CAJ | 학술논문

背景:封闭疗法可改善面肌痉挛临床特征,但穿刺点的位置、穿刺角度难以掌握,而穿刺深度不准确则严重影响疗效.目的:探讨面神经阻滞入路相关结构的解剖关系,为面神经阻滞的进针入路和减少并发症的发生提供解剖学依据.设计:以尸体为研究对象,模拟穿刺进行测量,观察性研究.单位:一所医学院解剖学教研室.对象:选择成年男性尸体28具(56侧,均为承德地区死后所捐献的尸体),对尸体进行面神经阻滞模拟穿刺,对相关指标进行测量获得了有关数据.方法:尸体仰卧,在其外耳门下、乳突前缘和下颌支后缘交汇处垂直进针,进针深度为针受阻为止;由穿刺点至下颌角作一纵行切口,向深面钝性分离找到面神经干、耳后动脉及颈静脉球在保留原位前提下,测量有关数据并进行统计学处理.主要观察指标:穿刺点位置、穿刺角度及穿刺点至面神经干的距离,面神经与穿刺针的位置关系及面神经与其主要毗邻结构间的距离关系.结果:面神经阻滞穿刺点的位置为外耳门下、乳突前缘和下颌支后缘的交汇处,垂直于正中矢状面进针,左侧深度为(19.91±0.09)mm,右侧深度为(19.82±0.10)mm.结论:确定了面神经阻滞准确的穿刺点、穿刺角度及深度,有利于阻滞治疗发挥确切效应.
배경:봉폐요법가개선면기경련림상특정,단천자점적위치、천자각도난이장악,이천자심도불준학칙엄중영향료효.목적:탐토면신경조체입로상관결구적해부관계,위면신경조체적진침입로화감소병발증적발생제공해부학의거.설계:이시체위연구대상,모의천자진행측량,관찰성연구.단위:일소의학원해부학교연실.대상:선택성년남성시체28구(56측,균위승덕지구사후소연헌적시체),대시체진행면신경조체모의천자,대상관지표진행측량획득료유관수거.방법:시체앙와,재기외이문하、유돌전연화하합지후연교회처수직진침,진침심도위침수조위지;유천자점지하합각작일종행절구,향심면둔성분리조도면신경간、이후동맥급경정맥구재보류원위전제하,측량유관수거병진행통계학처리.주요관찰지표:천자점위치、천자각도급천자점지면신경간적거리,면신경여천자침적위치관계급면신경여기주요비린결구간적거리관계.결과:면신경조체천자점적위치위외이문하、유돌전연화하합지후연적교회처,수직우정중시상면진침,좌측심도위(19.91±0.09)mm,우측심도위(19.82±0.10)mm.결론:학정료면신경조체준학적천자점、천자각도급심도,유리우조체치료발휘학절효응.
BACKGROUND: The blocking treatment can improve the clinic symptom of facial spasm. But the site, depth and the angle of puncturing point are very difficult to be defined, which will seriously infect the curative effect.OBJECTIVE: To study the applied anatomy of the related structures of facial muscle for blocking the facial nerve, and to provide anatomical bases for accurate puncturing point and preventing complications.DESIGN: An observation study based on cadavers and making the mimic puncture and measuring the correlative structures with anatomical method.SETTING: Department of anatomy in a medical college.PARTICIPANTS: Totally 28 adult male cadavers(56 sides) were used and the correlative index were measured.METHODS: The blocking point was located at the convergent point of the interior edge of cartilage of the external acoustic canal, the anterior fringe of mastoid processes and the posterior fringe of mandible ramus, the needle must be thrust vertically to the median sagittal plane. The puncturing needle stopped until it was barred. A longitudinal incision was made from the puncturing point to mandibula angle, and skin, superficial fascia were cut separately. Then carotid superficial fascia was cut from the posterior fringe of parotidean. The facial nerve trunk and the posterior auricular artery were preserved in site. A blunt isolation was made along its incision. Jugular glomus was appeared. Then the correlative index were measured and dealt with statistics method.MAIN OUTCOME MEASURES: The puncturing point, angle and depth,the distance between facial nerve trunk and puncturing point, the position relationship between facial nerve and puncturing needle and the distance relationship between facial nerve and principal structures adjacent to it.RESULTS: The blocking point was located at the convergent point of the interior edge of the external acoustic canal, the anterior fringe of mastoid processes and the posterior fringe of mandible ramus, the needle must be thrust vertically to the median sagittal plane. On the left side, the puncturing depth was (19.91 ± 0.09) mm, On the right side, the puncturing depth was(19.28±0. 10) mm.CONCLUSION: The experimental study could provide accurate puncturing point, angle and depth for blocking the facial nerve and bring the blocking treatment into full play.