颞部注射填充致颅内栓塞的解剖机制及危险因素研究

The anatomy and risk factors of intracranial embolism caused by temporal injection

目的探讨颞部注射填充致颅内栓塞的解剖机制和危险因素。方法 (1)对4个(8侧)成人头颅标本血管行乳胶灌注,对颈外动脉起点至颞浅动脉额支眶上缘水平段的血管(简称选取段动脉)进行解剖,获取血管铸型,测量其长度、起止点口径及体积(排水法)。(2)从浙江省人民医院影像库中获取2021年1月至2022年12月期间20例成人头颅CT血管成像数据(排除有颈部血管疾病者),对颈外动脉起点至颞浅动脉额支眶上缘水平段血管长度、起止点口径及体积进行测量。(3)由5位整形外科医生使用压力模拟测定设备按照临床操作习惯对真实颅骨模型颞区进行大力按压,并维持2 s,测得最大压强值,用最大压强值减去颈总动脉基础压强值[设置为90、120、150、200 mmHg(1 mmHg=0.133 kPa)4个等级],得到对颞区产生的额外的压强值。结果 (1)4个成人头颅标本共采集8条动脉,选取段动脉血管铸型形态均完整,血管长度为(169.5±7.2) mm,起点口径为(4.29±0.28) mm,终点口径为(1.31±0.15) mm,体积为(1.56±0.21) ml。(2)20例成人中,男11例,女9例,年龄23~53岁,其血管长度为(172.2±7.6) mm,起点口径为(5.63±0.43) mm,终点口径为(1.77±0.16) mm,体积为(1.59±0.23) ml。(3)5位医生对颞区局部按压产生的额外的压强值为(127.2±10.1) mmHg(113.8 ~138.6 mmHg)。结论当同时具备填充或挤压进入颞浅动脉注射量超过1.6 ml、动脉损伤和颞部大力挤压(局部压强大于基础压强110 mmHg以上)3个条件时,注射物可能自颈总动脉枢纽逆流入颈内动脉而进入颅内,此为颞部注射填充导致颅内栓塞的可能机制。

Objective To investigate the anatomic mechanism and risk factors of intracranial embolism caused by injection at temporal region.Methods(1)Latex perfusion was performed on the vessels of 8 cranial specimens.The vessels from the superficial temporal artery to the carotid artery were dissected to measure the length,the diameter of starting point and ending point and the volume of vessels(drainage method).(2)Cranial CT angiography of 20 patients(excluding patients with cervical diseases)were obtained from the database of Zhejiang Provincial People’s Hospital from January 2021 to December 2022.The length,the diameter of starting point and ending point,and the volume of vessels were measured.(3)5 plastic surgeons used pressure simulation measuring equipment to vigorously press the temporal region of the real skull model according to the clinical practice and maintain 2 s to obtain the maximum pressure value.The additional pressure on the temporal region was obtained by subtracting the common carotid artery base pressure[set at 90,120,150 and 200 mmHg(1 mmHg=0.133 kPa)]from the maximum pressure.Results(1)8 arteries were collected from 4 skull specimens.The length of vessels was(169.5±7.2)mm,the diameter of the starting point of vessel was(4.29±0.28)mm,the diameter of the ending point of vessel was(1.31±0.15)mm,and the volume was(1.56±0.21)ml.(2)There were 11 males and 9 females among 20 patients aged 23-53 years.The length of vessels was(172.2±7.6)mm,the diameter of the starting point of vessel was(5.63±0.43)mm,the diameter of the ending point of vessel was(1.77±0.16)mm,and the volume was(1.59±0.23)ml.(3)The mean value of additional pressure generated by local pressure on the temporal region by 5 physicians was(127.2±10.1)mmHg(113.8-138.6 mmHg).Conclusion When the injection volume into the superficial temporal artery was more than 1.6 ml,the artery was damaged,and the temporal area was pressed strongly(the local pressure was more than 110 mmHg above the basic pressure),the injection material might flow into the intracranial from the junction of the common carotid artery and into the internal carotid artery,which was the possible mechanism of the temporal filling leading to intracranial embolism.