改良圆孔外口穿刺术治疗上颌神经痛的骨性解剖学观测

目的　观测改良圆孔外口穿刺术进针路径的解剖特点，为临床提供解剖学支持。 方法　取80个（160侧）成人颅骨，用弯针（头端10 mm弯曲30 °）按改良圆孔外口穿刺入路进行模拟穿刺。测量穿刺针第1次到达上颌骨面深度（L1）、滑行至翼上颌裂上颌骨缘深度（L2）、滑行距离（L3）、针到达翼上颌裂上颌骨缘处裂宽（L4）、圆孔外口至眶下裂距离（L5）、翼上颌裂最大长（L6）和最大宽（L7）、颅骨前后径（LA）和横径（LB）。另取36例带完整软组织的矢状切头标本模拟穿刺，并与骨性测量结果相比较。 结果　左侧L1 ~ L7测量值分别为（23.04±3.42）、（38.14±3.63）、（20.67±3.93）、（5.85±1.27）、（19.66±2.61）、（23.38±2.49）及（6.66±1.24）mm，右侧L1 ~ L7测量值分别为（22.96±3.34）、（38.40±3.49）、（20.82±3.93）、（5.86±1.33）、（19.29±2.61）、（23.85±2.38）及（6.76±1.21）mm，左、右侧无统计学差异；双侧L1、L2与LA存在正相关关系，与LB不存在相关关系；双侧L1与L2存在正相关关系，L1与L3存在负相关关系，L2与L3存在正相关关系。颅骨标本测量结果适用于带全部软组织标本改良圆孔外口穿刺术。 结论　在颅骨任一侧行改良圆孔外口穿刺术，穿刺轨迹没有明显的差别，穿刺深度与颅骨长度和滑行距离有关，与颅骨宽度和侧别无关。

A modified percutaneous approach for treating maxillary neuralgia through external opening of paracentesis

Objective　To investigate the anatomic characteristics of the needle entry path of the modified percutaneous approach, providing morphological basis for the clinical puncture.　Methods　Eighty dried cadaveric adult skulls (160 sides) were collected and stimulated by using a curved needle (with a front end of 10mm bending 30°) according to the modified puncture approach. The following parameters were measured: the depth of the first arrival with the needle from the lower margin of the zygomatic arch to the maxillary surface (L1), the depth (L2) that the needle reached the maxillary margin of pterygomaxillary fissure, and gliding distance (L3), the fissure width that the needle reached the maxillary margin of pterygomaxillary fissure (L4), the distance from the external opening of foramen rotundus to the infraorbital fissure (L5), the maximum length of the fissura pterygomaxillaris (L6) and the maximum width (L7), the maximum length (LA) and width (LB) of the skull. Thirty-six sagittal head specimens with intact soft tissue were taken for simulated puncture to verify the feasibility of bone measurement results in the head.　Results　On the left side, the measured values of L1, L2, L3, L4, L5, L6, L7 were (23.04±3.42)mm, (38.14±3.63)mm, (20.67±3.93)mm, (5.85±1.27)mm, (19.66±2.61)mm, (23.38±2.49)mm, (6.66±1.24)mm, respectively. And on the right side, these measured values were (22.96±3.34) mm, (38.40±3.49) mm, (20.82±3.93) mm, (5.86±1.33) mm, (19.29±2.61) mm, (23.85±2.38) mm, (6.76±1.21) mm, respectively. There was no statistical difference between the left side and the right side (P>0.05). Bilateral L1 and L2 were positively correlated with LA, but not with LB. Bilateral L1 was positively correlated with L2 but negatively correlated with L3, and L2 was positively correlated with L3. Confirmatory experiments showed that the correlation of skull specimen measurements was still applicable in cranial biopsy.　Conclusions 　There is no significant difference in the trajectory of the puncture when the paracentesis is performed on either side of the skull. The puncture depth is related to the length of skull and gliding distance, but irrelevant to the width and the sides of the skull.