摘要
目的押对下颌神经阻滞入路相关结构及其毗邻关系进行解剖观测,为下颌神经阻滞入路和预防并发症的发生提供解剖学基础。方法:实验于2002-11/2005-11在郧阳医学院解剖学教研室完成。由郧阳医学院解剖学教研室提供120侧成人颅骨(男60侧,女60侧)和30侧尸体(男20侧,女10侧);均为无主尸体。测量了120侧成人颅骨卵圆孔等结构的数据,观测了30侧成人尸头下颌神经的毗邻结构。结果:①与下颌神经阻滞相关结构:男性除卵圆孔前壁厚、女性除颧弓中点下缘至翼突基部距离、卵圆孔宽径、卵圆前壁厚、卵圆孔前外侧缘至三叉神经压迹最近距离外,其余结构均存在侧别差异(P<0.05～0.01)。除左侧颧弓中点下缘至卵圆孔前外侧缘距离、左侧卵圆孔宽径、卵圆孔前壁厚外,其余侧别结构均存在性别差异(P<0.01)。下颌神经阻滞进针的深度:颧弓中点下缘至卵圆孔前外侧缘的距离熏男性左侧为(40.4±0.3)mm,右侧(40.9±0.4)mm。女性左侧为(39.8±0.6)mm,右侧为(40.2±0.7)mm。②下颌神经阻滞入路易损伤的结构及下颌神经的毗邻关系押下颌神经长度(10.4±1.6)mm,宽度为(4.5±1.5)mm,其中颅内段长(6.3±1.5)mm,卵圆孔内段长(5.1±0.6)mm。脑膜中动脉外径左侧为(1.5±0.3)mm,右侧为(1.5±0.4)mm。至上颌动脉起点的距离左侧为(7.1±0.4)mm,右侧为(8.3±0.3)mm。大部分脑膜副动脉入棘孔以前发出,起源于脑膜中动脉者22侧(73%)。上颌动脉者7侧穴23%雪。以双根起始者1侧(3%)。分支数,1支型24侧穴80%雪。2支型2侧(7%)。不存在4侧穴13%雪。脑膜副动脉分别经卵圆孔、蝶导血管、骨性翼棘孔入颅腔。下颌神经与脑膜中动脉的位置关系:脑膜中动脉位于下颌神经的后外侧22侧(73)%。位于下颌神经的外侧8侧(27%)。结论:获得了下颌神经的长度、宽度熏下颌神经阻滞进针的深度熏下颌神经阻滞入路易损伤的结构及下颌神经的毗邻关系熏以及圆孔、棘孔、破裂孔、颈静脉孔、海绵窦内等穿过的结构及毗邻关系的观测结果。下颌神经阻滞相关结构存在侧别和性别差异。
AIM： To provide anatomical basis for the blacking of mandibular nerve. and prevention of its complication.
METHODS： The experiment was performed at the Department of Anatomy, Yunyang Medical College form November 2002 to November 2005. 120 adult skulls （60 in each sex） and 30 necropsies （20 males and 10 females） were provided by the Department of Anatomy, Yunyang Medical College. Skull foramen ovale in 120 adult cases were measured and the adjoining structure related to mandibular nerve in 30 adult necropsies were studied.
RESULTS： ① The structure related to mandibular nerve blocking： Except the anterior wall thickness of oval foramen in male, and the distance from the midpoint of inferior border of zygomatic arch to the pterygoid process root, the width of oval foramen, the thickness of oval foramen and the minimum distance from the lateral border of oval foramen to the fossa of gasserian ganglion in female, there were differences in structure between different laterals （P 〈 0.05-0.01）. Except the distance from the midpoint of inferior border of left zygomatic arch to the lateral border of oval foramen, the width of left oval foramen and the anterior wall thickness of oval foramen, there were differences in lateral structure between different sexes （P 〈 0.01）. The depth of needle in mandibular nerve blocking： The distance from the midpoint of inferior border of zygomatic arch to lateral border of oval foramen was （40.4±0.3） mm in the left, and was （40.9±0.4） mm in the right for males. While that for females in the left was （39.8±0.6） mm, and was （40.2±0.7） mm in the right. ② The structure related to mandibular nerve blocking that easy to be injury as well as the adjacent relationships of mandibular nerve： The length was （10.4±1.6） mm and the width was （4.5±1.5） mm. The length of mandibular nerve in skull was （6.3±1.5） mm and the length in foramen ovale was （5.1±0.6） mm. The diameter of left middle meningeal artery was （1.5±0.3） mm. The diameter of fight one was （1.5±0.4） mm. The distance between the left middle meningeal artery and the beginning of left maxillary artery was （7.1±0.4） mm and the distance between the right middle meningeal artery and the beginning of right maxillary artery was （8.34±0.3） mm. Most of the accessory meningeal artery appeared before it went into foramen spinosum. There were 22 necropsies （73%） whose accessory meningeal artery originated from the middle meningeal artery, which originated from the maxillary artery was 7 ones （23%）, and that was originated from the middle meningeal artery and maxillary artery in one case （3%）. There were 24 necropsies （80%） with one artery branch, and 2 necropsies with two artery branches （7%）, 4 necropsies （13%） without artery branch. Accessory meningenl artery went into the skull through the foramen ovale, sphenoid duct and pterion spine respecting. The position relationship between mandibular nerve and middle meningeal artery： There were 22 necropsies （73%） with middle meningeal artery located in the posterior lateral of mandibular nerve and 8 necropsies （27%） located in the outer of mandibular nerve.
CONCLUSION： The length and width of mandibular nerve, the depth of needle in mandibular nerve blocking, the position relationship between mandibular nerve and middle meningeal artery, the adjoining relationship among foramen rotundum, foramen spinosum, foramen lacerum, vena carotid foramina and carvernous sinus are obtained. There are differences in mandibular nerve blocking structure between different laterals and between different sexes.
出处
《中国临床康复》
CSCD
北大核心
2006年第46期96-98,共3页
Chinese Journal of Clinical Rehabilitation
