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。     

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。     

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。现对鼻唇沟的解剖、分型及相关面部年轻化的研究进展作一综述。     

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     

膝关节半月板根部附着区的解剖学测量

目的:测量国人膝关节内外侧半月板前后根部附着区的解剖学数据,为临床修复半月板根部损伤提供解剖学基础。方法:选取30个国人成人尸体膝关节标本,其中男16例,女14例;死亡年龄35～68(55.6±7.8)岁。对半月板根部附着区结构进行解剖,测量内外侧半月板根部附着区中心点与胫骨内外侧髁间棘、后交叉韧带前缘、内侧胫骨平台软骨后方外侧缘及外侧胫骨平台软骨后方内侧缘等标志点的位置关系和各个附着区的面积。结果:内侧半月板后根部附着区:中心点位于胫骨内侧髁间棘后方(11.73±3.10) mm、外侧(2.77±0.86) mm,后交叉韧带前缘前(2.76±0.76) mm,内侧平台软骨外侧缘外(3.92±0.22) mm,附着区面积(31.29±5.18) mm~2。内侧半月板前根部附着区:中心点位于胫骨内侧髁间棘前方(25.40±5.27) mm、外侧(3.01±0.86) mm,附着区面积(46.18±11.60) mm~2。外侧半月板后根部附着区:中心点位于胫骨外侧髁间棘后方(4.51±1.35)mm、内侧(1.85±0.34) mm,后交叉韧带前缘前(6.91±1.11) mm,外侧平台软骨内侧缘内(3.16±0.96) mm,附着区面积(44.10±6.23) mm~2。外侧半月板前根部附着区:中心点位于胫骨外侧髁间棘前方(12.97±2.92) mm、外侧(1.31±0.22) mm,附着区面积(60.84±14.98) mm~2。结论 :该试验定量描述内外侧半月板前后根部附着区的面积以及其中心点与相应标志点的位置关系,为临床修复半月板根部损伤提供一定的解剖学参考。     

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。     

胫神经腓肠肌肌支切断小腿减肥术应用解剖探讨

目的:为临床胫神经腓肠肌肌支切断小腿减肥术提供形态学依据。方法:采用局部解剖学研究方法,观察测量胫神经在腘窝附近各分支走行位置、起点、长度及宽度。结果:胫神经在腘窝处发出4条主要分支:腓肠内侧皮神经、腓肠肌内侧头肌支、腓肠肌外侧头肌支和比目鱼肌肌支。变异情况主要有两种:①腓肠内侧皮神经与腓肠肌内侧头肌支共干起始(30%);②比目鱼肌肌支与腓肠肌外侧头肌支共干起始(30%)。腓肠肌内侧头肌支和腓肠肌外侧头肌支起点的平均高度分别为(-6.6±13.7)mm(、2.4±16.7)mm,神经起始处宽度分别为(2.3±0.4)mm(、2.5±0.4)mm,从起点到肌门处神经长度分别为(42±12)mm(、50±13)mm。结论:腓肠肌内、外侧头肌支从胫神经发出的位置比较恒定,神经较粗,较长,容易解剖分离。在腘窝皮肤皱褶处做长4～5cm横切口可暴露腓肠肌内、外侧头肌支。术中应注意神经变异情况,保护腓肠内侧皮神经和比目鱼肌肌支。     

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.     

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.     

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.     

The Anterior Approach to Hip and Pelvis

Objective Exposure of the anterior pelvic column and the anterior hip in the internervous plane between the femoral nerve (sartorius and rectus muscle) and the superior gluteal nerve (tensor fasciae latae, gluteus medius, and gluteus minimus muscle) as well as between the blood supply of the external (medial) and internal iliac artery (lateral). Indications All pelvic osteotomies. Shelf procedures. Anterior labral lesions. Fractures of the femoral head, anterior column, anterior acetabular wall, and high transverse acetabular fractures. Contraindications None. Surgical Technique Incision along the iliac crest, over the anterosuperior iliac spine to the lateral aspect of the proximal thigh. Separation of sartorius and tensor fasciae latae. Osteotomy and medial reflection of the anterosuperior iliac spine. Subperiosteal detachment of the abdominal muscles and the iliacus muscle. Division of both origins of the rectus. Elevation of the iliocapsular muscle and the psoas tendon. Incision and medial retraction of the periosteum at the anterior surface of the anterior acetabular wall to exposure the acetabular floor. Detachment of the tensor fasciae latae, gluteus medius, and gluteus minimus muscles to expose the outer ilium. Results To date, this modified Smith-Petersen approach has been used in approximately 700 periacetabular osteotomies. Complications: transient femoral (n = 1), sciatic (n = 5), and lateral femorocutaneous (30%) nerve deficits. Distal aspect of the scar always large, revision rare (n = 3). No vascular injuries. Resection of heterotopic ossification in five of six patients. Very low rates of infection, hematoma, deep thrombophlebitis, and embolism.