本文選題：耳再造 + 解剖學(xué)　； 參考：《北京協(xié)和醫(yī)學(xué)院》2013年博士論文

【摘要】：目的： 耳再造手術(shù)是整形外科中最具挑戰(zhàn)性的手術(shù)之一,術(shù)中所涉及的解剖區(qū)域包括顳區(qū)和乳突區(qū)。本研究通過(guò)解剖尸頭標(biāo)本,明確顳區(qū)、乳突區(qū)層次及神經(jīng)、血管分布和走行特點(diǎn),并討論其在手術(shù)中的應(yīng)用。 方法： 采用一般解剖學(xué)方法,對(duì)4例(8側(cè))尸頭標(biāo)本的顳區(qū)和乳突區(qū)進(jìn)行逐層解剖：1、由淺向深解剖顳區(qū)和乳突區(qū)的層次；2、解剖顳區(qū)和乳突區(qū)神經(jīng),觀察其走行和分布；3、解剖耳周肌肉分布情況及耳后肌供血血管；4、解剖顳淺動(dòng)脈、耳后動(dòng)脈及其分支,觀察耳后筋膜瓣中橫行血管的走行、數(shù)量及其于耳后筋膜瓣上的分布特點(diǎn)；5、測(cè)量耳后筋膜瓣的厚度及范圍。 結(jié)果： 1、顳區(qū)層次由淺至深為：皮膚、皮下淺筋膜脂肪層、顳淺筋膜層、筋膜下疏松結(jié)締組織層、顳深筋膜、顳肌、骨膜層；乳突區(qū)層次為：皮膚、皮下淺筋膜脂肪層、乳突淺筋膜層、筋膜下疏松結(jié)締組織層、深筋膜層、骨膜層。2、顳區(qū)神經(jīng)包括耳顳神經(jīng)、面神經(jīng)顳支,乳突區(qū)神經(jīng)包括耳大神經(jīng)和枕小神經(jīng)。3、顳淺筋膜和耳后筋膜存在豐富的血運(yùn),分別由顳淺動(dòng)脈和耳后動(dòng)脈供血。耳后動(dòng)脈于耳后區(qū)域向后方發(fā)出1-2條較粗的橫行分支,走行于耳后筋膜表面,其分布范圍約為8.8cm×5.95cm。4、耳后肌由耳后動(dòng)脈向后方發(fā)出的單支細(xì)小分支供血。5、耳后筋膜瓣上、中、下部的厚度分別為1.24±0.11mm、2.86±0.25mm和3.80±0.23mm。 結(jié)論： 耳廓再造手術(shù)中應(yīng)嚴(yán)格按解剖層次進(jìn)行操作,在形成筋膜瓣時(shí),應(yīng)保持解剖層次的連續(xù)性。術(shù)中使用耳后筋膜瓣包裹耳支架,具有形成方便、切口隱蔽、顱耳溝清晰等優(yōu)勢(shì),同時(shí)保留了顳淺筋膜的完整。在形成耳后筋膜瓣的過(guò)程中,可適當(dāng)保留一層較薄的皮下淺筋膜脂肪層,以保證筋膜瓣的血供,筋膜瓣下部可自其背側(cè)的胸鎖乳突肌表面進(jìn)行分離,并且可以將表面耳后肌去除,以減小筋膜瓣厚度。
[Abstract]:Objective:
Ear reconstruction is one of the most challenging operations in plastic surgery. The anatomical areas involved in the operation include the temporal region and the mastoid region. This study is a study of the temporal region, the level of the mastoid region and the nerve, the distribution of the vessels and the characteristics of the operation, and its application in the operation.
Method:
The temporal and mastoid regions of 4 cadaver head specimens of 4 cases (8 sides) were anatomically dissected by general anatomical methods: 1, the superficial and deep anatomy of the temporal and mastoid regions; 2, the anatomy of the temporal and mastoid nerve, and the observation of its walking and distribution; 3, the distribution of the auricular muscles and the blood supply of the posterior auricular muscle; 4, the anatomy of the superficial temporal artery and the posterior auricular artery. And the branches of the posterior fascia flap in the posterior auricular fascial flap, the number and the distribution of the posterior fascial flap; 5, the thickness and range of the posterior fascia flap were measured.
Result:
1, the temporal level is from shallow to deep: skin, subcutaneous fascia fatty layer, superficial temporal fascia layer, loose connective tissue layer under fascia, deep temporal fascia, temporal muscle, periosteum layer, skin, subcutaneous superficial fascia fatty layer, superficial fascia of mastoid fascia, loose connective tissue layer under fascia, deep fascia,.2 of periosteum layer, temporal nerve including auricular temporal deity. The temporal branches of the facial nerve and the mastoid nerve include the.3 of the auricular and occipital nerve, the superficial temporal fascia and the posterior fascia of the ear are rich in blood transportation, which are supplied by the superficial temporal artery and the posterior auricular artery, respectively. The posterior auricular artery emits 1-2 rough transverse branches in the posterior ear area, and travels on the surface of the posterior ear fascia, and its distribution range is about 8.8cm x 5.95cm.4. The posterior auricular muscle was supplied by the single branch of the posterior auricular artery to the posterior branch of the auricular artery for.5. The thickness of the posterior fascial flap of the ear was 1.24 + 0.11mm, 2.86 + 0.25mm and 3.80 + 0.23mm., respectively.
Conclusion:
During the reconstruction of the auricle, the operation should be carried out strictly according to the anatomical level, and the continuity of the anatomical level should be maintained when the fascial flap is formed. In the operation, the posterior ear fascia flap is used to wrap the ear stent. It has the advantages of convenient formation, concealed incision and clear cranial trench, while preserving the integrity of the superficial temporal fascia. It is appropriate to form the posterior fascia flap in the formation of the posterior ear. A thinner subcutaneous fascia fat layer is retained to ensure the blood supply of the fascia flap. The lower part of the fascia flap can be separated from the surface of the sternocleidomastoid muscle on the back side, and the posterior muscle of the ear can be removed to reduce the thickness of the fascia flap.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R602;R764.9

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