颏舌肌前移术的应用解剖学研究

Applied anatomic study for genioglossus advancement

目的 :为颏舌肌前移术提供解剖学依据。方法 :选取 4 0具成人尸头 ,解剖下颌骨、颏舌肌和颏舌骨肌 ,观察颏舌肌和颏舌骨肌的起止点和走行 ,测量颏棘及其相关参数 ,然后采用SPSS10 .0统计软件进行分析。结果 :颏舌肌和颏舌骨肌分别起于上、下颏棘。上颏棘的高度 (5 .82± 0 .71)mm ,宽度 (6 .98± 1.35 )mm ,突度(2 .92± 0 .97)mm ;下颏棘高度 (5 .97± 1.39)mm ,宽度 (3.81± 0 .5 2 )mm ,突度 (0 .77± 0 .6 2 )mm。颏下点至下颏棘下缘的距离 (5 .11± 1.33)mm ,下中切牙根尖至上颏棘上缘的距离 (14 .38± 3.4 0 )mm ,颏棘处下颌骨的厚度(11.95± 1.5 9)mm。男性下中切牙根尖至上颏棘上缘的距离大于女性 ,差异具有统计学意义 (P <0 .0 1)。上、下颏棘宽度、突度的差异具有统计学意义 ,而高度的差异无统计学意义。结论 :颏舌肌与颏舌骨肌同时前移时 ,骨块下端切口线应距颏下点约 5mm ;颏舌肌单独前移时 ,骨块下端的切口线应距颏下点约 11mm。骨块上端的切口距颏下点约 18mm。两侧的垂直切口各距离中线约 4mm。以颏下点及中线作为标志来定位颏舌肌前移术中的骨切口线更加直观、可行和准确。

Objective:To provide anatomic basis for genioglossus advancement.Method:Forty adult cadaver heads (male=29,female=11) were dissected to measure genial tubercles and observe the start-stop points of genioglossus muscle and geniohyoid muscle.Result:The genioglossus muscle originates from the superior mental spine,and the geniohyoid muscle originates from the inferior mental spine.The height ,width and process of the superior mental spin were(5.82±0.71)mm,(6.98±1.35)mm,(2.92±0.97)mm respectively, while(5.97± 1.39)mm,(3.81±0.52)mm,(0.77±0.62)mm in the inferior mental spine. The distance from the menton to the inferior edge of the inferior mental spine was(5.11± 1.33)mm.The thickness of the mandible at the genial tubercle was(11.95±1.59)mm in total.The distance from the apices of the incisors to the superior edge of the superior mental spine was(15.57±1.82)mm in male,(9.36±2.79)mm in female, which had statistically difference (t=6.21,P< 0.01).There are statistical difference at width,process between superior mental spine and inferior mental spine,not at height.Conclusion:The distance from the apices of the incisors to the superior edge of the superior mental spine in male is greater than that in female. When the genioglossus and geniohyoid are advanced simultaneously,the inferior horizontal bone cut should be approximately 5 mm above the menton, which should be 11 mm if the genioglossus is advanced single. The superior horizontal bone cut should be approximately 18mm above the menton.The lateral vertical cut should be 4 mm lateral to midline. It is visible, practicable and exact that the osteotomy is located with the menton and midline as marks.