腭裂的腭咽肌肉张力带重建  

Repairing cleft palate by velopharyngeal muscle tension bands reconstruction

作　　者：吴镝 尹宁北 Wu Di;Yin Ningbei(Department of Cleft Lip and Palate,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院唇腭裂中心,100144

出　　处：《中华整形外科杂志》2021年第12期1307-1313,共7页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81971853)。

摘　　要：在应用唇鼻肌肉张力带进行唇裂修复术后,笔者团队通过对腭咽部肌肉进行微米CT(Micro-CT)扫描和三维重建,对腭咽部6组肌肉的起止点和肌纤维走向进行分析,包括腭帆提肌、腭咽肌、腭帆张肌、腭垂肌、腭舌肌和咽上缩肌。发现腭咽肌和腭帆提肌相互配合调节软腭运动,翼钩区存在精细的滑轮结构,不应轻易破坏。对6组肌肉进行生物力学分析和空间结构分析,提出腭腱膜与腭垂肌构成腭咽肌肉主张力带、腭帆提肌和腭咽肌构成腭咽肌肉第一副张力带、腭咽肌和咽上缩肌构成腭咽肌肉第二副张力带,据此提出腭咽肌肉空间张力带重建的腭裂修复术。新术式重建了3组腭咽肌肉张力带的生物力学关系,最大限度地保护翼钩区精细解剖结构,初步实现了腭咽肌肉的生物力学仿生修复。Following repairing cleft lip by labial-nasal muscle tension bands reconstruction,our team analyzed six groups of velopharyngeal muscles by Micro-CT scanning and three-dimensional reconstruction,including levator veli palatini muscle,palatopharyngeus muscle,tensor veli palatini,palatoglossus,uvularis and superior constrictor of pharynx.It was found that palatopharyngeus and levator veli palatini cooperate with each other to regulate the movement of the soft palate.The structure around the pterygoid hamulus was a fine pulley-like structure that should not be destroyed easily.The velopharyngeal muscle tension bands were proposed by analyzing the biomechanics and spatial structure of six groups of muscles.The main muscle tension band was composed of palatine aponeurosis and uvularis.The first auxiliary tension band was composed of levator veli palatini and palatopharyngeus.The second auxiliary tension band was composed of the palatopharyngeus and superior constrictor of the pharynx.A new cleft palate repair technique based on reconstruction of the velopharyngeal muscle tension bands was proposed.This new method reconstructed the biomechanical relationship of the three groups of muscle tension bands and protected the structure around the pterygoid hamulus to reduce the damage.Biomechanical simulation of velopharyngeal muscle was realized primarily.

关 键 词：腭裂 解剖学 修复外科手术 腭咽肌肉张力带 

分 类 号：R782.2[医药卫生—口腔医学]