颞肌神经血管定位在颞肌筋膜法动力性矫正晚期面神经麻痹中的意义(英文)

Significance of locating the blood vessels and nerves of temporal muscle in dynamical correction of late-stage facial paralysis using temporal muscular fascia

背景:颞肌筋膜法动力性矫正晚期面神经麻痹(以下简称面瘫)的手术中,存在颞肌血管神经定位困难的问题。为明确颞肌的精细解剖而设计了此次实验。目的:通过分组进行人类颞肌的血管神经分束研究,以阐明颞肌动力修复晚期面瘫的显微解剖应用基础。设计:随机对照的研究。单位:南方医科大学南方医院整形外科及解剖教研室。对象:收集2000年自愿遗体捐助的20具24h内死亡的新鲜尸体头部标本,其中男性12具,女性8具,年龄在16～50岁,平均30岁,死因均为感染或肿瘤等疾病,随机分为4组。方法:分别用氧化铅、墨汁或甲基丙烯酸树脂进行血管灌注,并进行神经显微解剖染色,结果拍摄照片,在计算机中进行图像叠加,从而形成血管神经的分束构筑图。主要观察指标:①颞肌形态。②颞肌前动脉、颞深后动脉及颞中动脉直径、长度和分布面积百分比。③颞深前神经、颞深后神经及颞中神经直径、长度和分布面积百分比。④颞肌静脉的分布。⑤颞肌神经血管的分束。结果:颞肌具有可利用的、有独立神经血管支配的三个肌肉分区,互相之间有丰富的吻合支。结论:晚期面瘫眼、鼻和口部畸形的动力矫正可选用对应的颞肌神经血管束一期完成。

BACKGROUND:In the operation of dynamical correction of late-stage facial paralysis using temporal muscular fascia,it is difficult to locate the blood vessels and nerves of temporal muscle.This experiment is designed to clarify the precise anatomy of temporal muscle. OBJECTIVE:To study the neurovascular bundles of human temporal muscle through grouping studies to clarify the application basis of microanatomy for dynamical repairing of late-stage facial paralysis by temporal muscle. DESIGN:A randomized controlled study. SETTING:Plastic Surgery of South Hospital and Anatomical Teaching and Research Office of Southern Medical University. PARTICIPANTS:Head specimens of 20 fresh corpses having died within 24 hours which were voluntary mortal remains donated in 2 000 were collected,among which there were 12 males and 8 females,aged between 16 and 50 with an average age of 30.The causes of death were all such diseases as infection and tumor.They were randomly divided into 4 groups. METHODS:Blood vessels were filled respectively with lead oxide, ink or methacrylate and microanatomical staining of nerves was done. Then photos were taken and the pictures were combined in computer.Then a picture of nrurovascular bundles was obtained. MAIN OUTCOME MEASURES:①Morphology of temporal muscle; ②Diameter,length and percentage of distribution area of anterior temporal artery,deep posterior temporal artery,and middle temporal artery;③Diameter,length and percentage of distribution area of deep anterior temporal nerve,deep posterior temporal nerve and middle temporal nerve;④Distribution of temporal vein;⑤Neurovascular bundles of temporal muscle RESULTS:There were three muscle regions in temporal muscle, each was available for use and had independent neurovascular innervation.There were rich anastomotic branches between each other. CONCLUSION:The primary dynamical correction of the deformity of the eyes,the nose and the mouth in late-stage facial paralysis can be accomplished by using corresponding temporal neurovascular bundle.