鼻部动脉地形图绘制：超声与尸体双队列研究

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中文摘要

目的： 用于非手术鼻整形的软组织填充剂注射存在较低但有充分记录的严重血管并发症风险，包括皮肤坏死和不可逆视力丧失。本研究采用高分辨率多普勒超声对健康在世志愿者进行检查，并结合尸体宏观解剖，从不同的解剖学视角描述鼻部动脉地形，旨在确定风险较低的注射层次。
方法： 35名健康越南成年人（20名男性，15名女性）在鼻根、鼻背和鼻尖接受彩色多普勒超声（12 MHz）检查，测量软组织厚度、动脉至皮肤的深度、至骨性支架的间隙、至中线的距离以及血管口径。此外，对来自15具福尔马林固定越南尸体的30个半面进行解剖，以记录动脉起源和形态模式。数据采用重复测量方差分析和广义估计方程进行分析。
结果： 在鼻根/鼻背处，80.0%的受试者中可识别出宏观动脉，鼻尖处为71.4%。在所有三个部位，男性背侧动脉均显著更深（p < 0.05）。两个队列均显示出相似的高血管不对称率（超声显示60.0%存在双侧宏观动脉，尸体解剖显示53.3%）。识别出一条中央少血管走廊（鼻根处8.62 ± 1.07 mm，鼻背处8.04 ± 1.01 mm）；然而，在鼻尖处终末血管逐渐向中线汇聚。
结论： 鼻部动脉网络高度变异且不对称。仅依赖传统中线标志进行盲法注射与血管损伤的高风险相关。这些详细的地形数据支持个体化超声引导技术，以提高鼻部美容和重建手术的安全性。

英文摘要

PURPOSE: Soft-tissue filler injection for non-surgical rhinoplasty carries a low but well-documented risk of severe vascular complications, including skin necrosis and irreversible vision loss. This study employed high-resolution Doppler ultrasound in healthy living volunteers alongside macroscopic cadaveric dissection to characterize nasal arterial topography from distinct anatomical perspectives, aiming to identify lower-risk injection planes.
METHODS: Thirty-five healthy Vietnamese adults (20 males, 15 females) underwent color Doppler ultrasound (12 MHz) at the radix, rhinion, and nasal tip to measure soft tissue thickness, arterial depth to skin, clearance to framework, distance to midline, and vessel caliber. Additionally, thirty hemifaces from 15 formalin-fixed Vietnamese cadavers were dissected to document arterial origins and morphological patterns. Data were analyzed using repeated-measures ANOVA and Generalized Estimating Equations.
RESULTS: Macroscopic arteries were identified in 80.0% of subjects at the radix/rhinion and 71.4% at the nasal tip. Dorsal arteries were significantly deeper in males across all three sites (p < 0.05). Both cohorts demonstrated similarly high rates of vascular asymmetry (bilateral macro-arteries in 60.0% by ultrasound and 53.3% by cadaveric dissection). A central paucivascular corridor (8.62 ± 1.07 mm at the radix and 8.04 ± 1.01 mm at the rhinion) was identified; however, terminal vessels converged progressively toward the midline at the nasal tip.
CONCLUSION: The nasal arterial network is highly variable and asymmetric. Blind injections relying solely on traditional midline landmarks are associated with a high risk of vascular compromise. These detailed topographic data support individualized ultrasound-guided techniques to enhance safety in aesthetic and reconstructive nasal procedures.