滑车上及眶上神经血管束与皱眉肌的解剖学研究

Relationship among supratrochlear and supraorbital neurovascular bundles and corrugator muscle: an anatomical study

目的探讨滑车上、眶上神经血管束与皱眉肌的毗邻关系,为眉间手术提供解剖学依据。方法2019年7—10月,在潍坊医学院解剖学实验室用10具20侧成人头颅标本逐层解剖上睑及额部。以双侧内眦连线为X轴,面中线为Y轴,建立坐标系,分别测量滑车上神经、滑车上动脉、眶上神经内侧支、眶上神经外侧支、眶上动脉的坐标参数,得到其走行轨迹范围,并观察其层次及其与皱眉肌间的毗邻关系。结果皱眉肌起自额骨鼻突近眶内侧缘上部距中线(4.32±0.98)mm处,皱眉肌起端基底宽(9.91±1.41)mm,斜向外上穿眼轮匝肌及额肌分布于眉毛外1/3皮下。以内眦连线上15 mm,距面中线(16.58±1.70)mm及(16.17±1.42)mm连线为下底,以内眦连线上30 mm,距面中线(13.74±1.54)mm及(14.21±2.42)mm连线为上底所构成的梯形区域,为滑车上神经动脉在皱眉肌中行走的危险区。以内眦连线上22.5 mm,距面中线(26.03±1.55)mm及(28.11±2.46)mm连线为下底,以内眦连线上40 mm,距面中线(31.23±3.19)mm及(38.20±2.94)mm连线为上底所构成的梯形区域为眶上神经动脉在皱眉肌中行走的危险区。结论熟悉滑车上及眶上神经血管束与皱眉肌关系,手术操作可避免危险区,减少对表浅及深部神经血管的损伤。

Objective To explore the relationship among the supratrochlear and supraorbital neurovascular bundles and the corrugator muscle,in order to provide anatomical basis for eyebrow operations.Methods From July to October 2019,the upper eyelids and forehead of 10 adult skull specimens(20 sides)were dissected layer by layer in the anatomy laboratory of Weifang Medical College.The line of bilateral inner canthus was taken as the X-axis and the facial midline as the Y-axis to establish the coordinate system.The coordinate parameters of supratrochlear nerve,supratrochlear artery,medial branch of supraorbital nerve,lateral branch of supraorbital nerve and supraorbital artery were measured to obtain the range of its trajectory,and their level and their adjacent relationship with the corrugator muscle were observed.Results The corrugator muscle started from the upper part of the nasal process of the frontal bone near the medial margin of the orbit and was(4.32±0.98)mm from the midline.The base of the corrugator muscle start was(9.91±1.41)mm wide.The corrugator muscle run obliquely upward,through orbicularis oculi muscle and frontal muscle,and stopped at subcutaneous of the outer 1/3 of eyebrow.The trapezoid area was composed of the line of 15 mm above the inner canthus line,(16.58±1.70)mm and(16.17±1.42)mm from the facial midline as the lower base and the line of 30 mm above the inner canthus line,(13.74±1.54)mm and(14.21±2.42)mm from the facial midline,which was the dangerous area for the supratrochlear neurovascular bundles walking in corrugator muscle.The trapezoid area was composed of the line of 22.5 mm above the inner canthus line,(26.03±1.55)mm and(28.11±2.46)mm from the facial midline as the lower base and the line of 40 mm above the inner canthus line,(31.23±3.19)mm and(38.20±2.94)mm from the facial midline,which was the dangerous area for the supraorbital neurovascular bundles.Conclusions Familiar with the relationship among the supratrochlear and supraorbital neurovascular bundle and the corrugator muscle can avoid dangerous areas and reduce superficial and deep neurovascular injury during operation.