鼻唇沟区域解剖学研究

目的对颌面整形美容外科提供形态学依据。方法对20侧成人新鲜尸头行10%福尔马林血管灌注固定后,在手术放大镜下进行形态学观测。结果①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为1.3mm,外侧为4.5mm。③鼻唇沟内侧真皮层有肌纤维附着,外侧也有稀少肌束附着。④面部表浅肌肉之间不但存在腱膜,还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论进一步证实了有关SMAS 中央腱的理论假说。     

鼻唇沟区域解剖学研究

目的 对颌面整形美容外科提供形态学依据。方法 对20例成人新鲜尸头行10％福尔马林血管灌注固定后，在手术放大镜下进行形态学观测。结果 ①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为1．3mm，外侧为4．5mm。③鼻唇沟内侧真皮层有肌纤维附着，外侧也有稀少肌束附着。④面部有浅肌肉宰不但存在腱膜，还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论 进一步证实了有关SMAS中央腱的理论假说。     

鼻唇沟区的组织学特点

目的对颌面整形美容外科应用鼻唇沟区修复提供组织学依据。方法对4例成人新鲜尸头沿鼻唇沟全层连续切片500张,分别进行特殊染色,在光镜下进行组织学观测。结果⑴鼻唇沟内侧弹力纤维、网状纤维成分多于鼻唇沟外侧;⑵鼻唇沟内侧、底部、外侧3.0mm以内有多种走向肌束相互交叉附着于真皮,肌束来自上唇鼻翼提肌、上唇提肌、颧小肌、无名肌;⑶面部表浅肌肉之间不但存在腱膜,还有筋膜、肌肉、腱膜、筋膜共同构成一个立体网状结构;结论进一步证实了有关表浅肌肉腱膜系统(SMAS)中央腱的理论假说。     

股外侧切口的应用解剖

对３０具（６０侧）成尸下肢股外侧肌的形态、毗邻进行了观测。模拟股外侧切口，观察经过层次及可能损伤的结构。所见股外侧肌表面及深面与股中间肌之间均有腱膜，分别厚０．７±０．２ｍｍ，０．９±０．３ｍｍ。股外侧切口有２１．７％经过股四头肌间隙。提出行股外侧切口时应锐性切开股外侧肌表层及深面的腱膜，沿垂直于切口方向钝性分离肌纤维闭合切口时应仔细修复上述两层腱膜，以避免并发症的发生。     

鼻唇沟解剖及相关面部年轻化治疗的最新研究进展

鼻唇沟是鼻翼外侧延伸至口角的面部凹陷性区域.鼻唇沟的解剖层次由浅至深为皮肤层、脂肪室、表浅肌肉腱膜系统、纤维连接层和肌肉层;因产生机制不同可将鼻唇沟分为五型:皮肤型、脂肪垫型、肌肉型、下颌后移型和综合型.对于不同类型的鼻唇沟需采用差异化的治疗方法.因此掌握其解剖结构、准确评估并正确分类,对面部年轻化治疗至关重要.现对鼻...     

眉上提整形术

眉有明显的性别特征,女性眉通常高于眶上缘略呈弓形。男性眉位于眶上缘水平。眉部的肌肉主要的额肌,内侧部分的额肌与眶部的眼轮匝肌相互交织并斜向皱眉肌。额肌的鼻部附着到鼻骨。其余部分的额肌被由帽状腱膜形成的前后鞘包裹。其后鞘向下延续到眶上缘骨膜并参入构成眶隔膜。眉脂肪垫就存在于     

胫前肌外侧纵行劈开覆盖胫骨中1/3段复合性骨折

胫骨中1/8段复合性骨折相当常见,如果能尽快复盖已暴露的胫骨,随后应用外固定支架,就能既快又好地得到治愈。过去曾有用胫前肌内侧纵行劈开的肌皮瓣复盖已暴露的胫骨。本文作者通过尸解和5例临床病例证实,胫前肌不仅可作内侧纵行劈开,同样也适宜作外侧纵行劈开,可将其前外侧的肌皮瓣向内侧翻开180。复盖在暴露的胫骨上。与身体的其它肌肉相比,胫前肌有两点独特之处:一是呈环羽状,二是内部有一条几乎与肌肉长度相等的轴腱。肌纤维呈放射状附着在轴腱上,就像轮辐一样,在     

股外侧切口的应用解剖

对30具(60则)成尸下肢股外侧肌的形态、毗邻进行了观测。模似股外侧切口,观察经过层次及可能损伤的结构。所见股外侧肌表面及深面与股中间肌之间均有腱膜,分别厚0.7±0.2mm,0.9±0.3mm。股外侧切口有21.7％经过股四头肌间隙。提出行股外侧切口时应锐性切开股外侧肌表层及深面的腱膜,沿垂直于切口方向钝性分离肌纤维;闭合切口时应仔细修复上述两层腱膜,以避免并发症的发生。     

指背腱膜的解剖学研究

目的 探讨指背腱膜的构成特点及临床意义。方法 在30只成人尸体手标本上，通过模拟手术，对指背腱膜的构成特点进行了应用解剖学观测。结果 指背腱膜的构成复杂，其中的外侧腱束、外侧束、外侧腱和中央束在手指畸形的发生中有着特殊的临床意义。外侧腱束主要形成伸近节指间关节的功能解剖机制；其与外侧束形成的密切纤维联系而具有协同外侧腱的功能；该腱束与屈肌腱鞘有联系又使其具有平衡屈肌和伸肌肌力的作用。中央束在指背腱膜的整体协调、畸形的发生及矫正过程中起着重要的功能。结论 通过对指背腱膜的解剖研究，可以解释因指屈、伸肌腱平衡被破坏后所形成的畸形。     

腰神经根解剖及其在经皮穿刺腰椎间盘摘除术中的临床意义

目的加深对腰神经根周围解剖的认识,选择经皮穿刺最佳途径。方法对３０具成人尸体腰神经根周围结构进行解剖学观察、测量和摹拟穿刺。结果测量三角工作区面积（ｍｍ２）：Ｌ４～５为１０４６５±２３６６,Ｌ５～Ｓ１为９１８１±１６７８;直视下穿刺针进入角度（°）：Ｌ４～５为４５３３±１８１,Ｌ５～Ｓ１为４０４３±３４９,外区为４８４±２５６;穿刺点距后中线距离（ｍｍ）：Ｌ４～５为６９８±５７,Ｌ５～Ｓ１为６０６±７０,外区为９７１±９９;闭合穿刺成功率：Ｌ４～５为１００％,Ｌ５～Ｓ１为９０％,外区为６０％。结论经三角工作区穿刺是经皮后外侧入路腰椎间盘摘除术的最佳途径;对Ｌ５～Ｓ１间隙穿刺有困难时,可经三角工作区的外区进行穿刺手术。     

Anatomical Aspects of the Gastrocnemius Aponeurosis and Its Insertion: A Cadaveric Study

Anatomical variation in the attachment of the gastrocnemius muscle to the soleus muscle has not been studied previously. The gastrocnemius muscle may insert directly onto the tendinous superficial surface of the soleus; however, in most cases, the distal end of the gastrocnemius aponeurosis extends for a variable distance as a thin, tendinous sheet void of muscular attachments. Surgeons performing a gastrocnemius recession may target the exposed inferior portion of the aponeurosis that is not directly covered by muscle. This is the subject of this anatomical study. Fifty-three embalmed cadaveric specimens were dissected to measure the length of the gastrocnemius aponeurosis medially and laterally. Three aponeurosis length categories were subjectively developed according to the ease with which a surgeon might release the gastrocnemius from the soleus: long aponeurosis (minimum aponeurosis length greater than 10 mm; 53% of specimens); short aponeurosis (9%), and direct attachment of the gastrocnemius muscle to the soleus on the medial side, lateral side, or both (38%). The typical gastrocnemius aponeurosis in the sample was distinctly shorter medially and longer laterally. For aponeuroses in the long aponeurosis category, the median length medially was 22.5 mm and median length laterally was 51 mm. In the short aponeurosis category, median medial length was 5 mm and lateral length was 22 mm. The lateral length was 1.8 times greater than the medial length for the long aponeurosis and 5 times greater for the short aponeuroses. Understanding the variation of the gastrocnemius aponeurosis will aid the surgeon in choosing a recession technique, performing the procedure, and preventing iatrogenic complications.     

现代面部除皱术的面神经解剖学研究

目的明确ＳＭＡＳ与面神经的关系。方法对１２具（２４侧）成人尸头行大体解剖观察。结果ＳＭＡＳ分布于面中部,向前逐渐变薄,于口角水平外侧有小范围的“洞区”。面神经出腮腺后,并非在ＳＭＡＳ深面,而是在咬肌筋膜深面走行。面神经额支在颧弓以下０５ｃｍ区域穿出深筋膜,跨过颧弓。在颊脂肪垫区,大部分面神经分支走行在垫内,小部分分支形成面神经丛,分布于其表面。在颧大肌表面上１／３恒定有一颧支跨过,支配眼轮匝肌下外侧９例（占３７５％）;颧大、小肌及眼轮匝肌８例（占３３３％）;颧大、小肌７例（占２９２％）。结论面部多层次剥离除皱术应在颧弓以下０５ｃｍ区域行ＳＭＡＳ下剥离,至面中部时,应注意保护颧大肌表面上１／３段的面神经颧支,只在颧大肌中下２／３段区域进行剥离,向内掀起颧脂肪垫;或通过下睑缘皮肤切口,向下掀起眼轮匝肌（注意保护位于颧大肌上１／３段的面神经颧支）,与经耳前ＳＭＡＳ下剥离腔隙连通,如上操作可避免面神经损伤。     

Independent effect of various facial mimetic muscles on the nasolabial fold

The independent effect of the contraction of various facial mimetic muscles on the nasolabial fold was defined through study of cadaver dissections. The four major lip elevator muscles were identified and the effect of traction of these muscles on the nasolabial fold was studied. This study identified the levator alae muscle (levator labii superioris alaeque nasi) as the primary facial muscle responsible for creating the medial nasolabial fold. The levator labii superioris muscle was found to define the middle nasolabial fold. These two facial muscles may be significant in the etiology of the prominent nasolabial fold that occurs with aging.     

除皱术解剖学研究及临床应用

目的 以解剖学研究为基础寻找一种操作简单、安全、效果持久的除皱术式。方法 对6具新鲜尸体进行头面颈部逐层解剖，观察鼻唇沟旁脂肪分布特点及皮肤限制韧带分布，结合临床观察对其功能进行评价。结果面部老化时皮肤、皮下组织、SMAS均出现松弛，但松弛程度不同，各层组织需分别提升；鼻唇沟旁脂肪组织肥厚，有较大活动度，皮下分离不必超过咬肌前缘；面部老化后皮肤限制韧带变得松弛，只需双重折叠缝合面部SMAS便可矫正其松弛。临床应用局限性皮下分离，结合SMAS双重折叠缝合，进行100例除皱术，效果满意，无严重并发症。结论 局限性皮下分离，结合SMAS双重折叠缝合的除皱术是一种简单、安全、效果持久的除皱术式。     

Anatomy of the SMAS Revisited

Despite the relevance of the superficial musculoaponeurotic system (SMAS) in facial rejuvenation a clear anatomic definition of the SMAS is still lacking. Therefore, the morphology of the SMAS in 18 cadavers was investigated using different macroscopic and microscopic techniques. The region-specific anatomy of the SMAS is described in the forehead, parotid, zygomatic, and infraorbital regions, the nasolabial fold, and the lower lip. The SMAS is one continuous, organized fibrous network connecting the facial muscles with the dermis. It consists of a three-dimensional scaffold of collagen fibers, elastic fibers, and fat cells. Two different types of SMAS morphology were demonstrated: type 1 SMAS architecture is located lateral to the nasolabial fold with relatively small fibrous septa enclosing lobules of fat cells, whereas type 2 architecture is located medial to the nasolabial fold, where the SMAS consists of a dense collagen–muscle fiber meshwork. Overall, it was demonstrated that different facial regions show specific morphological characteristics, and thus region-specific surgical interventions may be necessary in facial rejuvenation.     

The Concentric Malar Lift: Malar and Lower Eyelid Rejuvenation

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. A minimally invasive technique for malar and lower lid lift is proposed. Two incisions are used: the standard subciliary lower eyelid incision and one on the lateral part of the upper eyelid. Through these incisions a skin flap lower eyelid dissection and a subperiosteal malar dissection are performed. The arcus marginalis itself is not transected as is the case when the malar area is entered from the lower eyelid. Rather, a subperiosteral release of the arcus marginalis is performed through a muscle-splitting incision at the lateral canthus. Eyelid malposition is avoided because the muscles, vessels, and nerves converging toward the medial canthus are not interrupted. The subperiosteal dissection of the arcus marginalis extends to the medial canthus and also releases the insertion of the orbicularis oculi superior malar part. Consequently, all the attachments of the tear trough are released. Two subperiosteal suspensions connect the central part of the nasolabial volume and, more laterally, the central part of the malar area to the inferolateral orbital rim. The elevation of the malar volume resulting from these suspensions is concentric with the orbit. A final third suspension vertically connects the orbicularis oculi muscle with the underlying periosteum to the bone of the lateral orbital rim. Significant skin excess is removed from the lower eyelid. Complete disinsertion of the tear trough attachments combined with the malar elevation treats the entire palpebromalar groove. The lifted fat volume fills the space resulting from the subperiosteal disinsertion. A safer, more natural and more reliable result is achieved because the vectors of traction with this technique are exactly opposite those of the midface aging process, and because a very stable fixation is created between the lifted malar periosteum and the malar and latero-orbital rim bones.Publication presented at the meeting of the Societe Francaise des Chirurgiens Esthetiques et Plasticiens 23 June 1996, and at the meeting of the Australian Society of Plastic Surgery 9 March 2002     

The extended SMAS facelift: identifying the lateral zygomaticus major muscle border using bony anatomic landmarks

Extended superficial musculoaponeurotic system (SMAS) rhytidectomy has been advocated for improving nasolabial fold prominence. Extended subSMAS dissection requires release of the SMAS typically from the upper lateral border of the zygomaticus major muscle and continued dissection medial to this muscle. This maneuver releases the zygomatic retaining ligaments and achieves more effective mobilization and elevation of the ptotic malar soft tissues, resulting in more dramatic effacement of the nasolabial crease. Despite its presumed advantages, few reports have suggested greater risk of nerve injury with this technique compared with other limited sub-SMAS dissection techniques. Although the caudal extent of the zygomaticus muscle insertion to the modiolus of the mouth has been well delineated, the more cephalad origin has been vaguely defined. We attempted to define anatomic landmarks which could serve to more reliably identify the upper extent of the lateral zygomaticus major muscle border and more safely guide extended sub-SMAS dissections. Bilateral zygomaticus major muscles were identified in 13 cadaver heads with 4.0-power loupe magnification. Bony anatomic landmarks were identified that would predict the location of the lateral border of the zygomaticus major muscle. The upper extent of the lateral border of the zygomaticus major muscle was defined in relation to an oblique line extending from the mental protuberance to the notch defined at the most anterior-inferior aspect of the temporal fossa at the junction of the frontal process and temporal process of the zygomatic bone. The lateral border of the zygomaticus major muscle was observed 4.4 +/- 2.2 mm lateral and parallel to this line. More accurate prediction of the location of the upper extent of the lateral border of the zygomaticus major muscle using the above bony anatomic landmarks may limit nerve injury during SMAS dissections in extended SMAS rhytidectomy.     

透明质酸骨膜表面注射填充鼻唇沟的疗效观察

目的介绍骨膜表面注射透明质酸治疗鼻唇沟老化的注射方法。方法对146例鼻唇沟老化患者,在鼻唇沟内侧低洼处,于骨膜表面进行多点注射,使鼻唇沟内侧与鼻唇沟嵴之间的“台阶”感消失;有较明显鼻唇沟皱褶者,配合鼻唇沟皱褶处真皮下适量填充;抽取146例采用真皮或真皮与皮下组织交界处注射的病例作为对照组进行比较。结果所有患者术后效果均满意。与对照组相比,透明质酸用量差异没有统计学意义;并发症发生率明显降低,差异有统计学意义（P〈0．05）。结论骨膜表面透明质酸注射治疗鼻唇沟老化,效果理想,能降低并发症的发生率,临床效果满意。