经颞下窝入路毫针盲刺蝶腭神经节可行性及安全性评估  

Feasibility and safety assessment of fossa infratemporalis approach for blind-needle at sphenopalatine ganglion

作　　者：张路[1] 房东亮[2] 姜大魏 许智先 郭孟萌 陈立和[1] 林佩君[1] 

机构地区：[1]中国中医科学院西苑医院针灸科,北京100091 [2]首都医科大学形态学系

出　　处：《中国针灸》2016年第11期1171-1176,共6页Chinese Acupuncture & Moxibustion

基　　金：中央级公益性科研院所基本科研业务费专项资金资助项目:ZZ 07085

摘　　要：目的：明确经颞下窝入路毫针盲刺蝶腭神经节的可行性及安全性,为临床操作和临床非即刻不良反应的预防提供解剖学依据。方法：观察60具干颅骨,选取面颅宽度测量点,观察翼腭窝变异情况。对6具成人湿颅取脑后,行经颞下窝入路针刺操作,打开翼腭窝后壁暴露翼腭窝,精细分离辨认蝶腭神经节,原位保留上颌动脉翼腭段,观察针灸针是否进入翼腭窝。测量进针深度、面颅宽度、针与蝶腭神经节间距离、针与上颌动脉翼腭段间距离、上颌动脉翼腭段与翼腭窝内走形的上颌神经间距离。结果：选取两侧眉弓下稍凹陷处距离作为面颅宽度,3具干颅存在翼腭窝变异。对湿颅行双侧针刺操作（共12次）,针均进入翼腭窝;进针深度与两侧眉弓下稍凹陷处距离间比例关系区间为44%-54%。12次操作中仅2次针尖触碰蝶腭神经节,针与蝶腭神经节平均距离：左侧（5.88±3.70）mm、右侧（6.43±5.54）mm。针与上颌动脉翼腭段平均距离：左侧（2.77±3.99）mm、右侧（2.53±3.10）mm,上颌动脉翼腭段与翼腭窝内走形的上颌神经间平均距离：左侧（2.83±4.05）mm、右侧（2.67±4.95）mm,以上各测量维度中双侧数据间均数比较差异均无统计学意义（均P〉0.05）。结论：1经颞下窝入路毫针盲刺蝶腭神经节操作时针具可进入翼腭窝,但直接触碰蝶腭神经节的概率不高;2临床治疗鼻炎疗效可能与针具近神经相关;3临床非即刻不良反应可能是针具刺中上颌动脉翼腭段造成;4面颅宽度与进针深度存在比例区间关系,综合考虑临床操作安全性、有效性,建议针对不同患者进针深度选取面颅宽度与进针深度比例区间下限。Objective To identify the feasibility and safety of fossa infratemporalis approach for blind-needle at sphenopalatine ganglion so as to provide anatomical evidence for the operation and the prevention of non-immediate adverse reaction. Methods The variations of pterygopalatine fossae in sixty dry skulls were observed by selecting measuring points for facial skull width. The brains of six wet skulls were taken out,then acupuncture of fossa infratemporalis approach was applied. Sphenopalatine ganglion was separated accurately with the pterygopalatine segment of maxillary arteria retained in the pterygopalatine fossa after its paries posterior was opened. We detected whether the needle was inserted into pterygopalatine fossa. Measurements showed needle inserted depth, facial skull width, the distance between the needle and sphenopalatine ganglion, the distance between the needle and the pterygopalatine segment of maxillary arteria,the distance between the pterygopalatine segment of maxillary arteria and the crotaphitie nerve in pterygopatatine fossa. Results The distance between the slight hollow under bilateral arcus superciliaris was selected as skull width, and 3 dry skulls showed the variation of pterygopalatine fossa. Needles were inserted into the pterygopalatine fossae of the wet skulls （12 times）. The proportion of the inserting depth to the distance between the slight hollow under bilateral arcus superciliaris was 44%-54%. Only twice did the needle contact sphenopalatine ganglion. The average distances between the sphenopalatine ganglion and the needle were （5.88±3.70） mm in the left side and （6, 43±5.54） mm in the right side. The average distances between the needle and the pterygopalatine segment of maxillary arteria were （2.77± 3.99） mm left and （2.53±3.10） mm right. The average distances between the pterygopalatine segment of maxillary arteria and the crotaphitie nerve in pterygopalatine fossa were （2, 83±4.05） mm left and （2.67±4.95） mm right. The mean data between the

关 键 词：针刺 蝶腭神经节 可行性 安全性 

分 类 号：R224[医药卫生—中医基础理论]