下睑部应用解剖学研究和下睑袋综合治疗对策
发布时间：2018-08-27 20:36
【摘要】： 一.目的 对下睑及其邻近区域进行系统、详细的解剖研究,明确国人眶隔弓状扩张部、眶隔脂肪、下睑缩肌等相关结构的部位、范围、形态、性状和毗邻关系,为临床寻找更加合理的下睑部整复手术提供解剖学理论基础。 对2000年以来治疗的1990例下睑袋畸形患者进行回顾性总结,根据下睑袋畸形的不同特点提出完善的下睑袋畸形分型方法,并提出相关手术治疗对策。 二.材料和方法 (一)基础部分: 材料:10具(20侧)成人尸体头部标本,男3具,女7具,年龄范围56—72岁。 方法:1侧采用矢状断层切片;19侧采用由表及里逐层解剖,观察下睑部及邻近区域各解剖结构间的部位、范围、形态、性状和相互间联系,采用游标卡尺测量,并作文字和图象记录。 (二)临床部分: 临床资料:1990例下睑袋畸形患者:女性1923例,男性67例,年龄范围17—71岁。 方法:记录不同患者下睑袋畸形的特点,分别应用不同手术方法进行治疗,并对其中391例患者进行了平均12.05个月的随访。 三.结果 (一)基础部分: 1、眶隔弓状缘在眶下缘的止点从内眦到外眦并不沿眶骨缘顶点走行,而是由眶内壁走行到眶外壁;眶隔各部分厚度不一,由内眦侧向外眦侧逐渐增厚。 2、弓状扩张部为眶隔的附属结构,起于眶隔,斜行向内眦方向深部走行,走行过程中与眶隔有纤维联系,在下斜肌中1/3段与包绕下斜肌的下睑缩肌浅层汇合,最终汇入Lockwood韧带。 3、切开弓状缘向上掀起眶隔,眶隔脂肪分为两叶,两叶脂肪团通过下斜枷喾指簟Ｏ蛏畈孔纷?眶隔脂肪与深部球后脂肪之间亦存在分隔,眶隔脂肪与深部球后脂肪性状不同。 另外,在2具3侧标本的外眦下方,有一倒三角形的赘生脂肪,该脂肪来源于上睑眶隔内,由眶隔深面外眦韧带浅面的潜在腔隙坠入下睑眶隔内。 4、下睑缩肌与眶隔在下睑板下2.5-3.4mm处融合,共同形成一膜样结构前行附着在下睑板下缘。 (二)临床部分: 1、下睑眶脂肪的突出可以归纳为下列组合:①内侧眶隔脂肪和外侧眶隔脂肪内侧叶突出;②内侧眶隔脂肪和外侧眶隔脂肪突出;③内侧眶隔脂肪、外侧眶隔脂肪内侧叶和外侧赘生脂肪突出;④内侧眶隔脂肪、外侧眶隔脂肪和外侧赘生脂肪突出;⑤内侧眶隔脂肪、外侧眶隔脂肪、外侧赘生脂肪或/和球后脂肪突出。 2、根据下睑袋畸形的特点将其分为四个类型五个亚型: Ⅰ型:单纯皮肤松弛,可伴有眼轮匝肌肥厚。Ⅱ型:单纯眶隔脂肪突出,可以有轻微皮肤松弛。根据眶隔脂肪突出特点又分为两型:Ⅱ_1型:内侧眶隔脂肪和外侧眶隔脂肪内侧叶突出,Ⅱ_2型:内侧眶隔脂肪和外侧眶隔脂肪均外突;Ⅲ型为松弛型眶隔脂肪疝出,眶隔脂肪疝出伴有下睑皮肤、眼轮匝肌、眶隔的松驰;Ⅳ型为Ⅲ型伴下睑支持结构松弛。 3、根据1990例患者不同的下睑袋畸形特点,对应每种手术方法的适应证和禁忌症,分别用①单纯睑缘皮肤切除下睑袋整复术;②皮瓣法下睑袋整复术;③微创结膜入路下睑袋整复术;④微创结膜入路结合单纯睑缘皮肤切除下睑袋整复术;⑤肌皮瓣法下睑袋整复术;⑥肌皮瓣法结合眼轮匝肌悬吊下睑袋整复术;⑦肌皮瓣法结合下睑缘楔形切除下睑袋整复术。对其中391例患者进行了平均为12.05个月的随访,随访中部分患者(共58例)有不同程度外形不良,但没有下睑外翻等严重并发症出现。 四.结论 1、根据眶脂肪的来源和包膜特点,下睑眶隔内脂肪应分为内侧眶隔脂肪、外侧眶隔脂肪和外侧赘生脂肪,其中外侧眶隔脂肪又根据弓状扩张部分为内侧叶和外侧叶。 2、从解剖学角度,最佳的结膜入路切口应该位于下睑睑板下缘2.5mm以内,行眶隔前入路。 3、下睑袋的畸形可分为四个类型五个亚型:Ⅰ型为单纯皮肤松弛,可伴有眼轮匝肌肥厚;Ⅱ型为单纯眶隔脂肪突出,可伴有轻微皮肤松弛:Ⅱ_1型:内侧眶隔脂肪和外侧眶隔脂肪内侧叶突出,Ⅱ_2型:内侧眶隔脂肪和外侧眶隔脂肪均外突;Ⅲ型为松弛型眶隔脂肪疝出,眶隔脂肪疝出伴有下睑皮肤、眼轮匝肌、眶隔的松驰;Ⅳ型为Ⅲ型伴下睑支持结构松弛。 4、我们针对下睑袋畸形的具体特点,应用①单纯睑缘皮肤切除下睑袋整复术;②皮瓣法下睑袋整复术;③微创结膜入路下睑袋整复术;④微创结膜入路结合单纯睑缘皮肤切除下睑袋整复术;⑤肌皮瓣法下睑袋整复术;⑥肌皮瓣法结合眼轮匝肌悬吊下睑袋整复术;⑦肌皮瓣法结合下睑缘楔形切除下睑袋整复术。共7种不同的手术方法进行治疗,证明这些手术方法能解决相应下睑袋畸形特点,但从另一个方面讲,这些方法亦存在着固有的缺点。因此,在临床上要根据患者的要求、详细的术前检查其下睑袋畸形的特征来选择合适的手术方法,从而取得良好的手术效果。
[Abstract]:I. purpose
The lower eyelid and its adjacent areas were systematically and anatomically studied. The location, range, shape, character and adjacent relationship of the orbital septum arcuate dilatation, orbital fat, lower eyelid constrictor and other related structures in Chinese were clarified, which provided anatomical theoretical basis for the clinical search for more reasonable lower eyelid surgery.
A retrospective summary of 1990 cases of lower eyelid blepharoplasty treated since 2000 was made. According to the different characteristics of lower eyelid blepharoplasty, a perfect classification method of lower eyelid blepharoplasty was put forward, and the relevant surgical treatment strategies were put forward.
Two. Materials and methods
(a) the basic part:
Materials: 10 head specimens (20 sides) of adult cadavers, including 3 males and 7 females, ranged from 56 to 72 years old.
Methods: Sagittal sectioning was performed on one side, surface and inner layers were dissected on 19 sides to observe the position, range, shape, character and relationship among the anatomical structures of the lower eyelid and its adjacent areas, and vernier calipers were used to measure them, and written and image records were made.
(two) clinical part:
Clinical data: 1990 cases of lower eyelid blepharoplasty: 1923 cases of female, 67 cases of male, age range 17 - 71 years old.
Methods: The characteristics of lower eyelid blepharoplasty in different patients were recorded and treated with different surgical methods. 391 of them were followed up for an average of 12.05 months.
Three. Results
(a) the basic part:
1. The arcuate margin of the orbital septum runs from the inner canthus to the outer canthus not along the apex of the orbital margin, but from the inner orbital wall to the outer orbital wall.
2. The arcuate dilatation is the orbital septum appendage, originating from the orbital septum, obliquely travels to the deep part of the inner canthus. During the course of traveling, there is a fiber connection with the orbital septum.
3. Incision of the arcuate margin lifts up the orbital septum, orbital fat is divided into two lobes, the two lobes of fat mass through the lower oblique flail finger O orbital fat and deep retrobulbar fat also exist between the separation, orbital fat and deep retrobulbar fat properties are different.
In addition, an inverted triangle of vegetative fat originated from the upper eyelid orbital septum and fell into the lower eyelid orbital septum from the underlying space of the shallow outer orbital ligament on the deep side of the orbital septum.
4. The inferior eyelid retractor fuses with the orbital septum at 2.5-3.4 mm below the lower tarsal plate to form a membrane-like structure and attaches to the inferior edge of the lower tarsal plate.
(two) clinical part:
1. The prominence of lower eyelid orbital fat can be summarized as follows: 1. Protrusion of medial orbital septum fat and medial lobe of lateral orbital septum fat; 2. Protrusion of medial orbital septum fat and lateral orbital septum fat; 3. Protrusion of medial orbital septum fat, medial lobe of lateral orbital fat and epiphytic fat; 4. The medial orbital septum fat, lateral orbital septum fat, lateral fat and / or retrobulbar fat protruding.
2, according to the characteristics of lower eyelid baggy deformity, it can be divided into four types and five subtypes:
Type I: Simple skin relaxation, accompanied by orbital muscle hypertrophy. Type II: Simple orbital fat protrusion, can have slight skin relaxation. According to the characteristics of orbital fat protrusion can be divided into two types: type II-1: medial orbital fat and lateral orbital fat medial lobe protrusion, type II-2: medial orbital fat and lateral orbital fat are protrusion; type III is relaxation. Type I orbital fat herniation, orbital fat herniation with lower eyelid skin, orbicularis oculi muscle, orbital septum relaxation; Type IV orbital fat herniation with lower eyelid supporting structure relaxation.
3. According to the different characteristics of lower eyelid blepharoplasty in 1990 patients, corresponding to the indications and contraindications of each surgical method, the lower eyelid blepharoplasty with simple eyelid margin skin excision, the lower eyelid blepharoplasty with skin flap, the lower eyelid blepharoplasty with minimally invasive conjunctival approach, the lower eyelid blepharoplasty with simple eyelid margin skin excision, the lower eyelid blepharoplasty with minimally invasive conjunctival approach _Musculocutaneous flap lower eyelid blepharoplasty; _Musculocutaneous flap combined with orbicularis oculi muscle suspension lower eyelid blepharoplasty; _Musculocutaneous flap combined with lower eyelid wedge resection lower eyelid blepharoplasty. 391 patients were followed up for an average of 12.05 months, some patients (58 cases) had different degrees of poor appearance, but no lower eyelid ectropion and so severe. Severe complications occurred.
Four. Conclusion
1. According to the origin and envelope characteristics of orbital fat, lower eyelid intraorbital fat should be divided into medial orbital fat, lateral orbital fat and lateral vegetative fat, of which lateral orbital fat is divided into medial and lateral lobes according to the arcuate expansion part.
2. From the anatomical point of view, the best conjunctival approach should be located within 2.5mm of the lower tarsal plate, and anterior orbital septum approach.
3. The deformity of the lower eyelid bag can be divided into four types and five subtypes: type I is simple skin relaxation, which may be accompanied by orbital muscle hypertrophy; type II is simple orbital fat protrusion, which may be accompanied by slight skin relaxation: type II: medial orbital fat and medial lobe of lateral orbital fat protrusion, type II: medial orbital fat and lateral orbital fat are exophytic; Type I was a relaxed orbital fat hernia with lower eyelid skin, orbicularis oculi muscle and orbital septum relaxation, type IV was a relaxed orbital fat hernia with lower eyelid supporting structure.
4. According to the specific characteristics of lower eyelid blepharoplasty, we applied: (1) simple eyelid margin skin resection lower eyelid blepharoplasty; (2) flap method lower eyelid blepharoplasty; (3) minimally invasive conjunctival approach lower eyelid blepharoplasty; (4) minimally invasive conjunctival approach combined with simple eyelid margin skin resection lower eyelid blepharoplasty; (6) musculocutaneous flap combined with eyelid ring surgery; A total of 7 different surgical methods were used to treat the lower eyelid blepharoplasty, which proved that these methods could solve the corresponding characteristics of lower eyelid blepharoplasty, but on the other hand, these methods also have inherent shortcomings. In order to obtain a good result, the lower eyelid blepharoplasty was performed by examining the characteristics of lower eyelid blepharoplasty before operation.
【学位授予单位】：中国协和医科大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R779.6;R322
本文编号：2208384
[Abstract]:I. purpose
The lower eyelid and its adjacent areas were systematically and anatomically studied. The location, range, shape, character and adjacent relationship of the orbital septum arcuate dilatation, orbital fat, lower eyelid constrictor and other related structures in Chinese were clarified, which provided anatomical theoretical basis for the clinical search for more reasonable lower eyelid surgery.
A retrospective summary of 1990 cases of lower eyelid blepharoplasty treated since 2000 was made. According to the different characteristics of lower eyelid blepharoplasty, a perfect classification method of lower eyelid blepharoplasty was put forward, and the relevant surgical treatment strategies were put forward.
Two. Materials and methods
(a) the basic part:
Materials: 10 head specimens (20 sides) of adult cadavers, including 3 males and 7 females, ranged from 56 to 72 years old.
Methods: Sagittal sectioning was performed on one side, surface and inner layers were dissected on 19 sides to observe the position, range, shape, character and relationship among the anatomical structures of the lower eyelid and its adjacent areas, and vernier calipers were used to measure them, and written and image records were made.
(two) clinical part:
Clinical data: 1990 cases of lower eyelid blepharoplasty: 1923 cases of female, 67 cases of male, age range 17 - 71 years old.
Methods: The characteristics of lower eyelid blepharoplasty in different patients were recorded and treated with different surgical methods. 391 of them were followed up for an average of 12.05 months.
Three. Results
(a) the basic part:
1. The arcuate margin of the orbital septum runs from the inner canthus to the outer canthus not along the apex of the orbital margin, but from the inner orbital wall to the outer orbital wall.
2. The arcuate dilatation is the orbital septum appendage, originating from the orbital septum, obliquely travels to the deep part of the inner canthus. During the course of traveling, there is a fiber connection with the orbital septum.
3. Incision of the arcuate margin lifts up the orbital septum, orbital fat is divided into two lobes, the two lobes of fat mass through the lower oblique flail finger O orbital fat and deep retrobulbar fat also exist between the separation, orbital fat and deep retrobulbar fat properties are different.
In addition, an inverted triangle of vegetative fat originated from the upper eyelid orbital septum and fell into the lower eyelid orbital septum from the underlying space of the shallow outer orbital ligament on the deep side of the orbital septum.
4. The inferior eyelid retractor fuses with the orbital septum at 2.5-3.4 mm below the lower tarsal plate to form a membrane-like structure and attaches to the inferior edge of the lower tarsal plate.
(two) clinical part:
1. The prominence of lower eyelid orbital fat can be summarized as follows: 1. Protrusion of medial orbital septum fat and medial lobe of lateral orbital septum fat; 2. Protrusion of medial orbital septum fat and lateral orbital septum fat; 3. Protrusion of medial orbital septum fat, medial lobe of lateral orbital fat and epiphytic fat; 4. The medial orbital septum fat, lateral orbital septum fat, lateral fat and / or retrobulbar fat protruding.
2, according to the characteristics of lower eyelid baggy deformity, it can be divided into four types and five subtypes:
Type I: Simple skin relaxation, accompanied by orbital muscle hypertrophy. Type II: Simple orbital fat protrusion, can have slight skin relaxation. According to the characteristics of orbital fat protrusion can be divided into two types: type II-1: medial orbital fat and lateral orbital fat medial lobe protrusion, type II-2: medial orbital fat and lateral orbital fat are protrusion; type III is relaxation. Type I orbital fat herniation, orbital fat herniation with lower eyelid skin, orbicularis oculi muscle, orbital septum relaxation; Type IV orbital fat herniation with lower eyelid supporting structure relaxation.
3. According to the different characteristics of lower eyelid blepharoplasty in 1990 patients, corresponding to the indications and contraindications of each surgical method, the lower eyelid blepharoplasty with simple eyelid margin skin excision, the lower eyelid blepharoplasty with skin flap, the lower eyelid blepharoplasty with minimally invasive conjunctival approach, the lower eyelid blepharoplasty with simple eyelid margin skin excision, the lower eyelid blepharoplasty with minimally invasive conjunctival approach _Musculocutaneous flap lower eyelid blepharoplasty; _Musculocutaneous flap combined with orbicularis oculi muscle suspension lower eyelid blepharoplasty; _Musculocutaneous flap combined with lower eyelid wedge resection lower eyelid blepharoplasty. 391 patients were followed up for an average of 12.05 months, some patients (58 cases) had different degrees of poor appearance, but no lower eyelid ectropion and so severe. Severe complications occurred.
Four. Conclusion
1. According to the origin and envelope characteristics of orbital fat, lower eyelid intraorbital fat should be divided into medial orbital fat, lateral orbital fat and lateral vegetative fat, of which lateral orbital fat is divided into medial and lateral lobes according to the arcuate expansion part.
2. From the anatomical point of view, the best conjunctival approach should be located within 2.5mm of the lower tarsal plate, and anterior orbital septum approach.
3. The deformity of the lower eyelid bag can be divided into four types and five subtypes: type I is simple skin relaxation, which may be accompanied by orbital muscle hypertrophy; type II is simple orbital fat protrusion, which may be accompanied by slight skin relaxation: type II: medial orbital fat and medial lobe of lateral orbital fat protrusion, type II: medial orbital fat and lateral orbital fat are exophytic; Type I was a relaxed orbital fat hernia with lower eyelid skin, orbicularis oculi muscle and orbital septum relaxation, type IV was a relaxed orbital fat hernia with lower eyelid supporting structure.
4. According to the specific characteristics of lower eyelid blepharoplasty, we applied: (1) simple eyelid margin skin resection lower eyelid blepharoplasty; (2) flap method lower eyelid blepharoplasty; (3) minimally invasive conjunctival approach lower eyelid blepharoplasty; (4) minimally invasive conjunctival approach combined with simple eyelid margin skin resection lower eyelid blepharoplasty; (6) musculocutaneous flap combined with eyelid ring surgery; A total of 7 different surgical methods were used to treat the lower eyelid blepharoplasty, which proved that these methods could solve the corresponding characteristics of lower eyelid blepharoplasty, but on the other hand, these methods also have inherent shortcomings. In order to obtain a good result, the lower eyelid blepharoplasty was performed by examining the characteristics of lower eyelid blepharoplasty before operation.
【学位授予单位】：中国协和医科大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R779.6;R322
【参考文献】
相关期刊论文 前10条
1 鲁开化;艾玉峰;杨晋杰;;下睑美容整形术有关诊断与术式选择[J];中国美容医学;1995年03期
2 陈 辉,赵新华,李小莉;眼袋整形的术式选择和治疗经验[J];中国美容医学;2002年04期
3 张本寿;不同类型眼袋患者的相应术式整复[J];中国美容医学;2002年06期
4 张本寿,林子豪,赵跃中;下睑袋分型及术式选择[J];中国美容医学;2003年02期
5 陈忠存;高尚;王永洁;王仲锋;;经外眦及结膜联合入路下睑年轻化美容整形术[J];中国美容医学;2006年11期
6 王炜,王卫峻,祁佐良,林晓曦,方建蔺,林李嵩,邹丽剑;眶区年轻化策略——王韧带松解及提紧的睑袋整形术(待续)[J];中国实用美容整形外科杂志;2005年04期
7 王炜,王卫峻,祁佐良,林晓曦,方建蔺,林李嵩,邹丽剑;眶区年轻化策略——王韧带松解及提紧的睑袋整形术(续)[J];中国实用美容整形外科杂志;2005年05期
8 黄勇;邢新;;外眦锚着术及进展[J];中国美容整形外科杂志;2006年04期
9 周丽云;睑袋整形方法的探讨和常见并发症的防治[J];实用美容整形外科;1995年03期
10 汪晓蕾,夏成俊,崔日香,羿士林,金铸,高景恒;下睑成形术的术式选择[J];实用美容整形外科杂志;1997年03期
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