摘要
目的:研究侧方蒂颅骨骨膜瓣的血运和经眶外壁骨性通道填充眼眶的解剖可行性,并将其初步应用于陈旧性眼眶骨折继发眼球内陷畸形的治疗。方法:解剖2例经40%甲醛溶液固定的成人尸颅,观察颅骨骨膜瓣经眶外壁骨性通道充填眼眶的途径和解剖可行性;用乳胶和墨汁各灌注1例新鲜尸头,观察颅骨骨膜瓣的血运分布和来源。使用侧方蒂颅骨骨膜瓣矫治2例单侧陈旧性眼眶骨折患者,术前和术后用软件测量眼球内陷度,评价治疗效果。结果:颅骨骨膜瓣可经眶外壁骨性通道转位进入眼眶,范围可达眶内壁和眶底;血管灌注未发现有轴行血管支配颞上线上方颅骨骨膜瓣;在墨汁灌注的一侧尸颅解剖中发现,颞中动脉走行于颞深筋膜深方,但也未越过颞上线;颅骨骨膜瓣浅层可以明显观察到腱膜下血管网分布;临床治疗的2名患者术前眼球内陷度分别为5.35 mm和6.86 mm,术后眼球内陷度均小于2 mm,获得满意疗效。结论:眶外壁骨性通道作为侧方颅骨骨膜瓣转位充填眼眶的手术通道安全可行,侧方颅骨骨膜瓣由腱膜下血管网供血,类似于随意皮瓣。使用侧方颅骨骨膜瓣充填眼眶治疗眼眶骨折后重度眼球内陷患者初步治疗效果良好。
Objective：To assess the vascularization of the laterally based pericranial flap and the feasibility of bony channel on the orbital lateral wall for transplantation of the flap,and apply this flap to treat traumatic enophthalmos.Methods： Two formalin preserved cadaver specimens were anatomized to observe the feasibility of pericranial flap transplantation through the bony channels on lateral orbital walls.Two fresh cadaver specimens were perfused with latex and ink respectively to observe the possible blood supply to laterally based pericranial flaps.Two patients with unilateral old orbital fracture were treated using this flap.The enophthalmos degrees were measured before and after operation to evaluate the effect of this therapy.Results： It was feasible to transplant the pericranial flap into orbit through the bony channel on lateral orbital wall,reaching the medial wall and orbital floor.Vascular perfusion did not reveal that the laterally based pericranial flap over the supra temporal line was vascularized by any axial vessel.The ink perfusion of one side showed that the middle temporal artery extended deeply under the deep temporal fascia,but didn＇t cross the supra temporal line.The subgaleal vascular plexus was observed obviously in the superficial layer of pericranial flap.The enophthalmos degrees of the two patients were respectively 5.35 mm and 6.86 mm prior to operation.They both showed desirable outcomes postoperation（ 2 mm）.Conclusion： It is feasible to transfer the laterally based pericranial flap into orbit through the lateral orbital wall channel.The laterally based pericranial flap is possibly vascularized by the subgaleal vascular plexus.The primary treatment of traumatic enophthalmos using the laterally based pericranial flap is satisfactory.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期761-765,共5页
Journal of Peking University:Health Sciences
基金
首都医学发展科研基金资助(2007-3008)~~
关键词
眼球内陷
假体植入
骨膜
解剖学
Enophthalmos
Prosthesis implantation
Periosteum
Anotomy
