大腦中動脈M1段的顯微解剖研究及臨床意義
發(fā)布時間：2018-10-30 14:26
【摘要】： 目的:研究大腦中動脈M1段的顯微解剖結(jié)構(gòu)、M1分叉部的體表投影及不同頭位下M1分叉部與側(cè)裂淺表靜脈的關(guān)系,為經(jīng)側(cè)裂入路手術(shù)提供參考數(shù)據(jù)及空間量化概念。 方法:在30側(cè)(15例)用福爾馬林溶液固定的濕性成人頭顱標(biāo)本上,用紅色乳膠灌注雙側(cè)頸內(nèi)動脈和椎動脈,分別左右翼點入路開顱,在顯微鏡下對大腦中動脈M1段進行顯微解剖,分別測量M1中點水平至蝶池前壁距離,M1段的長度和直徑,M1段中央支和皮質(zhì)支的支數(shù)及分支類型,觀察M1段的變異情況。在標(biāo)本上確定坐標(biāo)軸,即以眶下緣至外耳門上緣的水平線為X軸、通過外耳門前緣并與X軸垂直的線為Y軸(X軸上方為正,下方為負;Y軸前方為正,后方為負),測量M1分叉部在此坐標(biāo)系投影的數(shù)值。觀測不同頭位下M1分叉部和側(cè)裂淺表靜脈的關(guān)系,并測量M1分叉部與側(cè)裂淺表靜脈之間的垂直距離。所得數(shù)據(jù)用SPSS16.0軟件進行統(tǒng)計分析。 結(jié)果:大腦中動脈M1段位于蝶池中,大部份低于碟骨嵴的水平,部份平于碟骨嵴,M1段中點水平至池的前壁距離左側(cè):3.94士0.36mm,右側(cè):3.91士0.23mm,M1段長度左側(cè):18.30士3.06mm,右側(cè):18.01士2.44mm,直徑左側(cè):3.60士0.49mm,右側(cè):3.57士0.50mm。M1段發(fā)出的分支分為中央支和皮質(zhì)支,中央支支數(shù)左側(cè):8.27士2.49支,右側(cè):7.67士2.35支,共發(fā)出21支皮質(zhì)支,其中顳極動脈為12支(占57.14%),顳前動脈為5支(占23.81%),額眶動脈和額前動脈各2支(各占9.52%),M1段雙干型26例(占86.67%),三干型4例(占13.33%),未發(fā)現(xiàn)單干型,1例M1段存在變異為復(fù)型大腦中動脈,占3.33%,未發(fā)現(xiàn)副大腦中動脈。M1分叉部投影為左側(cè)X值:26.56士3.03mm、Y值:46.71士4.24mm,右側(cè)X值:27.03士2.92mm、Y值:45.48士4.20mm。尸頭向?qū)?cè)旋轉(zhuǎn)30°時,M1分叉部均在側(cè)裂淺表靜脈的額側(cè),旋轉(zhuǎn)60°時左側(cè)4例,右側(cè)5例M1分叉部位于側(cè)裂淺表靜脈的額側(cè),其余均在側(cè)裂淺表靜脈的下方。M1分叉部與側(cè)裂淺表靜脈之間的垂直距離左側(cè):14.60士2.27mm,右側(cè):15.03士2.36mm。 結(jié)論:1大腦中動脈M1段在蝶池的近后壁處行走,M1中點水平至蝶池前壁的距離為左側(cè):3.94士0.36mm,右側(cè):3.91士0.23mm,M1段分支類型多變,因此在分離蝶池時應(yīng)盡量靠近池腔的前壁,術(shù)中應(yīng)仔細觀察避免損傷。2 M1段真正分叉總在島閾的最高處,在以X=25.0mm、Y=45.0mm為圓心,10mm為半徑畫成圓的范圍內(nèi)共有M1分叉部的投影27例,占90.00%。3 M1分叉部與側(cè)裂淺表靜脈之間的關(guān)系和頭位密切相關(guān),尸頭向?qū)?cè)旋轉(zhuǎn)30°時,M1分叉部均在側(cè)裂淺表靜脈的額側(cè),旋轉(zhuǎn)60°時9例M1分叉部位于側(cè)裂淺表靜脈的額側(cè),21例在側(cè)裂淺表靜脈的下方。
[Abstract]:Objective: to study the microanatomical structure of M1 segment of middle cerebral artery, the surface projection of M1 bifurcation and the relationship between M1 bifurcation and superficial vein of lateral fissure under different head positions, so as to provide reference data and spatial quantification concept for translateral fissure approach. Methods: in 30 cases (15 cases) of wet adult skull fixed with formalin solution, the bilateral internal carotid artery and vertebral artery were infused with red latex, and the left and right pterygoid point approach was used to open the craniotomy, respectively. The M1 segment of the middle cerebral artery was dissected under microscope. The distance from the midpoint of M1 to the anterior wall of sphenoid cistern, the length and diameter of M1 segment, the number and type of branches of the central and cortical branches of M1 segment were measured, and the variation of M1 segment was observed. The coordinate axis is determined on the specimen, that is, the horizontal line from the lower orbital margin to the superior edge of the outer ear door is the X axis, and the line passing through the anterior edge of the outer ear door and perpendicular to the X axis is the Y axis (positive above the X axis and negative below the X axis). The Y axis is positive in front and negative in the rear). The value of M1 bifurcation projection in this coordinate system is measured. The relationship between M1 bifurcation and superficial vein of lateral fissure was observed under different head positions, and the vertical distance between M1 bifurcation and superficial vein of lateral fissure was measured. The data were analyzed by SPSS16.0 software. Results: the M1 segment of the middle cerebral artery was located in the sphenoid cistern, most of which was lower than the level of the disc crest. The distance from the middle point of the M1 segment to the anterior wall of the cistern was 3.94 鹵0.36 mm on the left side, and 3.91 鹵0.23 mm on the right side. The left side of M1 segment: 18.30 鹵3.06 mm, the right side 18.01 鹵2.44 mm, the left side 3.60 鹵0.49 mm in diameter, the right side: 3.57 鹵3.57 鹵0.50mm.M1, the branches are divided into central branch and cortical branch. The number of central branches was 8.27 鹵2.49 on the left and 7.67 鹵2.35 on the right. 21 branches of cortex were produced, including 12 of the temporal polar artery (57.14%) and 5 of the anterior temporal artery (23.81%). There were two branches of frontoorbital artery and anterior frontal artery (9.52% each), 26 cases (86.67%) of double trunk type in M1 segment and 4 cases (13.33%) of third trunk type. The accessory middle cerebral artery (M1) was projected to the left side X value: 26.56 鹵3.03mm Y value: 46.71 鹵4.24mm, right side X value: 27.03 鹵2.92mm Y value: 45.48 鹵4.20mm. When the head rotated to the opposite side 30 擄, the M1 bifurcation was located on the frontal side of the superficial vein of the lateral fissure, 4 cases on the left side at 60 擄rotation, and 5 cases on the frontal side of the superficial vein of the lateral fissure on the right side. The rest were below the superficial veins of the lateral fissure. The vertical distance between M1 bifurcation and superficial veins was 14.60 鹵2.27 mm on the left side and 15.03 鹵2.36 mm on the right side. Conclusion: 1 the M1 segment of the middle cerebral artery walks near the posterior wall of the sphenoid cistern. The distance from the midpoint of M1 to the anterior wall of the sphenoid cistern is 3.94 鹵0.36 mm on the left side and 3.91 鹵0.23 mm on the right side. Therefore, the sphenoid cistern should be separated as close as possible to the anterior wall of the cistern cavity, and the injury should be carefully observed during the operation. 2 the true bifurcation of M1 segment is always at the highest point of the island threshold, and the center of the sphenoid cistern is 45.0mm. There were 27 cases of M1 bifurcation projection within the radius of 10mm, accounting for 90.00.3 cases. The relationship between M1 bifurcation part and superficial vein of lateral fissure was closely related to the head position. When the head of the corpse rotated to the opposite side 30 擄, there was a close relationship between the projection of M1 bifurcation part and the superficial vein of lateral fissure. The M1 bifurcation was located on the frontal side of the superficial vein of the lateral fissure. In the 60 擄rotation, the M1 bifurcation was located on the frontal side of the superficial vein of the lateral fissure and 21 cases under the superficial vein of the lateral fissure.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R651;R322
本文編號：2300259
[Abstract]:Objective: to study the microanatomical structure of M1 segment of middle cerebral artery, the surface projection of M1 bifurcation and the relationship between M1 bifurcation and superficial vein of lateral fissure under different head positions, so as to provide reference data and spatial quantification concept for translateral fissure approach. Methods: in 30 cases (15 cases) of wet adult skull fixed with formalin solution, the bilateral internal carotid artery and vertebral artery were infused with red latex, and the left and right pterygoid point approach was used to open the craniotomy, respectively. The M1 segment of the middle cerebral artery was dissected under microscope. The distance from the midpoint of M1 to the anterior wall of sphenoid cistern, the length and diameter of M1 segment, the number and type of branches of the central and cortical branches of M1 segment were measured, and the variation of M1 segment was observed. The coordinate axis is determined on the specimen, that is, the horizontal line from the lower orbital margin to the superior edge of the outer ear door is the X axis, and the line passing through the anterior edge of the outer ear door and perpendicular to the X axis is the Y axis (positive above the X axis and negative below the X axis). The Y axis is positive in front and negative in the rear). The value of M1 bifurcation projection in this coordinate system is measured. The relationship between M1 bifurcation and superficial vein of lateral fissure was observed under different head positions, and the vertical distance between M1 bifurcation and superficial vein of lateral fissure was measured. The data were analyzed by SPSS16.0 software. Results: the M1 segment of the middle cerebral artery was located in the sphenoid cistern, most of which was lower than the level of the disc crest. The distance from the middle point of the M1 segment to the anterior wall of the cistern was 3.94 鹵0.36 mm on the left side, and 3.91 鹵0.23 mm on the right side. The left side of M1 segment: 18.30 鹵3.06 mm, the right side 18.01 鹵2.44 mm, the left side 3.60 鹵0.49 mm in diameter, the right side: 3.57 鹵3.57 鹵0.50mm.M1, the branches are divided into central branch and cortical branch. The number of central branches was 8.27 鹵2.49 on the left and 7.67 鹵2.35 on the right. 21 branches of cortex were produced, including 12 of the temporal polar artery (57.14%) and 5 of the anterior temporal artery (23.81%). There were two branches of frontoorbital artery and anterior frontal artery (9.52% each), 26 cases (86.67%) of double trunk type in M1 segment and 4 cases (13.33%) of third trunk type. The accessory middle cerebral artery (M1) was projected to the left side X value: 26.56 鹵3.03mm Y value: 46.71 鹵4.24mm, right side X value: 27.03 鹵2.92mm Y value: 45.48 鹵4.20mm. When the head rotated to the opposite side 30 擄, the M1 bifurcation was located on the frontal side of the superficial vein of the lateral fissure, 4 cases on the left side at 60 擄rotation, and 5 cases on the frontal side of the superficial vein of the lateral fissure on the right side. The rest were below the superficial veins of the lateral fissure. The vertical distance between M1 bifurcation and superficial veins was 14.60 鹵2.27 mm on the left side and 15.03 鹵2.36 mm on the right side. Conclusion: 1 the M1 segment of the middle cerebral artery walks near the posterior wall of the sphenoid cistern. The distance from the midpoint of M1 to the anterior wall of the sphenoid cistern is 3.94 鹵0.36 mm on the left side and 3.91 鹵0.23 mm on the right side. Therefore, the sphenoid cistern should be separated as close as possible to the anterior wall of the cistern cavity, and the injury should be carefully observed during the operation. 2 the true bifurcation of M1 segment is always at the highest point of the island threshold, and the center of the sphenoid cistern is 45.0mm. There were 27 cases of M1 bifurcation projection within the radius of 10mm, accounting for 90.00.3 cases. The relationship between M1 bifurcation part and superficial vein of lateral fissure was closely related to the head position. When the head of the corpse rotated to the opposite side 30 擄, there was a close relationship between the projection of M1 bifurcation part and the superficial vein of lateral fissure. The M1 bifurcation was located on the frontal side of the superficial vein of the lateral fissure. In the 60 擄rotation, the M1 bifurcation was located on the frontal side of the superficial vein of the lateral fissure and 21 cases under the superficial vein of the lateral fissure.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R651;R322
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