Atlas钛缆固定上颈椎的应用解剖

目的:为颈后路寰枢椎Atlas钛缆固定术和相关器械设计提供解剖学依据。方法:在100例中国成人干燥标本上,观察寰椎后弓和枢椎椎板的形态学特点并进行解剖学测量。结果:(1)寰椎后弓较纤弱,横截面呈扇形,内侧面从后上方向内下方倾斜;内侧面宽度:左侧(6.5±1.9)mm,右侧(6.3±1.7)mm;扇形角度:左侧(68±10)°,右侧(71 9)°。(2)枢椎椎板较粗大,上窄下宽,上缘厚度:左侧(4.5±1.3)mm,右侧(4.8±1.4)mm,下缘厚度:左侧(8.1±1.5)mm,右侧(7.8±1.6)mm;椎板高度:左侧(14.3±4.1)mm,右侧(14.5±3.6)mm,内侧面基本垂直,内侧面下缘多形成一骨嵴。结论:(1)寰椎后弓和枢椎椎板穿绕钛缆时宜自上向下操作;(2)设计枢椎椎板穿绕钛缆的引导器械时需考虑到其内侧面的骨嵴。     

下颌骨截骨术相关的骨学测量及临床意义

目的 测量与下颌骨截骨术有关的指标和探讨其临床意义,为避免下颌骨截骨术并发症提供形态学资料。方法 100个干燥和10个透明下颌骨,采用人体测量仪,按照人体测量手册所述及的下颌骨测量方法进行测量。结果 下颌体长为(72.0±5,4)mm,下颌体高和厚分别为(27.7±3.3)mm、(15.0±1.7)mm,下颌联合高为(33.4±3.7)mm;下颌支高和最小宽、髁突间宽、下颌角角度、下颌角间宽分别为(61.1±5.7)mm、(32.6±3.2)mm、(120.4±6.6)mm、(124.9±7.5)°、(100.2±6.8)mm;下颌孔上缘至下颌切迹最低点距离、下颌孔后缘至下颌支后缘的宽度、茎乳孔前缘至下颌支后缘的距离和下颌角最突点至下颌管的距离分别为(15.8±2.3)mm、(13.1±1.9)mm、(16.2±1.2)mm和(20.4±3.2)mm。结论 这些数据可作为临床医生施行下颌骨各型截骨术时的参考依据,从而避免其并发症的发生。     

下颌角肥大整形术相关解剖

目的 精细解剖下颌角周围软组织结构及下颌神经管,为下颌角肥大整形术提供解剖学参考。 方法 20例大体标本,观察及测量面动静脉、面神经下颌缘支及咬肌区的血管和神经。据下颌骨表面骨性标志定位5条径线,测量该5条径线上下颌神经管在下颌骨中的位置。计算各软组织结构和下颌神经管的安全范围。 结果 面动脉距下颌角点为23.18～36.28 mm,距咬肌前缘为-9.51～9.27 mm。面静脉距离下颌角点为17.79～32.03 mm。面神经下颌缘支贴近下颌角部及下颌骨下缘走行,距离下颌角点为-8.57～10.70 mm,而咬肌前缘下颌缘支距下颌骨下缘为-8.83～11.06 mm。咬肌的血供主要有面动脉咬肌支、颈外动脉咬肌支、上颌动脉咬肌支及面横动脉咬肌支这四大来源。咬肌神经多与咬肌动脉伴行进入咬肌。下颌神经管在5个截面中距离下颌骨外侧点分别大于10.50 mm、14.72 mm、15.60 mm、8.53 mm、6.74 mm。 结论 在剥离下颌角区软组织时,注意对咬肌前缘面动脉、面神经下颌缘支及下颌角点附近面神经下颌缘支的保护。去除咬肌的最佳层次为咬肌深层中份最厚点及中下份。而在截骨或劈骨时,根据下颌神经管的安全范围,可在下颌骨颊侧骨板快速画出一条指导性的安全线。     

下颌后静脉的形态学特点及其临床意义

目的:明确下颌后静脉的解剖学特点及其与下颌角之间的解剖关系,为下颌角截骨术中避免损伤下颌后静脉提供解剖学依据。方法:22侧福尔马林固定成人尸体头颈部标本,解剖观测下颌后静脉的走行、构成、长度、外径及其与周围结构的关系。结果:下颌后静脉位于下颌骨后缘,由颞浅静脉和上颌静脉合成。起始处外径为(5.6±2.6)mm,长度为(4.46±2.08)cm。围绕下颌支后缘静脉长度为(4.27±0.80)cm,围绕下颌体下缘静脉长度为(2.02±0.42)cm。结论:在改脸形手术中预切除下颌角的后缘和下缘均有静脉围绕,尤其在下颌支后缘的中段,静脉口径粗大,与下颌支之间仅隔以菲薄骨膜,在下颌角截骨术中要注意避免损伤此静脉。     

下颌骨骨折机理的解剖学研究

目的:为下颌骨骨折机理的研究提供解剖学依据。方法:10例新鲜颅面标本进行解剖,对咀嚼肌、位进行观察,把下颌骨横断截开,测量各个解剖区全厚骨质厚度。结果:下颌骨各部分骨质厚度:颏部正中(12.4±0.7)mm、颏孔区(10.6±1.1)mm、磨牙区(14.1±0.9)mm、下颌角(6.8±0.5)mm、下颌孔前区(10.1±1.0)mm、下颌孔后区(6.2±0.5)mm。下颌第3磨牙阻生时,骨质变薄。牙缺失时,骨质吸收牙槽突降低。咀嚼肌在下颌骨两侧呈镜面影像,附着于下颌骨的不同部位。牙尖交错位和下颌后退接触位时上下牙列接触,髁状突与颞骨关节面无间隙,下颌姿势位时使上下牙列及髁状突与颞骨关节面之间均有间隙。结论:(1)颏部正中、下颌体部、下颌角、髁突颈部为下颌骨解剖薄弱区域,下骨全厚骨质厚度和骨折无相关性;(2)下颌第3磨牙阻生、缺失牙、颏孔和尖牙窝使下颌骨变薄弱;(3)咀嚼肌的收缩和位的不同可以改变下颌骨骨折的发生部位;(4)下颌骨薄弱区、咀嚼肌和位共同影响下颌骨骨折的发生。     

颅底颈静脉孔区骨性测量的应用解剖

目的:通过研究颅底颈静脉孔及其周围结构形态学参数,为国人颅底应用解剖学和骨学体质调查积累资料,为颅底外科突破手术禁区提供形态学基础。方法:选取100例成人骨性颅底标本,测量了骨性颅底颈静脉孔的前后径、内外径及颈静脉窝的深度,颈静脉孔与邻近结构之间的距离,以及枕髁的长度、宽度及枕髁与周围结构之间的距离。结果:颈静脉孔的前后径左侧为(7.90±2.01)mm,右侧为(8.80±1.63)mm;内外径左侧为(13.9±2.44)mm,右侧(14.47±2.52)mm。颈静脉窝深度左侧(12.28±2.41)mm,右侧(13.79±3.67)mm。乳突尖与颈静脉孔的外侧缘的距离左侧为(23.47±2.65)mm,右侧为(22.84±2.88)mm;茎乳孔与颈静脉孔外缘的间距左侧为(7.44±1.36)mm,右侧为(6.78±1.61)mm。颈静脉孔内侧缘至舌下神经管内口外侧缘的距离左侧为(9.09±0.76)mm,右侧为(9.86±1.25)mm;枕髁前端距舌下神经管外口前缘间距左侧(14.46±1.23)mm、右侧(11.41±1.91)mm;枕髁后端距舌下神经管外口后缘间距左侧(11.09±2.75)mm,右侧(14.39±1.85)mm。结论:在颈静脉孔区肿瘤远外侧入路手术中,磨除孔外侧与乳突间骨质时,自乳突尖约16mm处注意保护自茎乳孔出颅的面神经;在内侧入路手术中可磨除枕髁前半部不超过11mm;枕髁磨除的厚度不超过10mm,以防在磨除枕髁时伤及横过髁中部深面的舌下神经。在切除颈静脉孔前缘或前上缘的肿瘤采用经口咽入路时磨除颈静脉结节的厚度在8mm以内可防止伤及舌下神经。     

面神经下颌缘支的应用解剖

目的了解面神经下颌缘支的正常层次解剖位置,为涉及面侧区和颌下区的美容外科手术提供临床应用解剖学资料。方法解剖33具（共66例）成人尸体标本的头颈部标本,观察了面神经下颌缘支的分支类型、走行、与面动脉的位置关系以及穿出腮腺处和与面动脉的交叉处的体表位置。结果面神经下颌缘支为1-2支,以单干型居多,约占58%,大多行于下颌骨下缘上方约占44%,行于骨下缘下方者占5%。未发现面神经下颌缘支不与面动脉交叉,位置在均下颌角下缘上、下方约0.5-1 cm范围内。面神经下颌缘支经过面动脉的浅面和深面者分别占89%和6%;面神经下颌缘支穿出腮腺处的体表位置分别在下颌角上方和下颌支后缘前方1 cm交点附近,面神经下颌缘支与面动脉交处距下颌支后缘约4 cm,距下颌骨下缘约1 cm。结论面神经下颌缘支的毗邻和行程关系较为复杂,了解其与周围结构的重要位置关系,可以减少美容外科手术因神经损伤造成下唇及口角功能障碍的发生。     

以面动脉为蒂逆行下颌缘皮瓣修复鼻缺损的应用解剖

目的 :为以面动脉为蒂逆行下颌缘皮瓣修复鼻缺损提供解剖学基础。方法 :3 6侧灌注红色乳胶成人头面部及 8侧铸型标本 ,详细解剖观测下颌缘皮瓣血供、下颌下缘平面至口角平面动静脉长度、面神经下颌缘支和面动脉交点处距下颌下缘距离。结果 :下颌缘皮瓣血供主要来源于面动脉及其分支 ,同时亦接受枕动脉及甲状腺上动脉的分支营养 ,并互相吻合。平下颌骨下缘平面 ,面动脉距下颌角距离为 2 .8± 0 .3 ( 2 .4～ 3 .5 )cm ,动脉前壁与静脉后壁距离 0 .7± 0 .2 ( 0 .4～ 1.2 )cm ,动脉后壁与静脉前壁距离 0 .4± 0 .2 ( 0～ 0 .9)cm。口角平面 ,动脉前壁与静脉后壁距离 1.4± 0 .4( 0 .5～ 1.9)cm ,动脉后壁与静脉前壁距离 0 .9± 0 .4( 0 .3～ 1.5 )cm ,两平面间面动静脉长 4.5± 0 .3 ( 4.1～ 5 .4)cm。面神经下颌缘支多为 1～ 2支 ,与面动脉的关系恒定 ,多走行于动脉的浅面 ( 83 .3 % )。另有 8%的下颌缘支弓状行于下颌骨下缘下方 1cm范围内。结论 :以面动脉为蒂的下颌缘皮瓣逆行转位修复全鼻缺损 ,具有推广应用价值     

有限元分析犬下颌不全截骨牵张时特定标志点位移情况

目的：利用犬不完全截骨牵张成骨的有限元模型观察牵张过程中下颌骨特定点位移情况。方法：有限元模型模拟不完全截骨（截骨处剩lmm舌侧皮质骨），观察下颌骨一些特定标志点在牵张过程中空间三维的位移趋势。结果：在牵张过程中牵张侧下颌骨标志点位移趋势为在内外（左右或x轴）方向上第五臼齿、喙突、髁状突前斜面前缘中点的运动趋势是向外的，而下颌角、髁状突后斜面后缘中点的运动趋势是向内的；在前后（y轴）方向上第五臼齿、喙突的运动趋势是向后的，而下颌角的运动趋势是向前的；在上下（z轴）方向上第五臼齿的运动趋势是向上的。结论：牵张侧下颌骨在矢状平面上有使下颌骨体前端拉高后端压低的倾向，在冠状平面上有使下颌骨体上缘外翻下缘内收的倾向。     

副下颌孔及周围骨孔的应用解剖

目的 研究副下颌孔及下颌孔与周围解剖结构间的关系,为临床手术提供参考的同时丰富解剖学资料。方法 选取200例成人干燥下颌骨,观察副下颌孔和无名孔的数量,用游标卡尺等测量最大副下颌孔内侧最低点和下颌孔内侧最低点到髁突内极、喙突尖端、下颌切迹最低点、下颌小舌尖、颏棘、下颌角、下颌角前切迹、下颌最后一颗磨牙远中中点的距离及下颌骨后缘的水平距离,并进行统计学分析。结果 副下颌孔出现率为30.75%,双侧同时出现多见;无名孔多为（13.51±3.98）个,主要位于下颌孔与下颌切迹水平之间;最大副下颌孔内面最下点到髁突内极、喙突尖端、下颌切迹最低点、下颌小舌尖、颏棘、下颌角、下颌角前切迹、下颌最后一颗磨牙远中中点的距离及下颌骨后缘的水平距离分别为（33.70±3.67）mm、（37.13±4.44）mm、（20.13±3.59）mm、（7.58±2.05）mm、（74.93±4.55）mm、（26.69±5.36）mm、（31.57±4.77）mm、（25.40±4.96）mm、（11.09±2.85）mm。下颌孔内面最下点到髁突内极、喙突尖端、下颌切迹最低点、下颌小舌尖、颏棘、下颌角、下颌角前切...     

下颌神经管的解剖结构

背景:在下颌后牙种植术中,由于下颌神经管走行于下颌骨体内,有时可损伤下齿槽神经,因而制约了牙种植术的应用。 因此,牙种植术的应用需详细了解下颌神经管的解剖结构。 目的：观察下颌神经管在下颌骨内的走行及管内的解剖结构。 方法：共纳入15具成人牙下颌骨标本与4具新鲜下颌骨动脉灌注标本。纳入对象均牙列完整,后牙无缺失,牙槽骨无吸收。测量15具成人牙下颌骨标本下颌管走行及其管腔各径长度,包括下颌管横径与纵径,下颌管至上下内外缘距离。观察4具新鲜下颌骨动脉灌注标本管内下颌神经管内神经、血管位置关系。 结果与结论：下颌管内缘至舌侧骨板的距离比下颌管外缘至颊侧骨板距离短(P < 0.01);下颌管上缘至牙槽嵴顶的距离较下颌管下缘至下颌骨下缘的距离大(P < 0.01)。表明下颌管在下颌骨体部走行中偏舌侧、偏下颌骨下缘。下颌神经管在下颌骨体部的部分横径小于纵径(P < 0.05),亦即下颌管截面形态为上下径略长的椭圆形。神经管横纵径于前后牙位区差异无显著性意义。实验还发现在暴露的下颌管腔中下牙槽神经及伴随血管有一层被膜包绕成神经血管束,血管位于神经上方,而且位置恒定,并发出小分支包绕神经。结果提示,下牙槽血管神经束在下颌管内走行中血管位于神经之上。     

下颌骨缺损个体化修复体的应力分析与优化设计

背景：采用钛网支架整复下颌骨缺损常因设计不合理、固定不当造成修复体松脱甚至折断导致失败。 目的：针对一侧髁状突的下颌骨缺损,探讨使下颌骨断端和修复体应力分布合理的最佳设计方案和固定方式。 方法：建立下颌骨断端的简易三维模型和三种修复体模型,模拟咀嚼运动,施加垂直方向载荷,进行有限元法应力分析。 结果与结论：3种设计方案中,延伸板形态与下颌骨外形一致并包绕下颌骨下缘,并在下颌骨下缘增加固定螺钉的设计,在负荷时修复体变形最小,下颌骨断端及固定螺钉受力也最小。提示在单端固定式下颌骨修复体的设计中,应将延伸板形态设计为与下颌骨外形一致且包绕下颌骨下缘,并有必要增加下颌骨下缘处的固定。     

Intrabony course of the inferior alveolar nerve in the edentulous mandible

The purpose of this study was to investigate the vertical positioning and intrabony branching patterns of the inferior alveolar nerve (IAN) in 39 edentulous human cadaveric mandibles by buccal microdissection. Dissected mandibles were classified on the basis of the height of the IAN within the body of the mandible and the branching pattern of the IAN. The IAN was located in the superior part of the body of the mandible in 30.7% (12/39) of cases, all of which showed a small posterior molar plexus of branches. In 69.2% (27/39) of cases the IAN was half-way or closer to the inferior border of the mandible. Of these latter cases, 41% demonstrated a small, posterior molar plexus of branches, 37% showed posterior and anterior plexuses, and 22% showed either no branches or a single trunk with a small number of single branches directed at the superior border of the mandible. These findings were rendered in 3D computer format for instructional purposes.     

Mandibular landmarks as an aid in minimizing injury to the marginal mandibular branch: A metric and geometric anatomical study

Iatrogenic injury to the marginal mandibular branch is an important reason for medicolegal actions. The aim of this study was to determine the distance of the marginal mandibular branch to the inferior border of the mandible as well as variation of nerve position in relation to this border. The marginal mandibular branch was dissected carefully in a number of 36 facial halves. Three points were identified on the inferior border of the mandibular ramus: Point A at the angle of the mandible, Point B just anterior to the facial artery, and Point C, 2 cm anterior to Point B. A metric and geometric morphometric analysis, including thin-plate spline and relative warp analysis was done to determine the variation of nerve position in relation to these three bony landmarks. The metric study indicated a median distance from Point A to the nerve 2.3 mm inferior to Point A, 2.4 mm superior to Point B, and 10.7 mm superior to Point C. The shape analysis indicated that variation in the position of the nerve occurs most commonly at Points A and B. We conclude that these mandibular landmarks may assist surgeons in minimizing marginal mandibular branch injury and patient discomfort.     

Localization of the supraorbital,infraorbital, and mental foramina using palpable,bony landmarks

The purpose of this study was to locate the infraorbital, supraorbital, and mental foramina by using palpable anatomical landmarks that are conducive to surgical use. Fourteen embalmed cadavers (27 sides) were dissected to expose the supraorbital, infraorbital, and mental foramina. Measurements were made from the lateral orbital rim at the zygomaticofrontal (ZF) suture to both the supraorbital and infraorbital foramina. The distance from the inferior orbital rim at the zygomaticomaxillary (ZM) suture to both foramina was also measured. The distance to the mental foramen was measured from the angle and the inferior border of the mandible. The supraorbital foramen was located 26.2 ± 2.8 mm medial and 13.5 ± 3.7 mm superior to the ZF suture. The infraorbital foramen was located 23.8 ± 3.1 mm medial and 30.9 ± 3.8 mm inferior to the ZF suture, on average. Vertical measurements made from the ZM suture to the supraorbital foramen averaged 34.4 ± 3.6 mm and from the ZM suture to the infraorbital foramina averaged 7.6 ± 2.2 mm. The mental foramen was 64.2 ± 6.4 mm medial to the angle of the mandible and 12.9 ± 1.6 mm superior to the inferior border of the mandible. This study provides data that may be useful in predicting the location of the supraorbital, infraorbital, and mental foramina using palpable landmarks. These data may be particularly helpful for surgery in patients with missing teeth or fractures of the maxillary bone. Clin. Anat., 2010. © 2009 Wiley‐Liss, Inc.     

Blood supply of the human fetal mandible

Gross anatomic and radiologic studies of the blood supply to the human mandible of the full-term fetus and newborn infant were performed on 22 specimens ranging from 320–538 mm crown-heel length and 1,192–4,108 gm in weight. Ten specimens were injected with red-lead and liquid soap to demonstrate the arteries radiographically. Twelve other specimens were injected with Castolite with a sprinkling of red-lead and yellow dye. The best side of each specimen was studied by radiography and dissection. This study demonstrated: (1) a masseteric arterial plexus supplying the coronoid process and the lateral wall of the ramus with contributions from the facial, masseter, transverse facial and external carotid arteries or combinations thereof; (2) a mental arterial plexus anastomosing with the mental, submental and inferior labial arteries; (3) an inferior alveolar artery supplying most of the body of the mandible with a majority of its branches passing in an upward direction; and (4) periosteal vessels supplying the lower border of the mandible and receiving their blood supply from the blood vessels supplying the muscles attaching to these areas and the periosteum. Supplemental to the above findings were anastomoses between the submental, mylohyoid and sublingual arteries along the medial border of the mandible. Also a significant variation not previously recorded was noted in one specimen in which the sublingual artery originated from the facial artery rather than the lingual.     

下颌神经管全长三维走向的测量及其临床意义

目的　研究下颌管的全长走行位置及其与四周骨板的毗邻关系 ,为临床下颌手术提供解剖学依据。方法　对14 0侧成人下颌骨进行冠状、矢状及水平三维剖面的测量。找出下牙槽神经管全长在下颌骨中走行的基本位置及其与四周骨松质、骨皮质的毗邻关系值。结果　下牙槽神经管在下颌骨中走行虽有变化 ,但下颌管全长的总体走行是紧贴着舌侧骨板 ;在下颌第一、二磨牙区下颌管走行与下颌下缘成平行状 ;在近颏孔时才折转向外和向颊侧出颏孔。结论　在牙种植术、下颌各类截骨术中按正常解剖方位并侧重于颊侧骨板操作 ,可以避免损伤下牙槽神经血管。     

Abnormal anterior belly of the digastric muscle: a proposal for the classification of abnormalities

We recognized an abnormal anterior belly of the digastric muscle in an 83-year-old male cadaver. Three muscle bundles were observed on the left anterior belly: (i) attached to the left digastric fossa; (ii) attached to the right digastric fossa; and (ii) attached to the raphe of the mylohyoid muscle. Four muscle bundles were recognized on the right anterior belly: (i) attached to raphe of the mylohyoid muscle; (ii, iii) attached to the exterior surface on the base of the mandible from the raphe of the mylohyoid muscle; and (iv) attached to the interior surface on the base of the mandible from the raphe of the mylohyoid muscle. The raphe of the mylohyoid muscle was curved significantly to right and the four abnormal bundles found on the right anterior belly (see above) were attached to its curved point.     

Anatomical localization of submandibular gland for botulinum toxin injection

The aim of this study was to document the anatomical landmarks of the submandibular gland (SMG) for a botulinum toxin injection. Thirty-four SMGs from 20 cadavers were examined. The mean length of a reference line between the angle of the mandible and the gnathion was 94.8 ± 5.9 mm, the proximal and distal point of the SMG from the angle of the mandible was 10.6% (11.5 ± 3.5 mm) and 41.8% (40.9 ± 5.2 mm), respectively. The facial artery came out of the SMG at 11.6% (14.6 ± 3.4 mm) and the position of the intersection of the facial artery with the inferior border of the mandible was located at 24.4% (28.0 ± 5.5 mm) from the angle of the mandible. The shape of the SMG was generally triangular or irregular round on the anatomical position. The mean superior–inferior diameter, anterior–posterior diameter and medial–lateral diameter of the gland was 28.8 ± 4.1, 30.0 ± 6.1 and 15.1 ± 3.5 mm, respectively. The safety zone for the injection was 20–35% from the mandible angle on the inferior view and 1.5 cm below the inferior line of the mandible on the lateral view. In addition, the needle should be inserted to a depth of 2.0 cm from the skin surface on the inferior view. These results may assist in determining a accurate localization of injection sites for the SMG, particularly for injections without ultrasound guidance.