眶内动眼神经的显微解剖学研究

Microanatomy studies of orbital oculomotor nerve

目的为避免经眶手术入路损伤动眼神经,提供动眼神经的显微解剖结构资料。方法对30例头颅标本每侧眼眶进行血管灌注红、蓝乳胶,对动眼神经的分支、毗邻关系、走行进行观察和测量。结果动眼神经在入眶上裂前分为上、下2支者占95.0%(57/60),在眶上裂内分支者占5.0%(3/60),96.7%(58/60)动眼神经上睑提肌支经过上直肌处接近于眶的中点,86.7%(52/60)的睫状神经节位于动眼神经下支后1/3处。结论动眼神经眶内走行、毗邻关系复杂,动眼神经解剖学研究有助于减少眶内手术出血及损伤,动眼神经上睑提肌支经过上直肌处和睫状神经节可以作为眶内手术定位的标志。

Objective To provide anatomic data for avoiding damage to the orbital oculomotor nerve dung the intraorbital operation. Methods The microsurgical anatomy of the orbital oculomotor nerve and its branches and adjacent structures through their intraorbital courses were observed and measured in each side of 30 adult cadaveric heads fixed in formalin, in which the arteries and veins were injected red and blue latex. Results The oculomotor nerve of total 50 eyes were divided into superior and inferior divisions before the superior orbital fissure in 95.0% （57 eyes） and 5.0% （3 eyes） of the nerve divided into the two divisions in the superior orbital fissure. The transition point of the branch from the superior rectus to levator palpebrae superior muscle located proximally in the middle of the orbit in 95.7% （58 eyes）. The ciliary ganglion originated mostly in one-third proximal of the inferior division in 85.7% （52 eyes）. Conclusions The oculomotor nerve has a complex course and adjacent relationship. The microanatomical knowledge of the nerve can reduce the bleeding and injury in the orbital operation. The transition point of the branch from the superior rectus to levator palpebrae superior muscle and ciliary ganglion is critical key points to the various orbital approaches.