿者6名年齡24～37歲,平均29.5歲,無跟球震顫和眼球運(yùn)動(dòng)障礙.對(duì)受檢者原在位和第二限位共5個(gè)注視點(diǎn)進(jìn)行MRI水平位,矢狀位,冠狀位掃描。在掃描圖片上對(duì)pulley結(jié)果進(jìn)行觀察和分析。 結(jié)果:解剖觀察到,在直肌穿過Tenon氏囊的部位,Tenon氏囊的結(jié)締組織筋膜反折增厚,非常緊密地附著在眼外肌表面,不易與眼外肌剝離,此結(jié)構(gòu)就是Pulley。Pulley結(jié)構(gòu)在內(nèi)直肌與下直肌之間和外直肌與上直肌之間結(jié)締組織相對(duì)增厚,而在上直肌與內(nèi)直肌之間以及下直肌與外直肌之間結(jié)締組織相對(duì)薄弱。通過H-E染色,Masson三色染色以及F-actin染色證明Pulley結(jié)構(gòu)主要由大量膠原纖維和少量平滑肌組成。MRI掃描動(dòng)態(tài)觀察到:兩眼平視前方位時(shí),內(nèi)外直肌與眼方位一至,當(dāng)眼向左斜視時(shí),左側(cè)的內(nèi)直肌和右側(cè)的外直肌與眼的方位之間出現(xiàn)了一個(gè)角度,即急拐彎現(xiàn)象。眼向右斜視時(shí)也出現(xiàn)了與左側(cè)相同的情況。 結(jié)論: 1、眼外肌近眼球端有一致密結(jié)締組織纖維包繞,并相互連結(jié)形成一個(gè)完整結(jié)締組織鞘,鞘的后緣位于眼球后極與赤道平面之間。此結(jié)構(gòu)則是Pulley結(jié)構(gòu)。 2、MRI動(dòng)態(tài)掃描表明眼外肌確實(shí)存在Pulley結(jié)構(gòu)樣功能,并急拐彎處與本文觀察到的結(jié)締組織鞘后緣一致,而與眶壁相連的纖維節(jié)制韌帶存在于鞏膜前緣平面與中緯線平面之間。因此原認(rèn)為Pulley結(jié)構(gòu)是點(diǎn)作用或纖維滑車作用應(yīng)修正為Pulley作用是由眼外肌完整纖維結(jié)締組織鞘整體作用的結(jié)果。
[Abstract]:Objective: to explore the anatomical basis of Pulley structure of extraocular muscles and the application of pulley theory in the diagnosis and treatment of ocular muscle diseases. Methods Anatomical observation of Pulley's structure: opening the orbital wall with bone scissors, separating and removing the intraorbital periosteum and fat, carefully dissecting the extraocular muscle and carefully dissecting the extraocular muscle, and carefully dissecting the free edge of the Tenon's sac along the abdomen of each extraocular muscle to the eyeball and the surface of the extraocular muscle. The connective tissue around the Pulley structure was carefully stripped and removed, and the length of the Pulley structure from the scleral attachment point to the Pulley was measured and recorded. The pulley tissue mass was removed and put into 4% paraformaldehyde solution for 2 hours. The paraffin sections were stained with HE staining and F-actin staining. The imaging observation of pulley tissue structure and Pulley structure was confirmed: 6 healthy volunteers were 2437 years old with an average age of 29.5 years. No heel ball tremor or eye movement disorder. MRI horizontal, sagittal and coronal scans were performed on 5 fixation points. The pulley results were observed and analyzed on the scanning images. Results: anatomically, the connective tissue fascia of Tenon's sac was thickened at the place where rectus muscle passed through Tenon's sac. It was very closely attached to the surface of the extraocular muscle and could not easily be peeled off from the extraocular muscle. The connective tissue between the inner rectus and the inferior rectus and between the outer rectus and the superior rectus is thicker than that between the superior rectus and the medial rectus and the connective tissue between the inferior rectus and the external rectus is relatively weak. It was proved by H-E staining and F-actin staining that the structure of Pulley was mainly composed of a large number of collagen fibers and a small amount of smooth muscle. There is an angle between the left medial rectus and the right lateral rectus and eye azimuth. The same is true when the eye strabismus to the left. Conclusion: 1. There is a dense connective tissue fiber wrapped in the proximal end of the extraocular muscle and connected with each other to form a complete connective tissue sheath. The posterior edge of the sheath lies between the posterior pole of the eyeball and the equatorial plane. This structure is a Pulley structure. 2the dynamic scanning shows that the extraocular muscle does exist Pulley structure-like function, and the sharp curve is consistent with the posterior edge of connective tissue sheath observed in this paper. The fibrous abstinent ligament associated with the orbital wall exists between the anterior scleral plane and the central weft plane. Therefore, it was thought that the Pulley structure should be modified by the point action or fiber trochlea action to the effect of Pulley, which was the result of the whole function of connective tissue sheath of the complete fiber of the extraocular muscle.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R777.4;R322
本文編號(hào)：2173349
[Abstract]:Objective: to explore the anatomical basis of Pulley structure of extraocular muscles and the application of pulley theory in the diagnosis and treatment of ocular muscle diseases. Methods Anatomical observation of Pulley's structure: opening the orbital wall with bone scissors, separating and removing the intraorbital periosteum and fat, carefully dissecting the extraocular muscle and carefully dissecting the extraocular muscle, and carefully dissecting the free edge of the Tenon's sac along the abdomen of each extraocular muscle to the eyeball and the surface of the extraocular muscle. The connective tissue around the Pulley structure was carefully stripped and removed, and the length of the Pulley structure from the scleral attachment point to the Pulley was measured and recorded. The pulley tissue mass was removed and put into 4% paraformaldehyde solution for 2 hours. The paraffin sections were stained with HE staining and F-actin staining. The imaging observation of pulley tissue structure and Pulley structure was confirmed: 6 healthy volunteers were 2437 years old with an average age of 29.5 years. No heel ball tremor or eye movement disorder. MRI horizontal, sagittal and coronal scans were performed on 5 fixation points. The pulley results were observed and analyzed on the scanning images. Results: anatomically, the connective tissue fascia of Tenon's sac was thickened at the place where rectus muscle passed through Tenon's sac. It was very closely attached to the surface of the extraocular muscle and could not easily be peeled off from the extraocular muscle. The connective tissue between the inner rectus and the inferior rectus and between the outer rectus and the superior rectus is thicker than that between the superior rectus and the medial rectus and the connective tissue between the inferior rectus and the external rectus is relatively weak. It was proved by H-E staining and F-actin staining that the structure of Pulley was mainly composed of a large number of collagen fibers and a small amount of smooth muscle. There is an angle between the left medial rectus and the right lateral rectus and eye azimuth. The same is true when the eye strabismus to the left. Conclusion: 1. There is a dense connective tissue fiber wrapped in the proximal end of the extraocular muscle and connected with each other to form a complete connective tissue sheath. The posterior edge of the sheath lies between the posterior pole of the eyeball and the equatorial plane. This structure is a Pulley structure. 2the dynamic scanning shows that the extraocular muscle does exist Pulley structure-like function, and the sharp curve is consistent with the posterior edge of connective tissue sheath observed in this paper. The fibrous abstinent ligament associated with the orbital wall exists between the anterior scleral plane and the central weft plane. Therefore, it was thought that the Pulley structure should be modified by the point action or fiber trochlea action to the effect of Pulley, which was the result of the whole function of connective tissue sheath of the complete fiber of the extraocular muscle.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R777.4;R322
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相關(guān)期刊論文 前4條
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，本文編號(hào)：2173349
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