19被浏览9,210分享邀请回答51 条评论分享收藏感谢收起29 条评论分享收藏感谢收起手术后面瘫是否能够恢复恢复机率有多大恢_百度知道
手术后面瘫是否能够恢复恢复机率有多大恢
我有更好的答案
一般适当应用药物或能自己恢复。颅脑手术，如果神经没有完全切断，可部分恢复或全部恢复，特别是桥小脑角区、面神经、听神经手术，术中损伤刺激面神经导致面瘫，根据损伤情况恢复各异，如果神经完全切断，或因肿瘤导致神经需完整切除，建议尽早做神经修复手术，恢复几率要看手术者的技术，以及患者的恢复能力非颅脑手术引起的面瘫，可能与面神经炎、手术麻醉有关
为您推荐：
其他类似问题
您可能关注的内容
换一换
回答问题，赢新手礼包
个人、企业类
违法有害信息,请在下方选择后提交
色情、暴力
我们会通过消息、邮箱等方式尽快将举报结果通知您。您现在的位置是： &
吻合血管神经小肌肉游离移植动态修复晚期面瘫围手术期护理
摘　要:面瘫是由于先天或后天感染、外伤、面部肿瘤手术、创伤等引起的面部自主运动丧失，表情丧失，额纹消失，无皱眉及扬眉功能，眼裂扩大，下睑外翻，鼻唇沟消失，口角下垂，不能吹口哨和鼓腮等形态畸形和功能障碍。晚期面瘫的外科修复是整形外科的一大难题。Thompson于1971年最早报道以拇短伸肌、趾短伸肌去神经游离移植治疗面瘫，之后应用于腭咽环轧效果良好，但其术后肌肉液化肌萎缩现象较明显，导致肌肉力量不足而影响功能恢复。
特别说明：本文献摘要信息，由维普资讯网提供，本站只提供索引，不对该文献的全文内容负责，不提供免费的全文下载服务。
金月芽期刊网 2018上传用户：vgwmptdmuv文档下载 ：『』&&『』『』学位专业：&关 键 词 ：&&&&&权力声明：若本站收录的文献无意侵犯了您的著作版权，请点击。摘要:（摘要内容经过系统自动伪原创处理以避免复制，下载原文正常，内容请直接查看目录。）研讨配景早期面瘫构成的缘由庞杂，经常给神经、肌肉的修复带来异常年夜的艰苦。因为面神经毁伤终究招致面肌萎缩、变性，成为无功效的纤维组织，故早期面瘫修复最经常使用的术式是带血管神经蒂的动力肌游离移植。国际外学者已开辟出多种带血管神经肌肉游离移植修复面瘫的供区，包含颞肌、胸锁乳突肌、胸小肌、背阔肌、股薄肌、腹内斜肌、前锯肌、股二头肌短优等供区一期或二期法修复部门脸部脸色。王炜所设计的节段性断层背阔肌游离移植，可一期完成跨面神经移植和带血管神经肌肉移植修复面下2/3瘫，术后后果好，在静态及浅笑时两侧脸色丰硕、对称。杨年夜平劈开股直肌的两块亚单元Ⅰ期游离移植医治面瘫，静态与静态下吵嘴对称。虽然整形内科专家开辟了很多肌瓣供区，年夜部门供肌因为受剖解形状所限，在临床运用上各有其顺应性。而背阔肌、前锯肌肌纤维斜行，血供为多源性，安排神经长，股直肌、股薄肌神经血管呈节段性散布，是以背阔肌、前锯肌、股直肌、股薄肌作为供区肌在面瘫的修复中有辽阔的远景。肌肉游离移植后肌瓣的痴肥与血肿对面瘫的恢复晦气，战胜肌瓣的痴肥，取得数量多而渺小的肌瓣更有益于脸部脸色肌的重建。若何对供区停止剖解并取得合适的小面积肌瓣，在术前必需有明白的懂得。上述供肌内神经、血管的散布类型、外径、伴行关系等剖解材料尚不周全，影响肌瓣的设计和手术展开，是以有需要对背阔肌、前锯肌、股直肌、股薄肌进一步显微剖解。带血管神经蒂肌肉游离移植修复面瘫的后果受诸多身分影响，肌瓣的血液供给情形是一个异常主要的方面。肌肉血供的显示以往较经常使用的办法是墨汁通明法，血管铸型扫描电镜法可拍摄器官构造微血管修建的平面照片。很多学者在明胶氧化铅血管灌注的基本长进一步采取X片的拍摄，对背阔肌、股直肌、股薄肌等动脉造影，显示出肌内血管的二维图形，肌内血管显示清楚。但这些办法尚难以描写供体肌及其血管、神经的庞杂平面关系，不克不及直不雅、抽象地显示供体肌及其血管、神经的平面修建，未便于公道地停止分叶肌瓣的术前设计。剖解学、影象学与盘算机三维软件的联合使血管的三维可视化成为能够。应用动脉标识技巧，CT扫描，选择适合的三维软件重建供区肌内血管与肌瓣的三维数字化模子，是完美肌瓣设计的有用手腕。带血管神经蒂肌肉游离移植修复面瘫的后果与移植肌的压缩力也有异常亲密的关系，游离肌肉移植后压缩力过强或过弱影响脸部外不雅和脸色。因此术前精确估量到达预期后果所需移植肌年夜小及术后移植肌压缩后果猜测是术者和患者最关怀的成绩，也是今朝还没有处理的困难。无限元剖析是模仿软组织变更的最有用的办法。Kober等运用无限元办法模仿剖析品味肌的运动形状。周伊顗胜利树立了眼球一眼外肌肌肉驱动无限元模子，模仿眼肌的运动，剖析眼外肌肌力年夜小、应力应变散布。若何树立移植肌一上面部皮肤皮下组织无限元模子，停止力加载和位移加载，在模仿剖析中到达预期面瘫修复后果所需的移植肌瓣年夜小及术后移植肌压缩后果，是本研讨进一步商量的偏向。目标1。经由过程背阔肌、前锯肌、股直肌、股薄肌肌内血管神经的显微剖解，不雅测肌内神经、血管的散布类型、外径、伴行关系及血管神经蒂的长度，为分叶肌瓣与组合肌瓣游离移植修复早期面瘫供给剖解学材料。2。构建供体肌及其神经、血管的三维数字化模子，直不雅、抽象地显示血管、神经的走行、散布、吻合与邻接关系，停止基于肌肉血管、神经修建的分叶肌瓣平面设计，为分叶肌瓣游离移植修复早期面瘫供给三维可视化剖解基本和手术参数。3。树立肌肉驱动的移植肌一上面部皮肤皮下组织复合体三维无限元模子，运用模子模仿剖析面瘫动力肌移植所需肌肉年夜小和术后移植肌压缩后果。资料与办法1。显微剖解在20例经血管灌注的防腐与新颖成人尸首标本上，以佩戴式显微镜剖解不雅察背阔肌、前锯肌、股直肌、股薄肌肌内血管神经散布特色。不雅测以下目标①背阔肌的形状特色，背阔肌内神经与血管的散布类型，肌内节段动脉长度、外径与神经支的长度、横径，神经与血管在肌内的伴行关系；②前锯肌的形状特色，前锯肌的动脉起源、散布类型，动脉的外径、长度，胸长神经及其分支的横径、长度及散布特色，血管与神经的邻接关系；③股直肌的形状特色，股直肌内动脉的起源、长度、外径，动脉的散布类型，神经支的散布特色与肌内的血管神经束；④股薄肌的形状特色，股薄肌内动脉起源、外径、长度，神经支的横径、长度及在肌内的可分别长度，肌内血管神经的邻接关系。2。供体肌血管三维重建、神经标示与分叶肌瓣设计对2具新颖成人标本采取改进的羧甲基纤维素一氧化铅血管标识技巧标识血管，经螺旋CT扫描取得序列Dicom数据，导入Mimics软件，应用软件供给的阈值法、区域发展法、Boolean运算、Mask编纂法等朋分对象朋分感兴致构造，面重建肌肉及其血管，并停止基于肌内显微剖解成果的三维神经标示，构建供体肌及其神经、血管的三维数字化模子。经由过程交互不雅察、应用模仿手术对象，停止基于肌肉血管、神经修建的分叶肌瓣平面设计，并丈量血管蒂的长度和肌瓣的长度、宽度、厚度。3。无限元剖析应用Mimics10。0软件平台，停止基于影象的个别化上面部皮肤皮下组织建模，导入ANSYS软件，与基于术前筹划或术式的移植肌实体模子停止搭接运算，生成移植肌一皮肤皮下组织复合实体模子；拔取单位类型、资料属性，停止自在网格划分，树立肌肉驱动的上面部皮肤皮下组织复合无限元模子；在模子有用性验证满足后，施加束缚前提，分离停止27N肌力加载和8mm纵向位移加载求解，不雅察肌肉压缩后果，估量到达预期后果所须要移植肌的横断面积。成果1。背阔肌、前锯肌、股直肌、股薄肌的显微剖解①背阔肌动脉骨干长度为25。0±5。8mm，背阔肌动脉内侧支的长度为24。8±6。0mm，肇端外径为1。5±0。2mm，外侧支的长度为30。4±8。1mm，肇端外径为1。8±0。3mm。背阔肌节段动脉的散布可分为两年夜类型第Ⅰ型（平衡型），第Ⅱ型（羽状型）。段动脉散布到响应的节段肌瓣，分为内1段、内2段、内3段、外1段、外2段、外3段、外4段。段动脉的外径年夜于0。5mm，内侧段动脉较外侧段动脉长。胸背神经在肩胛骨下角立体邻近分为内上支与外下支，其分支与段动脉的伴行率90%以上。②前锯肌肌束在终点的宽度25。7±2。9mm，厚度为6。0±0。7mm，肌束在前锯肌支入肌点处宽度20。7±3。0mm，厚度7。9±0。7mm。胸背动脉前锯肌支一支型占62。5%，二支型占37。5%。第一支前锯肌支的外径为1。5±0。4mm，长度为50。0±5。2mm，第二支前锯肌支的外径为2。0±0。5mm，长度为57。1±6。3mm，分支沿肌束间入肌。胸长神经的横行分支数有3一10支，胸外侧动脉与胸长神经之间相距48。0±6。3mm，胸背动脉的前锯肌支与胸长神经之间末尾的间隔0一3。3mm。③股直肌的动脉血管分为3品种型Ⅰ型，单支优势动脉5%；Ⅱ型，股直肌下动脉为优势血管80%；Ⅲ型，股直肌上动脉或股直肌中动脉与股直肌下动脉均为优势血管占15%。股直肌神经骨干长度为14。8±1。3（12。7一17。9）cm，均匀外径1。6±0。2mm，股直肌神经支的浅支与深支至股直肌中1/3部内侧缘与股直肌下动脉的前支、后支一路伴行入肌，75%股直肌标本中有神经血管的中央收入现，走行在肌的中1/3部。④股薄肌上中1/3的血供起源于股深动脉、闭孔动脉、旋股内侧动脉、旋股外侧动脉等。股深动脉收回的股薄肌支是股薄肌上、中1/3部最重要和恒定的血供，管径较粗，在股薄肌上部长度均匀达132。9（120。0一155。6）mm。股薄肌下1/3部动脉分支较短较渺小。股薄肌神经肇端处的横径1。9±0。3（1。3一2。6）mm，从肇端处至入肌点的神经骨干长度为5。7±0。5（4。3一6。9）cm，股薄肌前部神经支可分别长度为8。6±1。4（6。6一11。7）cm，后部神经支可分别长度为9。4±1。4（6。8一12。8）cm。40%标本的股薄肌内有2个血管神经束，45%股薄肌内有3个以上的血管神经束。2。供体肌血管三维重建、神经标示与分叶肌瓣设计①CT图象二维断面图象清楚、比较度好、无显著伪影，可显示0。5mm渺小血管，血管朋分轻易、定位便利、丈量精确。②供体肌一血管一神经三维数字模子可精确、清晰、平面地显示血管的走行、散布和空间邻接关系；肌肉内神经的分支散布，神经支与血管的伴行关系都可显示。模子平面感强，直不雅、抽象，能依据须要停止交互不雅察，随意率性缩放、扭转、挪动，可零丁显示或组合显示，还可通明不雅察和分色不雅察。③分叶肌瓣的平面设计肌瓣平面感强，直不雅、抽象；能随意率性交互不雅察；可精确丈量血管蒂的长度，肌瓣的长、宽、厚度，为手术供给准确参数。背阔肌节段肌瓣的三维模子显示了背阔肌内、外侧区5个节段肌瓣的血管蒂与肌瓣的平面形状，外1段、外2段上部较厚，中下部较薄，内1段较内2段、内3段薄；股直肌可分别为2一3个分叶肌瓣，中央部肌瓣较薄较短；股薄肌内可截取前后2个分叶肌瓣。3。树立的移植肌一皮肤皮下组织复合体三维无限元模子由移植肌和上面部皮肤皮下组织构成，与CT重建的实体影象比拟，几何类似性优越。模子可以随意率性扭转和缩放，可依据分歧研讨情形添加肌肉和调剂肌肉地位。全部模子共有2978个节点，10666个单位。个中移植肌564个节点，1918个单位，一切单位形状较为规矩。以肌力27N加载时，上唇纵向最年夜位移为3。9047mm，应力应变散布沿肌肉终点至止点渐增长；加载纵向位移8mm剖析时，总反感化力即为所需肌力，共为55。431N，求得所需肌肉横断面积约为149。8mm~2。肌肉驱动上面部皮肤皮下组织的活动进程可动画显示，直不雅真切。结论1。以背阔肌神经动脉内、外侧支为蒂可剪裁一蒂双叶肌瓣、双蒂双叶肌瓣或一蒂三叶肌瓣；以背阔肌血管前锯肌支为蒂可截取4一5个条束状的肌瓣，以背阔肌血管为蒂可设计背阔肌与前锯肌结合肌瓣以股直肌神经血管为蒂可将股直肌分别为2一3个分叶肌瓣，以股薄肌神经血管为蒂，可将股薄肌决裂为2一3个分叶肌瓣。这些分叶肌瓣有足够的神经血管蒂长度，可供重建早期面瘫的面上1/3与面下2/3脸色肌功效。2。在供体肌、血管三维重建的基本上，停止基于响应肌剖解的三维神经标示，可构建出供体肌一血管一神经三维数字模子，直不雅、抽象地显示了肌内神经、血管的重要分支和伴行关系，可停止基于血管神经散布的分叶肌瓣术前的平面设计和不雅测，为动力肌游离移植修复面瘫供给手术参数，为教授教养、科研供给数字化模子。3。基于影象与术前筹划或手术所树立的移植肌一上面部皮肤皮下组织无限元模子几何类似性和力学类似性好，为动力肌游离移植修复面瘫手术供给了一种可定量化术前设计、术后后果评价的办法。重要立异点1。经由过程对早期面瘫肌移植经常使用供体肌内、外神经血管的针对性剖解不雅测，取得有益于供辨别叶肌瓣剪裁设计的体系性剖解学材料，为动力肌游离移植修复早期面瘫供给形状学基本。2。在供体肌、血管三维重建的基本上，停止基于响应肌剖解的三维神经标示，构建出供体肌一血管一神经三维数字模子。该模子直不雅、抽象地显示了肌内神经、血管的重要分支散布及神经、血管的年夜致伴行关系。3。提出了基于血管、神经分支散布平面设计分叶肌瓣的新理念，在供体肌一血管一神经三维数字模子长进行分叶肌瓣的平面设计和丈量，为动力肌游离移植修复早期面瘫供给了手术参数，可为教授教养、科研供给数字模子。4。初次树立了肌肉驱动的移植肌一上面部皮肤皮下组织复合体三维无限元模子，为动力肌游离移植修复早期面瘫手术供给了可定量化术前设计、术后后果评价的办法。Abstract:The reason on the background of early facial paralysis complicated, often to repair the nerve and muscle caused abnormal Nianye hard. Because the facial nerve damage eventually lead to hemifacial atrophy, degeneration, become no effect of fibrous tissue, so early facial paralysis to repair the most frequently used technique is with neurovascular pedicle power free muscle transplantation. The scholars at home and abroad has opened up a number of neurovascular free muscle transplantation for the repair of facial paralysis of the donor area and contains temporal muscle and sternoclavicular sternocleidomastoid muscle, pectoralis minor muscle, latissimus dorsi, shares thin muscle, internal oblique, serratus anterior muscle, short excellence of biceps femoris for district one stage or two stage method to repair department facial expressions. Wangwei segmental fault back transplantation of free latissimus dorsi, completion of the first phase of cross facial nerve grafting and with neurovascular muscle transplantation for repair of 2 / 3 of paralysis, postoperative effect is good, in the static and smiling face on both sides of the rich, symmetrical. Yang big flat two block split rectus femoris sub unit one-stage free transplantation treatment of facial paralysis, static and static symmetry. Although plastic surgery experts opened up a lot of muscle flap donor site, Nianye sector for muscle because limited by dissection configuration, in clinical use have the compliance. The latissimus dorsi, serratus anterior muscle fiber oblique, blood supply for multi-source, arrangement of long nerve, rectus femoris, femoral thin muscle nerves and blood vessels were segmental distribution is to the dorsal latissimus dorsi, saw muscle, the rectus femoris muscle and gracilis muscle for muscle area has broad prospects in the repair of facial paralysis. Free muscle transplantation after muscle flap of obesity and hematoma of facial paralysis recovery unlucky, overcome the muscle flap of obesity, made number and small muscle flap is more beneficial to the reconstruction of facial muscles in the face. How to stop for dissection and gain small muscle flap right before operation, must have a clear understanding. The intramuscular nerve and blood vessel distribution type, diameter, with relations anatomize material is not comprehensive, influence muscle flap design and operation is to need a muscle, the rectus femoris, shares the gracilis muscle further microdissection of the dorsal latissimus dorsi, before saw. With neurovascular pedicle free muscle transplantation for the repair of facial paralysis is affected by many factors, consequences, blood supply situation of muscle flap is a very important aspects. Blood supply to the muscle shows the method is often used in the past is ink vitrification and vascular cast and scanning electron microscopy (SEM) can shoot organ structure of micro vessel built plane photos. Many scholars in the vascular perfusion of gelatin lead oxide based take further X-ray photography. The latissimus dorsi muscle, the rectus femoris, shares a thin muscle arteriography showed the intramuscular vessels of the two-dimensional graphics, intramuscular vascular displayed clearly. But these measures is difficult to describe donor planar complex relationship between muscle and its blood vessels, nerves, cannot directly, abstract display donor muscle and its blood vessels and nerves of the plane construction, do not facilitate fair to stop before leaf muscle flap surgery design. Anatomy and imaging combined with computer 3D software to 3D visualization of blood vessels can be. The application of CT scan, artery identification techniques, 3D digital model selection for the reconstruction of 3D software for intramuscular vascular and muscle flap, muscle flap is a perfect design useful wrist. The consequences and transplantation of muscle pedicled with neurovascular free muscle transplantation for the repair of facial nerve compression force is also very close, compression force free muscle transplantation strong or weak effects of facial appearance and face. The preoperative accurate estimate of transplanted muscle compression consequences or patients are most concerned about the achievement to reach the expected consequences for transplantation and postoperative muscle size, also there is no difficulty in processing. Finite element analysis is the most useful way to mimic soft tissue changes. Kober using infinite element method to simulate the movement of taste muscle shape analysis. Yi Yi Zhou victory set eye extraocular muscle driven finite element model, imitate the eye muscle movement, analysis of extraocular muscle strength Nianye, stress and strain distribution. How to establish the muscle transplantation on facial skin subcutaneous tissue of infinite element model and stop loading and displacement loading, after simulation analysis to reach expected paralysis repair consequence transplant muscle flap of the eve of the small operation and transplantation of muscle compression consequences, is the bias of this study further discussed. Target 1. Through the process of dorsal latissimus dorsi, saw the muscle, the rectus femoris, shares in the gracilis muscle blood vessels and nerves of microdissection, indecent test intramuscular nerve and blood vessel distribution types, outer diameter, with relations and neurovascular pedicle length, divided into ramified musculocutaneous flap and combined muscle flap free transplantation for the repair of early facial paralysis for dissection to materials science. 2. Construction of donor muscle and nerves and blood vessels of the 3D digital model, intuitive, abstract display nerves and blood vessels, course, distribution, anastomosis and adjacency relations, based on building muscle blood vessels and nerves of ramified musculocutaneous flap graphic design for ramified musculocutaneous flap in the reconstruction of the early facial paralysis supply 3D visualization of anatomy and operation parameters. 3. Establish a muscle driven muscle transplantation on facial skin subcutaneous tissue complex three-dimensional infinite element model, use the model to simulate and analyze the dynamic facial muscle transplantation required muscle size and graft muscle compression effect. Materials and methods 1. Microdissection in 20 patients with the vascular perfusion of antisepsis and fresh adult corpse specimens, to wear microscopic dissection indecent observes the latissimus dorsi, serratus anterior muscle, the rectus femoris, shares thin muscle intramuscular neurovascular distribution characteristics. Indecent shape characteristics measured the following goal of latissimus dorsi, spreading type dorsal neurovascular latissimus dorsi in muscle, the length and diameter of segmental artery and nerve branch length, transverse diameter, blood vessels and nerves in the muscle in the concomitant relationship between the serr shape feature, serratus anterior arterial origin, spreading type, artery diameter, length, long thoracic nerve and its branch diameter, length and distribution characteristics of adjacen the shape characteristics of the rectus femoris, rectus femoral origin, length and diameter of artery, spreading type artery, nerve distribution characteristics and neurovascular bundle in the shape characteristics of the gracilis muscle and gracilis artery origin, diameter, length, diameter, length of nerve and muscle in the adjacent muscle length respectively, blood vessel and nerve. 2. Donor muscle of 3D reconstruction of vessels, nerves signs and ramified musculocutaneous flap design of 2 fresh adult specimens taken modified carboxymethyl cellulose litharge blood vessel identification skills identification vascular, by spiral CT scan to obtain sequence DICOM data, Mimics software, to provide application software of threshold value method, method of regional development, Boolean operation, mask compilation method Peng sub object Peng points interest structure, surface reconstruction of skeletal muscle and its vascular and stop 3D neural intramuscular microdissection result based on markup construct donor muscle and nerves and blood vessels of the 3D digital model. Through the process of interactive indecent, application of imitating operation object, based on muscle blood vessels and nerves built into ramified musculocutaneous flap of graphic design and measurement of vascular pedicle length and muscle flap length, width and thickness of the. 3. Mimics10 finite element analysis application. 0 software, stop above of skin and subcutaneous tissue modeling based on images of the individual are imported into ANSYS software, and based on preoperative planning or operative muscle transplants entity mold stop overlapping operations, muscle transplantation skin subcutaneous tissue of composite so select the unit type, attribute, stop free mesh, establish a muscle driven above of skin and subcutaneous tissue composite in to meet the model usefulness validation, imposed constraints, separate stop 27N muscle loading and 8mm longitudinal displacement loading solution, not Yacha muscle contraction after fruit, measure reaches the expected consequences need the transplanted muscle cross-sectional area of the. Results 1. The latissimus dorsi, microdissection of serratus anterior muscle, rectus femoris, gracilis dorsi artery backbone length is 25. 0 + 5. 8mm, the length of the dorsal latissimus dorsi branch artery inside 24. 8 + 6. 0mm, the beginning of a diameter of 1. 5 + 0. 2mm, lateral branch length is 30. 4 + 8. 1mm, the beginning of a diameter of 1. 8 + 0. 3mm. Latissimus dorsi segmental artery distribution can be divided into two types of type I (balanced type), type II (- type). Segmental artery spread to the segmental muscle flap response, divided into 1 segments, 2 segments, 3 segments within and outside the 1 section, 2 section, 3 section, 4 section. The diameter of segmental artery is greater than 0. 5mm, a medial lateral segmental artery long segmental artery. The thoracodorsal nerve in the inferior angle of scapula into adjacent stereo branch and branch, branch and segmental artery accompanying rate above 90%. The serratus anterior muscle at the end of the width of 25. 7 + 2. 9mm, the thickness is 6. 0 + 0. 7mm, fasciculations in the serratus anterior muscle into the branch point width 20. 7 + 3. 0mm, a thickness of 7. 9 + 0. 7mm. The thoracodorsal artery serratus anterior branch of a type accounted for 62. 5%, two type accounted for 37. 5%. The first saw the muscular branches of 1 diameter. 5 + 0. 4mm, the length is 50. 0 + 5. 2mm, second front saw the muscular branches of 2 diameter. 0 + 0. 5mm, the length is 57. 1 + 6. 3mm, the muscle bundles along the branch. Long thoracic nerve transverse branch number 3 to 10, between the lateral thoracic artery and long thoracic nerve are 48. 0 + 6. 3mm, thoracodorsal artery serratus anterior muscle branch at the end of interval between the 0 and 3 long thoracic nerve. 3mm. (3) of the rectus femoris artery is divided into 3 types of type I, single branch dominant artery 5%; type II, shares inferior artery was the dominant vascular 80%; type III, shares rectus artery or rectus femoris artery and rectus femoris artery were dominant vessel accounted for 15%. The rectus femoris nerve backbone length is 14. 8 + 1. 3 (12. 7 a 17. 9) cm, uniform diameter of 1. 6 + 0. 2mm, shares rectus muscle nerve branches of the superficial branch of deep branch to femoral rectus in 1 / 3 part of the medial border of the rectus femoris artery anterior branch, after a road accompanying into muscle, 75% of the rectus femoris muscle specimens with nerve and blood vessel of the revenue of the central government, walking in the middle 1 / 3 part of the muscle. The gracilis muscle in the 1/3 blood supply originated from the deep femoral artery and obturator artery and medial femoral circumflex artery, lateral femoral circumflex artery. Gracilis branches of deep artery recover is the most important part in 1/3 gracilis, and constant blood supply, larger diameter, the upper gracilis muscle length is even up to 132. 9 (120. 0 a 155. 6) mm. The gracilis muscle 1/3 branches of artery and short and small. At the beginning of the gracilis muscle nerve diameter 1. 9 + 0. 3 (1. 3 a 2. 6) mm, from at the beginning to enter the nerve length is 5 point muscle backbone. 7 + 0. 5 (4. 3 a 6. 9) cm gracilis anterior nerve branches were length of 8. 6 + 1. 4 (6. 6 a 11. 7) cm, posterior nerve branch length is 9 respectively. 4 + 1. 4 (6. 8 a 12. 8) cm. 40% specimens of the gracilis muscle in 2 neurovascular bundle 45% gracilis muscle with neurovascular bundle more than 3. 2. Donor muscle vascular reconstruction, neural marker and leaf flap design of CT image two-dimensional sectional image clear, contrast, no significant artifacts, can display 0. 5mm small blood vessels, blood vessels split easily, convenient, accurate positioning measurement. II donor muscle and vascular nerve three-dimensional digital model can be precise, clear, flat display the blood vessel, dispersal and spatia spreading branches of the intramuscular nerve, nerve and blood vessel concomitant relationship can be displayed. Model plane sense of strong, intuitive, abstract, can according to the need of interaction not Yacha, random whims and scaling, torsion, move can be Lingding display or display combination, but also lit not Yacha and color observations. 3 points the ramified musculocutaneous flap graphic design muscle flap plane sense of strong, intuitive, free rate of sexual intercourse not Y accurate measurement of vascular pedicle length, muscle flap length, width, thickness, operation provide accurate parameters. Muscle sparing latissimus dorsi muscle flap of the 3D model shows the plane shape of the dorsal latissimus dorsi, lateral region of five segmental muscle flap vascular pedicle and muscle flap, and 1, and 2 on the top section of the thick, thin in the middle and lower, paragraph 1 than 2, 3 rectus femoris can respectively for 2 3 leaf muscle flap, in the central part of the muscl femoral thin muscle can be intercepted before and after the two divided leaf muscle flap. 3. Establish a skin subcutaneous tissue transplant muscle complex three-dimensional infinite element model by transplantation of muscle and subcutaneous tissue of skin above a solid image and CT reconstruction compared to similar geometric superiority. The mold can be arbitrarily torsion and zoom, can be based on different research add muscle and muscle position adjustment. All models have a total of 2978 nodes, 10666 units. The transplantation of muscle of 564 nodes, 1918 units, all units are custom shape. The muscle strength of 27N loading, the maximum displacement of 3 longitudinal upper lip. 9047mm, stress and strain distribute along the muscle end to the stop poin analysis of load longitudinal displacement 8mm, the total power required for offensive strength, for a total of 55. 431N, to obtain the required muscle cross-sectional area is about 149. 8mm~2. The above of skin and subcutaneous tissue muscle driven processes can be animated, intuitive vivid. Conclusion 1. To within the dorsal latissimus dorsi nerve artery, lateral branches can cut a pedicle bilobed flap, Futaba Bi pedicled muscle flap or a pedicle dorsal latissimus dorsi vascular of serratus branch as the pedicle interception of 4 to 5 fascicular muscle flap and to back latissimus dorsi myocutaneous artery could be designed dorsal latissimus dorsi and before serratus combined with muscle flap to rectus femoris neurovascular pedicle the rectus femoris were 2 3 divided leaf muscle flap and gracilis musculocutaneous neurovascular pedicle, the gracilis muscle rupture of 2 3 leaf muscle flap. The leaf muscle flap has sufficient neurovascular pedicle length, 1/3 and surface reconstruction for early facial paralysis face 2/3 face muscle function. 2. Donor muscle and vascular three-dimensional reconstruction, stop based on response marked muscle anatomy of three-dimension neural, build a donor muscle and vascular nerve three-dimensional digital model, intuitive, abstract shows intramuscular nerve and blood vessel and an important branch of concomitant relationship can stop base spread to the neurovascular points ramified musculocutaneous flap of graphic design and indecent test, dynamic muscle graft to repair facial paralysis supply operation parameters, for teaching, research and the provision of digital model. 3. Based on the images with preoperative planning and operation set up muscle transplants a facial skin subcutaneous tissue of infinite element model geometry similar mechanical properties and similar good, power free muscle transplantation for the repair of facial paralysis operation provides a quantitative preoperative design and postoperative evaluation of the consequences of the way. An important innovation point 1. Through process of incipient facial muscle transplantation often use donor muscle, nerve and blood vessel to dissect indecent test, useful for discrimination of ramified musculocutaneous flap cut design system of anatomy materials for dynamic muscle graft in repairing the early shape of facial paralysis supply basic. 2. In the donor muscle and vascular three-dimensional reconstruction on the basis of the stop based on response marked muscle anatomy of three-dimension neural, build a donor muscle and vascular nerve in a 3D digital model. This model is intuitive, abstract shows the important branch of nerves and blood vessels of intramuscular nerves and blood vessels of the spread and general concomitant relationship. 3. The vascular and nerve branches spread graphic design new concept of ramified musculocutaneous flap based on, in donor muscle vascular nerve in a 3D digital model of the ramified musculocutaneous flap of graphic design and measurement, dynamic muscle graft to repair the early facial paralysis supply the operation parameters, for teaching, scientific research supply digital model. 4. First set up the drive muscle muscle transplants a facial skin and subcutaneous tissue complex three-dimensional infinite element model, for dynamic muscle graft in reconstruction of incipient facial surgery provides the quantitative preoperative design and postoperative evaluation of the consequences of the way.目录:摘要3-9ABSTRACT9-16前言19-24第一部 分肌肉游离移植修复晚期面瘫的应用解剖24-48&&&&1.1 材料和方法25-26&&&&1.2 结果26-40&&&&1.3 讨论40-46&&&&参考文献46-48第二部分 供体肌及血管的三维重建与术前设计48-61&&&&2.1 材料与方法48-50&&&&2.2 结果50-55&&&&2.3 讨论55-59&&&&参考文献59-61第三部分 下面部移植肌-皮肤有限元模型的建立与应用初探61-78&&&&3.1 材料与方法62-65&&&&3.2 结果65-69&&&&3.3 讨论69-76&&&&参考文献76-78全文小结78-79综述79-89附录89-90研究生期间主要科研成果90-91致谢91-92分享到：相关文献|}