【作者】 陈兵；

【导师】 徐达传；

【作者基本信息】 第一军医大学 ， 解剖学， 2001， 博士

【摘要】 目的： ①对颧部进行专题解剖研究，以期为颧部修复重建手术的开展提供应用基础理论； ②研究颧骨整形的立体可视化和手术仿真模拟； ③探讨颧骨缩小术和颅骨、锁骨、肋骨、髂骨等骨皮瓣颧骨修复再造术的方法和解剖要点。 材料与方法： ①解剖15例30侧防腐成人头部标本和9例18侧新鲜成人头部标本； ②观察头面部血管铸型标本10例18侧； ③解剖2具成人尸体标本； ④复习有关解剖资料； ⑤应用3DCMFCAS操作系统。 结果： ①颧骨是面部较突出的部位，影响容貌的特征之一，由菱形的骨体与4个骨突组成，有3个面和5个缘。 ②除颧大肌起自颧骨体与颧弓的交界处，咬肌起于颧弓下缘、颧弓颧骨的内侧面外，其余部位无肌肉附着，颧骨呈“游离”状。 ③颞深筋膜起自颞肌附着缘，由单层逐渐分为深浅两层向下分别附着于颧弓上缘的内侧面和外侧面，两者之间含有脂肪垫，并在其上部有颞中静脉走行。经颞深筋膜的深、浅两层之间的间隙直接达颧弓上缘是安全的手术入路。 ④面神经的颞支和颧支在颧弓下缘出腮腺，出腮腺后由腮腺筋膜分隔包裹走行于SMAS和深筋膜之间的SMAS下层内，斜向前上方行走并逐渐分支，于肌肉的深面进入并支配之。 ⑤3DCMFCAS可进行颧骨缩小术等手术的仿真模拟，可用于手术前的讨论和制定手术方案和临床教学等。但目前只能进行硬组织的切割和移位，不能预测手术后面部软组织和外观的变化，不能用于颧骨切削缩小术和双侧颧骨扩增术的模拟，不能与精细的电脑加工机械连接在体外复制出模型和加工制作植入体，有待于进一步开发研究。 ⑤颧骨有丰富的血供，滋养动脉从颧骨的后内侧缘进入骨内经颧面孔穿出成为颧面动脉。面横动脉、颗饯动脉、眶下动脉。面动脉及上颌动脉均有分支达颧骨周围组织，井有细小血管经骨膜供养颧骨。 ①在颧弓平面下颌骨冠突与颧骨间的距离为（1．3士3．6）nun及该处颧骨的厚度为（8．8士2．3）mm，冠突与颧弓间的距离为（6．5土 1．2）mm及该处颧弓的厚度为Q．3土0．4）M。 ③颅骨、锁骨、肋骨和骼骨具有一定的弧度适合于颧骨的修复重建，根据颅骨、锁骨、肋骨和骼骨等部位的解剖和血供特点可设计额部扩张皮瓣复合额顶颅骨瓣转移、颈部扩张皮瓣带锁骨转移、胸背动脉蒂第11、12肋骨皮瓣游离移植或带蒂转移、双蒂骼骨皮瓣游离移植修复颧骨部位的骨及软组织缺损，各有其优缺点。 结论： ①观察了颧部的组织层次及颧骨的形态、颧骨与肌肉的关系、颧骨与颗浅、深筋膜的关系、颧骨与面神经的关系。颧骨的血液供应、颧骨与下颌骨冠突的关系（颧骨后间隙）井于颧弓平面测量颧骨颧弓的厚度等。 ②3DCMFCAS具有三维重建达到立体可视化效果，可手术仿真模拟。可用于手术前的讨论和制定手术方案和临床教学等优点。但仍有许多不足有待于进一步开发研究。 ③分析总结了颧骨手术入路的解剖要点。颧部理想手术层次是在骨膜下，可减少面神经的损伤。 ④颧骨磨削术适合于颧骨骨质较厚者，最大磨削厚度为颧骨厚度的一半。颧骨截骨缩小术适合于颧骨颧弓向前向外隆凸颧骨后间隙增宽者，提出了解剖安全线和临床实用截骨线。 ⑤额部皮肤扩张复合颅骨瓣、颈胸部预扩张皮瓣带半片锁骨转移。胸背动脉蒂第 11。12肋骨皮瓣、双蒂骼骨皮瓣游离移植在修复颧部方面有良好的血供基础和意义，各有其优、缺点。更多还原

【Abstract】 Object:o provide anatomic basis for the reconstruction of the zygomatic region , the special topic research of zygomatic region was taken.(2)To study the operation mimesis of the zygomatic plastic.(3)To research the technique and anatomic key points of the zygomatic reduction and the zygomatic reconstaiction with bone flaps of the calvarial bone, clavicle, rib, iliac.Methods:?0 sides of 15 antisepsis adult head specimens and 18 sides of 9 fresh adult head specimens were studied.(2)18 sides of 10 blood vessel cast head specimens were observed.(3)2 adult cadavers were anatomized.(4)The related anatomic materials were reviewed. ㏕he 3DCMFCAS was applied.Results:㎝alar is the prominent part and appearance feature of face, consists of a rhombic bone body and 4 processuses.(2)M. zygomatic major origins from the boundary point between zygomatic body and arch, M. masseter origins from the margo inferior of the zygomatic arch and the medial aspect of zygomatic bone; except the two muscles, there are no muscles attaching to zygomatic bone, which is "dissociated".(3)The deep temporal fascia origins from the attachment edge of M. temporal and divides into two lamellas(the deep and superficial lamellas), which attach to the lateral and medial sides of the zygomatic arch respectively. There is a fat pad between the two lamellas. V. temporalis media travels in the upside of the fat pad. The secure operation pathway is passing through the-3-interspace between the deep and superficial lamellas to the superior edge of the zygomatic arch.(4)R. temporales and R. zygomatici come out of the parotid gland at the margo inferior of the zygomatic arch(segregated and bundled by the parotid fascia), run forward and up, ramify gradually in the lamella under the SMAS, and go into the depth of muscle and innervate it.(?3DCMFCAS can be used to simulate the zygomatic reduction, the sclerous tissues can be cut and displaced, but the change of the appearance and the soft tissue of face cannot be predicted. 3DCMFCAS cannot be used to simulate the zygomatic cutting reduction and the zygomatic augmentation. 3DCMFCAS cannot be used to link with a meticulous machine to reproduce a model or form an implant.㏕here have rich blood supply in zygomatic bone. The nutrient artery goes into the zygomatic bone from the posterior margo medialis, becomes the zygomaticofaciale artery out of the zygomaticofaciale foramen. The periosteum arteries origin from the A. transversa faciei, the A. temporalis superficialis, the A. infraoribitalis, the A. facialis, the A. maxillaris and so on.㏕he distance between the processus coronoideus and the malar is 12.3 + 3.6m and the thickness of malar in this point is 9.8?.3mm; The distance between the processus coronoideus and the malar arch is 5.2+ 1.2mm and the thickness of malar arch in this point is 3.3 ?.4mm<>㏕he calvarial bone, clavicle, rib and iliac have a radian and are suited to the zygomatic reconstruction. The expanded forehead flap with scapular bone, the expanded cervix flap with clavicle, the eleventh or twelfth rib flap with the arteriae thoracodorsalis pedicle and the iliac flap with double pedicles are designed by the characteristic of the anatomy and blood supply. Those flaps are suited for the zygomatic reconstruction with different advantages and disadvantages.Conclusion:㏕he tissue structure of the zygomatic region and the shape of the zygomatic bone were observed. The relation between zygomatic bone and muscle, the relation between zygomatic bone and the deep and superficial temporal fascia, the relation between zygomatic bone and the face nerve, the blood supply of zygomatic bone, the relation between zygomatic bone and the coronoid process were researched.(2)3DCMFCAS can be used for simulating the operations, discussing and making an operation plan preoperation, teaching, and so on; but it has a lot of disadvantages, should be developed.(3)Anatomic key points of the zygomatic operation were summarized. To decrease the dam更多还原