眶内侧壁的显微外科解剖

Microsurgical anatomy of the medial orbital wall

目的:为鼻眼相关外科手术提供解剖学参考资料。方法:在手术显微镜下观察20例(40侧)成人颅骨标本和15例30侧经10%福尔马林固定的成人尸头标本眶内侧壁的Dacryon点、筛孔、额筛缝及视神经管眶口。结果:Dacryon点至筛前、中、后孔中点、视神经管眶口的距离分别为(19.28±1.42)mm、(27.06±2.05)mm、(31.11±2.08)mm和(37.47±2.11)mm,Dacryon点至眶上缘、眶下缘的距离分别为(16.50±1.38)mm和(19.65±1.41)mm。颅骨标本的筛孔1、2、3孔和4孔出现率为0%、62.5%、32.5%和5%;尸头标本的筛动脉1、2、3、4支和5支出现率分别为10%、53.3%、33.3%、0%和3.3%。筛前、中、后孔位于额筛缝上方分别占37.5%、33.3%和35.7%,位于额筛缝分别占60%、66.7%和64.3%,所有筛孔中只有一孔(筛前孔)位于额筛缝下方。结论:Dacryon点、额筛缝是眶内侧壁的2个恒定的解剖标志,眶内侧壁手术时在额筛缝以下切除内侧壁是安全的。

Objetive： To provide anatomic data for nasoocular relational surgery. Methods： The medial wall of the orbit was studied in 20 cases （40 sides） of adult human skulls and 15 cadavers （30 sides） under an operation microscope. Dacryon point, ethmoidal foramen, frontoethmoidal suture and the orbital opening of the optic canal were observed. Results： The distance from the Dacryon point to the middle point of the anterior, middle, posterior ethmoidal foramen, and orbital opening of the optic canal were 19.28±1.42 mm, 27.06±2.05 mm, 31.11±2.08 mm, 37.47±2.11 mm, respectively. The distance from the Dacryon point to the supraorbital margin and infraorbital margin was measured as 16.50±1.38 mm and 19.65±1.41 mm, respectively. The present ratio of single, two, three and four ethmoidal foramina on the skull specimens were 0%, 62.5%, 32.5% and 5%, respectively and that of single, two, three, four and five branches of the ethmoidal arteries on the cadavers were 10%, 53.3%, 33.3%, 0% and 3.3%, respectively. The anterior, middle and posterior ethmoidal foramen were located over the frontoethmoidal suture in 37.5%, 33.3% and 35.7% of the cases, while located in the frontoethmoidal suture, in 60%, 66.7% and 64.3%, respectively. In all the ethmoidal foramina, only one case was situated below the frontoethmoidal suture. Conclusion： The Dacryon point and frontoethmoidal suture are the two invariable anatomic landmarks in the medial orbital wall. It is safe to dissect the medial wall of the orbit below the frontoethmoidal suture in operations in the region of the medial orbital wall.