【作者】 陈宝峰；

【导师】 韦强；

【作者基本信息】 广西医科大学 ， 整形美容外科， 2012， 硕士

【摘要】 目的：了解B型超声波观测口轮匝肌的可行性,并探讨其在单侧唇裂术后疗效评估中的应用价值。方法：应用B型超声波对168名19-25岁正常人及36名同年龄段单侧唇裂术后患者的上唇口轮匝肌进行观测,在不同生理状态下记录口轮匝肌超声声像图并定点测量口轮匝肌浅、深层厚度,记录其数值,所得数据进行统计学分析。此外,在B超下测量唇裂术后患者口轮匝肌瘢痕的宽度、厚度；并测量6项唇部术后外观评价指标；分析口轮匝肌修复重建效果、瘢痕愈合情况与外观评价的关系。结果：1、正常人与唇裂术后患者上唇B超声像图表现：正常人上唇组织的超声声像图为一多层次结构：由浅到深是表现为连续致密高回声线的皮肤、稍低回声的口轮匝肌浅层、条索状低回声的口轮匝肌深层,稍低回声的粘膜下层和稍强回声的粘膜层；唇裂术后青年上唇组织健侧尚可清晰分出各层组织,在患侧相当于人中嵴处,可见到口轮匝肌浅、深层连续性不同程度中断,被高回声的瘢痕组织取代,各层组织分层不清。2、在不同生理状态下(自然闭嘴和撅嘴),男女口轮匝肌厚度无明显差别。口轮匝肌浅层在人中凹处最薄,两侧人中嵴处最厚,呈一个“中间低,两边高”的形态；口轮匝肌深层为一均厚的带状肌肉。在撅嘴状态下,口轮匝肌浅层肌肉增厚,深层无明显变化。3、单侧唇裂术后患者上唇口轮匝肌浅层超声测值,越靠近患侧瘢痕处的测量值越小,差异具有统计学意义(P<0.05)。4、唇裂术后患者6项外观评价指标与口轮匝肌瘢痕宽度相关性有统计学意义(P<0.05)；口轮匝肌重建修复效果好,瘢痕宽度小的,外观评价优良；口轮匝肌重建修复效果差,瘢痕宽度宽的,外观评价较差。结论：应用B型超声检查上唇口轮匝肌切实可行,可以获得与实体解剖层次相吻合的超声声像图；唇裂修复术后的口轮匝肌浅层肌肉厚度与正常人群的差异考虑与手术创伤及先天发育不足有关；利用B型超声波观察单侧唇裂术后口轮匝肌修复重建效果和检测瘢痕宽度进行唇裂术后效果评价,与临床观察结果相符,有一定的临床应用价值。更多还原

【Abstract】 Objection:To realize the feasibility of which the observation of the orbicularis oris with the high frequency ultrasound and explore it’s application in the postoperative evaluation of unilateral harelipMethods:Using the high frequency ultrasound to observe the upper lip orbicularis oris of168normally adults and36adult postoperative patients of unilateral harelip. Scan the upper lip orbicularis oris and observe the shape and structure of the orbicularis oris in ultrasonogram. According to the gross anatomy and microscopic anatomy of human specimens, measure the orbicularis oris’thickness; and then measure the36adult postoperative patients’cicatrix width and thickness of orbicularis oris, then analyze the relation with6indexs of upper lip deformity. Analyze the the relation between plerosis effect of orbicularis oris and hand evaluation of postoperative patients.Results:The upper lip organizations are different between the normal youth and unilateral cleft lip postoperative youth in ultrasonogram: the upper lip organizations are divided into five layers from shallow to deep in the normal youth. The orbicularis oris of postoperative patients is interrupt and malposition. The thickness of the men and women’s orbicularis oris are the same; the shallow layer shows a "among low, both sides high" form and it will become thickened in pouted state. The postoperative patients’shallow layer are thinner than the normal youth.6indexs of upper lip deformity and cicatrix width are statistically significant correlation; It is associated with better orbicularis oris plerosis, smaller cicatrix width and good hand evaluation of postoperative patients.Conclusion:Using the Ultrasound technology to observe the orbicularis oris can obtain a clear Dimensional Ultrasonographic of the anatomical structure, it not only can be used to observe the plerosis effect of orbicularis oris, but also used to evaluate the operation effect. The orbicularis oris with cicatrix will impact the growth of the shallow layer but not the deep layer of the orbicularis oris.更多还原