本文選題：淚槽畸形　切入點(diǎn)：瞼頰溝畸形　出處：《貴州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過對不同年齡段人體下瞼局部解剖及下眼眶矢狀面觀察,對比淚槽和瞼頰溝畸形,探討中老年淚槽和瞼頰溝畸形的解剖學(xué)特點(diǎn),在臨床上制定個性化整形手術(shù)方案。方法選取不同年齡的三組尸體標(biāo)本(青年組、中年組、老年組),每組均為5例女性標(biāo)本,3例男性標(biāo)本。分別從下瞼局部解剖及眼眶矢狀面觀察對比淚槽和瞼頰溝畸形,并測量各組下瞼皮膚厚度、顴部脂肪墊厚度、中年組和老年組眶隔脂肪突出下眶緣的距離,計算平均值及標(biāo)準(zhǔn)差。對我科近兩年收集的淚槽和瞼頰溝畸形30例臨床病例(其中中老年病例26例)。以Hirmand分型標(biāo)準(zhǔn)為基礎(chǔ),根據(jù)不同年齡淚槽和瞼頰溝畸形的程度、下瞼薄弱松弛下垂的程度及眶隔脂肪膨出的程度等,分為六種類型。手術(shù)方法主要選擇經(jīng)皮入路松解眼輪匝肌限制韌帶、眶隔脂肪瓣填充溝槽凹陷、去除眼袋、提升下瞼手術(shù)。不同類型的畸形,具體的手術(shù)方式不同。結(jié)果通過對不同年齡淚槽和瞼頰溝畸形的大體標(biāo)本及組織切片觀察測量,統(tǒng)計學(xué)計算結(jié)果:1.下眼瞼皮膚厚度:青年組(0.35±0.08)mm;中年組(0.31±0.06)mm;老年組(0.26±0.05)mm。2.青年組顴部脂肪墊上緣覆蓋于淚槽及瞼頰溝,此處厚度為(3.18±0.15)mm;中年組顴部脂肪墊萎縮并下移,此處厚度為(1.16±0.13)mm;老年組,顴部脂肪墊萎縮明顯下移,無脂肪覆蓋于淚槽及瞼頰溝。3.中年組觀察到:下瞼各層組織輕度薄弱、松弛和下移,眶隔脂肪輕度或中度松弛膨出,淚槽及瞼頰溝輕度凹陷畸形;老年組觀察到:下瞼各層組織中度薄弱、松弛和下移,眶隔脂肪不同程度松弛膨出,淚槽及瞼頰溝中重度凹陷畸形。此外,眼輪匝肌限制韌帶在下瞼內(nèi)側(cè)和外側(cè)均與骨膜銜接緊密。臨床觀察結(jié)果:30例患者術(shù)后隨訪3至6個月,淚槽及瞼頰溝凹陷畸形不同程度改善,同時達(dá)到去除眼袋、提升下瞼的目的。術(shù)后隨訪根據(jù)Barton坡度分級、下瞼提升效果分級及患者的滿意度調(diào)查�？陀^評價術(shù)后結(jié)果:患者基本滿意。但年齡越大,淚槽和瞼頰溝畸形和下瞼下垂改善效果較年輕患者差。結(jié)論在瞼部和顴部組織厚薄過渡部位,隨著年齡的增長,由于內(nèi)側(cè)和外側(cè)眼輪匝肌限制韌帶固定的力量,及下瞼皮膚軟組織受重力作用,出現(xiàn)淚槽及瞼頰溝畸型。根據(jù)其發(fā)生的原因,再加上術(shù)前的客觀評估及分型,選擇不同的整形手術(shù)方式可達(dá)到較滿意的效果。
[Abstract]:Objective to study the anatomical characteristics of lacrimal groove and eyelid buccal sulcus in middle and old age by observing the local anatomy of lower eyelid and sagittal surface of lower eyelid of human body at different ages and comparing the malformation of lacrimal groove and eyelid buccal groove. Methods three groups of cadaver specimens of different ages (youth group, middle age group, middle age group) were selected. The local anatomy of lower eyelid and orbital sagittal plane were used to observe and compare lacrimal groove and eyelid buccal sulcus, and the thickness of lower eyelid skin and zygomatic fat pad were measured in each group. The distance of orbital septum fat protruding the lower orbital margin in middle age group and old group was calculated, the mean value and standard deviation were calculated. 30 cases of lacrimal groove and eyelid buccal sulcus were collected in our department in recent two years (including 26 cases of middle and old age cases). According to the degree of lacrimal groove and malformation of eyelid and buccal sulcus at different ages, the degree of weak relaxation of lower eyelid and the degree of fat exudation of orbital septum were divided into six types. The main operative method was to release the limited ligament of orbicularis oculi by percutaneous approach. The orbital septum fat flap filled the grooves, removed the pouch and raised the lower eyelid. Different types of deformities and different operative methods were performed. Results the gross specimens and tissue sections of lacrimal grooves and blepharobuccal sulcus deformities of different ages were observed and measured. The thickness of lower eyelid skin was 0.35 鹵0.08mm in the young group, 0.31 鹵0.06mm in the middle age group, 0.26 鹵0.05nm. 2in the aged group. The upper margin of the fat pad in the zygomatic region of the young group was covered with lacrimal groove and sulcus of eyelid cheek, the thickness of the fat pad was 3.18 鹵0.15mm; the fat pad of the zygomatic part of the middle age group was atrophy and moved down. The thickness here is 1.16 鹵0.13 mm. In the aged group, the zygomatic fat pad shrank obviously and the fat did not cover the lacrimal groove and eyelid buccal sulcus .3.The middle age group observed that the lower eyelid tissues were slightly weak, relaxed and moved down, and the orbital septum fat was slightly or moderately loosely inflated. Slight deformity of lacrimal groove and eyelid buccal sulcus was observed in the senile group. In the old group, the lower eyelid tissue was moderately weak, relaxed and moved down, the orbital septum fat was loosely inflated to varying degrees, the lacrimal groove and the eyelid cheek sulcus were deformed in the middle and severe degree. The constrictive ligament of orbicularis oculi was closely connected with the periosteum on the medial and lateral sides of the lower eyelid. Results 30 cases of 30 cases were followed up for 3 to 6 months after operation. The deformity of lacrimal groove and eyelid and buccal sulcus were improved in different degrees, and the bags of eyes were removed at the same time. Objective to improve the lower eyelid. A follow-up survey was conducted according to the Barton gradient, the lower eyelid lifting effect and the patients' satisfaction. Objective evaluation showed that the patients were basically satisfied, but the older the patients were, The improvement of lacrimal sulcus and blepharobuccal sulcus deformity and ptosis was worse than that of young patients. Conclusion in the thick transition region of eyelid and zygomaticus, the medial and lateral orbicularis oculi muscle restricts the strength of ligaments fixation with the increase of age. The malformation of lacrimal groove and eyelid and buccal sulcus appeared in the skin and soft tissue of lower eyelid by gravity. According to the causes of the occurrence and the objective evaluation and classification before operation, different plastic surgery methods could achieve satisfactory results.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R622

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