视神经视觉假体微电极植入的应用解剖学研究
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摘要
【目的】探讨视觉假体微电极芯片植入视神经的相对安全区,为临床视神经手术提供解剖学依据。
【方法】30例成人头颅标本,动脉灌注混有红色染料的乳胶,观测视神经周围主要血管、神经的行程和外径等数据;4例新鲜成人头颅标本(动脉灌注墨汁混合液),球后4～8mm视神经连续切片,片厚20μm,显微镜观察和Image Advanced 3.0测量神经横断面中各象限血管断面数和血管的总面积,并进行统计学处理。
【结果】在眶外侧可见外直肌上缘(3.83±1.43)mm处有泪腺动脉和神经与其伴行向前至泪腺。将外直肌向下牵引,显露视神经,两者之间的间隙称为外直肌—视神经间隙,其深度为(8.14±0.90)mm,主要有睫状短神经和颞侧睫状后动脉等结构穿行。在眶上方,可见眼动脉多数起始于颈内动脉,视网膜中央动脉由眼动脉发出后主要经下方穿入视神经,穿入处距球后(0.85±0.28)cm,其中距离≤4mm者19.2%,≥8mm者76.9%,球后6.5mm处穿入者3.9%。鞘动脉穿入鞘膜的方位,内侧20%,上方29.3%,外侧6.7%,下方44%。在球后与总腱环中点处,视神经左右径(3.96±0.35)mm,上下径(4.18±0.33)mm。
在碳素墨汁混合液灌注的新鲜标本上还观察到,视神经鞘上分布着丰富的血管网,血管在鞘膜上大致呈前后纵向走行。取球后4～8mm段视神经连续切片,显微镜下发现,鞘膜的血管网向神经实质内以近似直角的方式向中心发出许多小支,呈向心性走行。调整、校正后Image Advanced 3.0软件分析视神经实质内各象限血管断面数和血管的总面积,小血管的断面数为( 178.936±8.666 ) ,血管总面积为(0.001280±0.000035)mm2,各象限间无显著差异。
【结论】
1、经眶外侧壁入路显露视神经的手术中,要注意保护外直肌上缘的泪腺动脉和神经,以免影响泪腺的功能。暴露视神经时需经过外直肌—视神经间隙,手术显露视神经时应注意保护该间隙结构。
2、在球后4～8mm间植入微电极芯片或进行视神经手术较为安全。
3、经外侧植入视觉假体微电极芯片或进行其它视神经手术可最大限度的减少对视神经血供的影响。
4、视神经外径约4mm,视网膜中央动脉在视神经实质中央呈前后纵向走行,微电极芯片最好沿神经纵行植入,且植入深度不宜过深,以免影响视网膜血供。
5、因外伤或植入微电极芯片等原因造成视神经缺血所致的神经纤维受损不存在象限的差异。
【Objective】To investigate the relatively safe area of implanting vision prosthesis microelectrode to optic nerve,and to provide anatomic data for operations of optic nerve.
【Methods】The courses and external diameters of the arteries and nerves were observed and measured on thirty adult cadaver heads, which were formalized and vascular cast by red emulsion. Four cases of freezed adult cadaver heads(intra-arterial infusion mixed liquids of prepared Chinese ink), the optic nerve that 4～8mm posterior to eyeball was cut in serial sections 20μm in thick. The vessel section count(VSC) and vessel section surface area(VSS) in the 4 quadrants of transverse sections of optical nerve were counted and measured by microscope and Image Advanced 3.0,then data were analyzed using SPSS 13.0.
【Results】
Opened the lateral orbital wall and paries superior orbitae of adult cadaver heads.From the lateral orbital wall lacrimal artery and nerve went forword to lacrimal gland at (3.83±1.43)mm above the superior margin of external rectus muscle. The interspace between the external rectus muscle and the optic nerve was called external rectus muscle-optic nerve inter- space.There were short ciliary nerves and posterior ciliary artery through it , and its depth was (8.14±0.90)mm. Most of the central retinal artery (CRA) entered optic nerve from the bottom of the nerve, where was behind the eyeball(0.85±0.28)cm, the distance≤4mm was 19.2%,≥8mm was76.9%,entered behind the eyeball 6.5mm was 3.9%. The position of the sheathed arterioles penetrating sheath of optic nerve was :medial 20%,superior 29.3%,lateral 6.7%,inferior 44%. The transverse and vertical diameter of optic nerve were (3.96±0.35)mm and (4.18±0.33)mm at the midpoint between the annulus tendineus communis and posterior pole of eyeball.
It was observed from adult cadaver heads(infused with mixed liquids of prepared Chinese ink) that there were plenty of microarteries on the optic nerve sheath,which anastomosed each other and run longitudinaly and anterior-posteriorly. By microscope, it was observed that there was vascular network on the sheath, which erupting small branches to the center of the nerve by vertical mode and the segmental microarterial lay centrally to their corresponding arterioles..The number of cross section of microvasculature was (178.936±8.666),the average of cross section of was (0.001280±0.000035) mm2,and there were no significant differences between the varies quadrants.
【Conclution】
1. To protect the lacrimal artery and nerve above on the superior margin of external rectus muscle when the optic nerve was exposed in the operation. Pay attention to the structures among the interspace between external rectus muscle and optic nerve.
2. It would be safer to implant microelectrode or operate on the optic nerve where was 4～8mm behind the eyeball.
3. To minimize the damage to the blood supply of optical nerve, the vision prosthesis microelectrode should be implanted through the lateral of optical nerve.
4. The outer diameter of optic nerve was about 4mm,and the CRA run lengthways and anterior-posteriorly in the center of optic nerve. To avoid retinal ischemia,the vision prosthesis microelectrode should be implanted lengthways,and too deeply incision was not suitable.
5. There were no differences among the blood supply of each quadrant of optic nerve when it was damaged by traumatism or implanting microelectrode.
【方法】30例成人头颅标本,动脉灌注混有红色染料的乳胶,观测视神经周围主要血管、神经的行程和外径等数据;4例新鲜成人头颅标本(动脉灌注墨汁混合液),球后4～8mm视神经连续切片,片厚20μm,显微镜观察和Image Advanced 3.0测量神经横断面中各象限血管断面数和血管的总面积,并进行统计学处理。
【结果】在眶外侧可见外直肌上缘(3.83±1.43)mm处有泪腺动脉和神经与其伴行向前至泪腺。将外直肌向下牵引,显露视神经,两者之间的间隙称为外直肌—视神经间隙,其深度为(8.14±0.90)mm,主要有睫状短神经和颞侧睫状后动脉等结构穿行。在眶上方,可见眼动脉多数起始于颈内动脉,视网膜中央动脉由眼动脉发出后主要经下方穿入视神经,穿入处距球后(0.85±0.28)cm,其中距离≤4mm者19.2%,≥8mm者76.9%,球后6.5mm处穿入者3.9%。鞘动脉穿入鞘膜的方位,内侧20%,上方29.3%,外侧6.7%,下方44%。在球后与总腱环中点处,视神经左右径(3.96±0.35)mm,上下径(4.18±0.33)mm。
在碳素墨汁混合液灌注的新鲜标本上还观察到,视神经鞘上分布着丰富的血管网,血管在鞘膜上大致呈前后纵向走行。取球后4～8mm段视神经连续切片,显微镜下发现,鞘膜的血管网向神经实质内以近似直角的方式向中心发出许多小支,呈向心性走行。调整、校正后Image Advanced 3.0软件分析视神经实质内各象限血管断面数和血管的总面积,小血管的断面数为( 178.936±8.666 ) ,血管总面积为(0.001280±0.000035)mm2,各象限间无显著差异。
【结论】
1、经眶外侧壁入路显露视神经的手术中,要注意保护外直肌上缘的泪腺动脉和神经,以免影响泪腺的功能。暴露视神经时需经过外直肌—视神经间隙,手术显露视神经时应注意保护该间隙结构。
2、在球后4～8mm间植入微电极芯片或进行视神经手术较为安全。
3、经外侧植入视觉假体微电极芯片或进行其它视神经手术可最大限度的减少对视神经血供的影响。
4、视神经外径约4mm,视网膜中央动脉在视神经实质中央呈前后纵向走行,微电极芯片最好沿神经纵行植入,且植入深度不宜过深,以免影响视网膜血供。
5、因外伤或植入微电极芯片等原因造成视神经缺血所致的神经纤维受损不存在象限的差异。
【Objective】To investigate the relatively safe area of implanting vision prosthesis microelectrode to optic nerve,and to provide anatomic data for operations of optic nerve.
【Methods】The courses and external diameters of the arteries and nerves were observed and measured on thirty adult cadaver heads, which were formalized and vascular cast by red emulsion. Four cases of freezed adult cadaver heads(intra-arterial infusion mixed liquids of prepared Chinese ink), the optic nerve that 4～8mm posterior to eyeball was cut in serial sections 20μm in thick. The vessel section count(VSC) and vessel section surface area(VSS) in the 4 quadrants of transverse sections of optical nerve were counted and measured by microscope and Image Advanced 3.0,then data were analyzed using SPSS 13.0.
【Results】
Opened the lateral orbital wall and paries superior orbitae of adult cadaver heads.From the lateral orbital wall lacrimal artery and nerve went forword to lacrimal gland at (3.83±1.43)mm above the superior margin of external rectus muscle. The interspace between the external rectus muscle and the optic nerve was called external rectus muscle-optic nerve inter- space.There were short ciliary nerves and posterior ciliary artery through it , and its depth was (8.14±0.90)mm. Most of the central retinal artery (CRA) entered optic nerve from the bottom of the nerve, where was behind the eyeball(0.85±0.28)cm, the distance≤4mm was 19.2%,≥8mm was76.9%,entered behind the eyeball 6.5mm was 3.9%. The position of the sheathed arterioles penetrating sheath of optic nerve was :medial 20%,superior 29.3%,lateral 6.7%,inferior 44%. The transverse and vertical diameter of optic nerve were (3.96±0.35)mm and (4.18±0.33)mm at the midpoint between the annulus tendineus communis and posterior pole of eyeball.
It was observed from adult cadaver heads(infused with mixed liquids of prepared Chinese ink) that there were plenty of microarteries on the optic nerve sheath,which anastomosed each other and run longitudinaly and anterior-posteriorly. By microscope, it was observed that there was vascular network on the sheath, which erupting small branches to the center of the nerve by vertical mode and the segmental microarterial lay centrally to their corresponding arterioles..The number of cross section of microvasculature was (178.936±8.666),the average of cross section of was (0.001280±0.000035) mm2,and there were no significant differences between the varies quadrants.
【Conclution】
1. To protect the lacrimal artery and nerve above on the superior margin of external rectus muscle when the optic nerve was exposed in the operation. Pay attention to the structures among the interspace between external rectus muscle and optic nerve.
2. It would be safer to implant microelectrode or operate on the optic nerve where was 4～8mm behind the eyeball.
3. To minimize the damage to the blood supply of optical nerve, the vision prosthesis microelectrode should be implanted through the lateral of optical nerve.
4. The outer diameter of optic nerve was about 4mm,and the CRA run lengthways and anterior-posteriorly in the center of optic nerve. To avoid retinal ischemia,the vision prosthesis microelectrode should be implanted lengthways,and too deeply incision was not suitable.
5. There were no differences among the blood supply of each quadrant of optic nerve when it was damaged by traumatism or implanting microelectrode.
引文
1 Chow AY. Electrical stimulation of the retina with subretinal electrodes and high density microphotodiode array implants ( abstract ) . Invest Ophthalmol Vis Sci. 1993, 34: S835.
2 Govsa F, Erturk M, Kayalioglu G, et al. Neuro-arterial relations in the region of the optic canal[J]. Surg Radiol Anat. 1999, 21(5):329-335.
3 Volker M,Shinoda K,Sachs H,et a1.In vivo assessment of subretinally implanted microphotodiode arrays in cats by optical coherence tomography and fluorescein angiography[J]. Graefes Arch Clin Exp Ophthalmol. 2004,242:792-799.
4 Gislin D, David B, Mark S.H, et al. Paragraph text reading using a pixelized prosthetic vision simulator: parameter dependence and task learning in free-viewing conditions[J]. Invest Ophthalmol Vis Sci. 2006,47:1241-1250.
5 Veraart C, Raftopoulos C, Mortimer JT, et al. Visual sensations produced by optic nerve stimulation using an implanted self-sizing spiral cuff electrode[J]. Brain Res. 1998, 813(1):181-186.
6 Margalit E,Maia M,Weiland JD, et a1.Retinal prosthesis for the blind[J].Surv Ophthalmol. 2002,47:335-356.
7 Normann RA, Warren DJ, Ammermuller J, et al. High-resolution spatio-temporal mapping of visual pathways using multi-electrode arrays[J]. Vis Res. 2001, 41:1261-1275.
8 Rizzo JF 3rd,Wyatt J,Loewenstein J,et a1.Perceptual efficacy of electrical stimulation of human retina with a microelectrod e array during short-term surgical trials[J].Invest Ophthalmol Vis Sci. 2003,44:5362-5369.
9 刘志雄,张志刚,袁贤瑞,等. 眶内肿瘤手术入路的显微外科解剖[J].中华耳鼻咽喉颅底外科杂志,2002, 8(3):151-153.
10 夏蓉, Passagia JG. 眶内球后结构的显微解剖[J].上海第二医科大学学报, 1999, 19(3): 252-255.
11 朱盛修, 现代显微外科学[M].长沙: 湖南科学技术出版社, 1994, 540-541.
12 王金德, 陈绍春, 范艳, 等. 经颅开眶球后入路的应用解剖[J]. 解剖与临床, 2005,10(1):8-11.
13 Erdogmus S.Govsa F. Anatomic features of the intracranial and intracranialicular portions of ophthalmic artery:for the surgical procedures[J]. Neurosurg Rev.2006, 29(3):213-218.
14 Tsutsumi S. Rhoton AL. Microsurgical anatomy of the central retinal artery[J]. Neurosurgery. 2006, 59(4):870-879.
15 朱友余,庞刚,石献忠,等.眼动脉及其分支的显微解剖学研究[J].解剖与临床,2005,10(3):189-191.
16 刘奕蓉,郑桓,刘学钧,等.眼动脉及其相关动脉的应用解剖学研究[J].临床耳鼻咽喉科杂志,2005,19(8):368-370.
17 李凤鸣.眼科全书[M].人民卫生出版社,1996,175-179.
18 刘学均,张子明,刘奕蓉,等.视觉传导路营养动脉的显微解剖及其临床意义[J].眼科研究,2005,23(3):304-307.
19 纪荣明,周晓平,许家军,等.视神经的观测[J].解剖学杂志,2001,24(2):188.
20 刘芳,陈尔瑜,党瑞山,等.胆经小腿 7 寸以下穴区地部血管分布与钙元素的关系[J].中国针灸,2000,20(7):419-421.
21 崔成立,杜颋,刘秀清.活体墨汁灌注和软蜡厚切片在实验研究中的应用[J].包头医学院学报,2004,20(4):280-281.
22 李德华,李娟.甲醛碳素墨水灌注法对延髓内微血管构筑的研究[J].锦州医学院学报,2003,24(1):34-35.
23 Schleich JM,Dillenseger JL,Loeuiller L et al.Three-dimensional reconstruction and morphologic measurements of human embryonic hearts:a newdiagnostic and quantitative method applicable to fetuses younger than 13 weeks of gestation[J].Pediate Dev Pathol.2005,Jul-Aug,8(4):463-473.
24 郑瑾,佘振珏,谭德炎,等.胚胎连续组织切片的计算机三维重建[J].解剖学研究,2005,27(4):295-298.
25 王清良,卞修武,蒋雪峰,等.计算机辅助的人脑间变性星形细胞瘤微血管构筑三维重建[J].第三军医大学学报,2006,28(11):1148-1150.
26 Burgoyne CF.Dowe JC.Bellezza AJ.Hart RT.Three-dimensional reconstruction of normal and early glaucoma monkey optic nerve head connective tissues[J]. Burgoyne etal. IOVS 2004,45(12):4388-4399.
27 罗永春,陈菁,朱刚,等.大鼠再生坐骨神经病理结构计算机三维重建研究[J]. 中国医学计算机成像杂志,2004,10(3):209-212.
28 陈增淦,陈统一,张键,等.臂丛神经显微结构的计算机三维重建[J].中华骨科杂志,2004,24(8):462-466.
29 Hayreh SS,Dass R. The ophthalmic artery:ⅡBranches. Br J Ophthal,1962,46:165.
30 蔡兆明,陈瑞华.视网膜中央动脉对视神经血供关系的研究[J].解剖学杂志,1993;16(6):538
31 黄海辉,蔡兆明,陈瑞华,等.视神经眶内部微血管的计量研究[J].解剖学杂志,2000,23(4):373-374.
1 Ciofi GA, Wang L.Optic nerve blood flow in glaucoma[J].Semin Ophthalmol, 1999,14(3):164-170.
2 Hayreh SS. Blood supply of the optic nerve head[J]. Ophthalmologica, 1996,210(5):285-295.
3 Wybar KC. Anastomoses between the retinal and ciliary arterial circulations[J].Br J Ophthalmol,1956,40(2):65-81.
4 Lieberman MF, Maumenee AE, Green WR. Histoligic studies of the vasculature of the anterior optic nerve[J]. Am J Ophthalmol,1976,82:405-423.
5 Andrzej W,Fryczkowski, Baird S.Scanning electron microscopy of vascular casts of the human scleral lamina cribrosa[J].Int Ophthalmol,1984,7(2): 95-100.
6 赵颖,李凤鸣,夏家骝.视神经乳头的微血管构筑[J].眼科学报,1988,4(3):150-155.
7 朱友余,庞刚,石献忠,等.眼动脉及其分支的显微解剖学研究[J].解剖与临床,2005,10(3):189-191.
8 刘奕蓉,郑桓,刘学钧,等.眼动脉及其相关动脉的应用解剖学研究[J].临床耳鼻咽喉科杂志 2005,19(8): 368-370.
9 李凤鸣.眼科全书[M].人民卫生出版社,1996.175-179.
10 陈绍春,王金德,范艳,等.眼动脉眶内段的应用解剖研究[J].解剖与临床,2005,10(1):4-8.
11 王 福 , 张 奎 起 . 眼 动 脉 及 其 主 要 分 支 的 解 剖 学 观 测 [J]. 眼 科 研究,2002,18(1):83-85.
12 崔模,魏宝林,柴戬臣,等.眼动脉及其主要分支的研究[J].中华眼科杂志,1984,20(1):30-33.
13 刘学均,张子明,刘奕蓉,等.视觉传导路营养动脉的显微解剖及其临床意义[J].眼科研究,2005,23(3):304-307.
14 陶存山,卢亦成,楼美清,等.视神经管及其相关结构的显微外科解剖[J].江苏医药.2005.31(10):757-759.
15 姚毅,马志中.前部视神经中视网膜中央血管管腔特征[J]. 中华眼科杂志,1999,35(5):393-394.
16 姚毅,马志中.老年人视网膜中央血管在前部视神经的解剖特征[J].中华眼底病杂志,1997,13(4):213-214.
17 黄海辉, 蔡兆明,陈瑞华,等.视神经眶内部微血管的计量研究[J].解剖学杂志,2000,23(4):373-374.
18 田继辉,徐军,张庆华.眼动脉纤维解剖学研究[J].中风与神经疾病杂志,2004,21(3):252-253.
19 Yoshii I, Ikeda A. A new look at the blood supply of the retro-ocular space[J]. Anat Rec, 1992, 233(2): 321-328.
20 赵恒珂,李光宗,曹焕军,等.眼动脉显微外科解剖学观察[J].中国临床解剖学杂志,2002,20(5):352-354.
21 朱世杰,赵恒珂、李光宗,等.视神经减压术的应用解剖学研究[J].潍坊医学院学报,1990,12(4):1-3.
22 Chou PI, Sadun AA, Lee H. Vasculature and morphometry of the optic canal and intracanalicular optic nerve[J].J Neuroophthalmol.1995,15(3):186-90.
23 杨有雄,廖建春,陆勤康,等.视神经管的显微外科解剖学研究[J]. 解剖与临床,2007,12(1):7-10.
24 Hayreh SS,Dass R. The ophthalmic artery:Ⅱ Branches. Br J Ophthal,1962,46:165.
2 Govsa F, Erturk M, Kayalioglu G, et al. Neuro-arterial relations in the region of the optic canal[J]. Surg Radiol Anat. 1999, 21(5):329-335.
3 Volker M,Shinoda K,Sachs H,et a1.In vivo assessment of subretinally implanted microphotodiode arrays in cats by optical coherence tomography and fluorescein angiography[J]. Graefes Arch Clin Exp Ophthalmol. 2004,242:792-799.
4 Gislin D, David B, Mark S.H, et al. Paragraph text reading using a pixelized prosthetic vision simulator: parameter dependence and task learning in free-viewing conditions[J]. Invest Ophthalmol Vis Sci. 2006,47:1241-1250.
5 Veraart C, Raftopoulos C, Mortimer JT, et al. Visual sensations produced by optic nerve stimulation using an implanted self-sizing spiral cuff electrode[J]. Brain Res. 1998, 813(1):181-186.
6 Margalit E,Maia M,Weiland JD, et a1.Retinal prosthesis for the blind[J].Surv Ophthalmol. 2002,47:335-356.
7 Normann RA, Warren DJ, Ammermuller J, et al. High-resolution spatio-temporal mapping of visual pathways using multi-electrode arrays[J]. Vis Res. 2001, 41:1261-1275.
8 Rizzo JF 3rd,Wyatt J,Loewenstein J,et a1.Perceptual efficacy of electrical stimulation of human retina with a microelectrod e array during short-term surgical trials[J].Invest Ophthalmol Vis Sci. 2003,44:5362-5369.
9 刘志雄,张志刚,袁贤瑞,等. 眶内肿瘤手术入路的显微外科解剖[J].中华耳鼻咽喉颅底外科杂志,2002, 8(3):151-153.
10 夏蓉, Passagia JG. 眶内球后结构的显微解剖[J].上海第二医科大学学报, 1999, 19(3): 252-255.
11 朱盛修, 现代显微外科学[M].长沙: 湖南科学技术出版社, 1994, 540-541.
12 王金德, 陈绍春, 范艳, 等. 经颅开眶球后入路的应用解剖[J]. 解剖与临床, 2005,10(1):8-11.
13 Erdogmus S.Govsa F. Anatomic features of the intracranial and intracranialicular portions of ophthalmic artery:for the surgical procedures[J]. Neurosurg Rev.2006, 29(3):213-218.
14 Tsutsumi S. Rhoton AL. Microsurgical anatomy of the central retinal artery[J]. Neurosurgery. 2006, 59(4):870-879.
15 朱友余,庞刚,石献忠,等.眼动脉及其分支的显微解剖学研究[J].解剖与临床,2005,10(3):189-191.
16 刘奕蓉,郑桓,刘学钧,等.眼动脉及其相关动脉的应用解剖学研究[J].临床耳鼻咽喉科杂志,2005,19(8):368-370.
17 李凤鸣.眼科全书[M].人民卫生出版社,1996,175-179.
18 刘学均,张子明,刘奕蓉,等.视觉传导路营养动脉的显微解剖及其临床意义[J].眼科研究,2005,23(3):304-307.
19 纪荣明,周晓平,许家军,等.视神经的观测[J].解剖学杂志,2001,24(2):188.
20 刘芳,陈尔瑜,党瑞山,等.胆经小腿 7 寸以下穴区地部血管分布与钙元素的关系[J].中国针灸,2000,20(7):419-421.
21 崔成立,杜颋,刘秀清.活体墨汁灌注和软蜡厚切片在实验研究中的应用[J].包头医学院学报,2004,20(4):280-281.
22 李德华,李娟.甲醛碳素墨水灌注法对延髓内微血管构筑的研究[J].锦州医学院学报,2003,24(1):34-35.
23 Schleich JM,Dillenseger JL,Loeuiller L et al.Three-dimensional reconstruction and morphologic measurements of human embryonic hearts:a newdiagnostic and quantitative method applicable to fetuses younger than 13 weeks of gestation[J].Pediate Dev Pathol.2005,Jul-Aug,8(4):463-473.
24 郑瑾,佘振珏,谭德炎,等.胚胎连续组织切片的计算机三维重建[J].解剖学研究,2005,27(4):295-298.
25 王清良,卞修武,蒋雪峰,等.计算机辅助的人脑间变性星形细胞瘤微血管构筑三维重建[J].第三军医大学学报,2006,28(11):1148-1150.
26 Burgoyne CF.Dowe JC.Bellezza AJ.Hart RT.Three-dimensional reconstruction of normal and early glaucoma monkey optic nerve head connective tissues[J]. Burgoyne etal. IOVS 2004,45(12):4388-4399.
27 罗永春,陈菁,朱刚,等.大鼠再生坐骨神经病理结构计算机三维重建研究[J]. 中国医学计算机成像杂志,2004,10(3):209-212.
28 陈增淦,陈统一,张键,等.臂丛神经显微结构的计算机三维重建[J].中华骨科杂志,2004,24(8):462-466.
29 Hayreh SS,Dass R. The ophthalmic artery:ⅡBranches. Br J Ophthal,1962,46:165.
30 蔡兆明,陈瑞华.视网膜中央动脉对视神经血供关系的研究[J].解剖学杂志,1993;16(6):538
31 黄海辉,蔡兆明,陈瑞华,等.视神经眶内部微血管的计量研究[J].解剖学杂志,2000,23(4):373-374.
1 Ciofi GA, Wang L.Optic nerve blood flow in glaucoma[J].Semin Ophthalmol, 1999,14(3):164-170.
2 Hayreh SS. Blood supply of the optic nerve head[J]. Ophthalmologica, 1996,210(5):285-295.
3 Wybar KC. Anastomoses between the retinal and ciliary arterial circulations[J].Br J Ophthalmol,1956,40(2):65-81.
4 Lieberman MF, Maumenee AE, Green WR. Histoligic studies of the vasculature of the anterior optic nerve[J]. Am J Ophthalmol,1976,82:405-423.
5 Andrzej W,Fryczkowski, Baird S.Scanning electron microscopy of vascular casts of the human scleral lamina cribrosa[J].Int Ophthalmol,1984,7(2): 95-100.
6 赵颖,李凤鸣,夏家骝.视神经乳头的微血管构筑[J].眼科学报,1988,4(3):150-155.
7 朱友余,庞刚,石献忠,等.眼动脉及其分支的显微解剖学研究[J].解剖与临床,2005,10(3):189-191.
8 刘奕蓉,郑桓,刘学钧,等.眼动脉及其相关动脉的应用解剖学研究[J].临床耳鼻咽喉科杂志 2005,19(8): 368-370.
9 李凤鸣.眼科全书[M].人民卫生出版社,1996.175-179.
10 陈绍春,王金德,范艳,等.眼动脉眶内段的应用解剖研究[J].解剖与临床,2005,10(1):4-8.
11 王 福 , 张 奎 起 . 眼 动 脉 及 其 主 要 分 支 的 解 剖 学 观 测 [J]. 眼 科 研究,2002,18(1):83-85.
12 崔模,魏宝林,柴戬臣,等.眼动脉及其主要分支的研究[J].中华眼科杂志,1984,20(1):30-33.
13 刘学均,张子明,刘奕蓉,等.视觉传导路营养动脉的显微解剖及其临床意义[J].眼科研究,2005,23(3):304-307.
14 陶存山,卢亦成,楼美清,等.视神经管及其相关结构的显微外科解剖[J].江苏医药.2005.31(10):757-759.
15 姚毅,马志中.前部视神经中视网膜中央血管管腔特征[J]. 中华眼科杂志,1999,35(5):393-394.
16 姚毅,马志中.老年人视网膜中央血管在前部视神经的解剖特征[J].中华眼底病杂志,1997,13(4):213-214.
17 黄海辉, 蔡兆明,陈瑞华,等.视神经眶内部微血管的计量研究[J].解剖学杂志,2000,23(4):373-374.
18 田继辉,徐军,张庆华.眼动脉纤维解剖学研究[J].中风与神经疾病杂志,2004,21(3):252-253.
19 Yoshii I, Ikeda A. A new look at the blood supply of the retro-ocular space[J]. Anat Rec, 1992, 233(2): 321-328.
20 赵恒珂,李光宗,曹焕军,等.眼动脉显微外科解剖学观察[J].中国临床解剖学杂志,2002,20(5):352-354.
21 朱世杰,赵恒珂、李光宗,等.视神经减压术的应用解剖学研究[J].潍坊医学院学报,1990,12(4):1-3.
22 Chou PI, Sadun AA, Lee H. Vasculature and morphometry of the optic canal and intracanalicular optic nerve[J].J Neuroophthalmol.1995,15(3):186-90.
23 杨有雄,廖建春,陆勤康,等.视神经管的显微外科解剖学研究[J]. 解剖与临床,2007,12(1):7-10.
24 Hayreh SS,Dass R. The ophthalmic artery:Ⅱ Branches. Br J Ophthal,1962,46:165.