下瞼部應(yīng)用解剖學研究和下瞼袋綜合治療對策
發(fā)布時間：2018-08-27 20:36
【摘要】： 一.目的 對下瞼及其鄰近區(qū)域進行系統(tǒng)、詳細的解剖研究,明確國人眶隔弓狀擴張部、眶隔脂肪、下瞼縮肌等相關(guān)結(jié)構(gòu)的部位、范圍、形態(tài)、性狀和毗鄰關(guān)系,為臨床尋找更加合理的下瞼部整復手術(shù)提供解剖學理論基礎(chǔ)。 對2000年以來治療的1990例下瞼袋畸形患者進行回顧性總結(jié),根據(jù)下瞼袋畸形的不同特點提出完善的下瞼袋畸形分型方法,并提出相關(guān)手術(shù)治療對策。 二.材料和方法 (一)基礎(chǔ)部分: 材料:10具(20側(cè))成人尸體頭部標本,男3具,女7具,年齡范圍56—72歲。 方法:1側(cè)采用矢狀斷層切片;19側(cè)采用由表及里逐層解剖,觀察下瞼部及鄰近區(qū)域各解剖結(jié)構(gòu)間的部位、范圍、形態(tài)、性狀和相互間聯(lián)系,采用游標卡尺測量,并作文字和圖象記錄。 (二)臨床部分: 臨床資料:1990例下瞼袋畸形患者:女性1923例,男性67例,年齡范圍17—71歲。 方法:記錄不同患者下瞼袋畸形的特點,分別應(yīng)用不同手術(shù)方法進行治療,并對其中391例患者進行了平均12.05個月的隨訪。 三.結(jié)果 (一)基礎(chǔ)部分: 1、眶隔弓狀緣在眶下緣的止點從內(nèi)眥到外眥并不沿眶骨緣頂點走行,而是由眶內(nèi)壁走行到眶外壁;眶隔各部分厚度不一,由內(nèi)眥側(cè)向外眥側(cè)逐漸增厚。 2、弓狀擴張部為眶隔的附屬結(jié)構(gòu),起于眶隔,斜行向內(nèi)眥方向深部走行,走行過程中與眶隔有纖維聯(lián)系,在下斜肌中1/3段與包繞下斜肌的下瞼縮肌淺層匯合,最終匯入Lockwood韌帶。 3、切開弓狀緣向上掀起眶隔,眶隔脂肪分為兩葉,兩葉脂肪團通過下斜枷嚳指�。舷|畈孔紛?眶隔脂肪與深部球后脂肪之間亦存在分隔,眶隔脂肪與深部球后脂肪性狀不同。 另外,在2具3側(cè)標本的外眥下方,有一倒三角形的贅生脂肪,該脂肪來源于上瞼眶隔內(nèi),由眶隔深面外眥韌帶淺面的潛在腔隙墜入下瞼眶隔內(nèi)。 4、下瞼縮肌與眶隔在下瞼板下2.5-3.4mm處融合,共同形成一膜樣結(jié)構(gòu)前行附著在下瞼板下緣。 (二)臨床部分: 1、下瞼眶脂肪的突出可以歸納為下列組合:①內(nèi)側(cè)眶隔脂肪和外側(cè)眶隔脂肪內(nèi)側(cè)葉突出;②內(nèi)側(cè)眶隔脂肪和外側(cè)眶隔脂肪突出;③內(nèi)側(cè)眶隔脂肪、外側(cè)眶隔脂肪內(nèi)側(cè)葉和外側(cè)贅生脂肪突出;④內(nèi)側(cè)眶隔脂肪、外側(cè)眶隔脂肪和外側(cè)贅生脂肪突出;⑤內(nèi)側(cè)眶隔脂肪、外側(cè)眶隔脂肪、外側(cè)贅生脂肪或/和球后脂肪突出。 2、根據(jù)下瞼袋畸形的特點將其分為四個類型五個亞型: Ⅰ型:單純皮膚松弛,可伴有眼輪匝肌肥厚。Ⅱ型:單純眶隔脂肪突出,可以有輕微皮膚松弛。根據(jù)眶隔脂肪突出特點又分為兩型:Ⅱ_1型:內(nèi)側(cè)眶隔脂肪和外側(cè)眶隔脂肪內(nèi)側(cè)葉突出,Ⅱ_2型:內(nèi)側(cè)眶隔脂肪和外側(cè)眶隔脂肪均外突;Ⅲ型為松弛型眶隔脂肪疝出,眶隔脂肪疝出伴有下瞼皮膚、眼輪匝肌、眶隔的松馳;Ⅳ型為Ⅲ型伴下瞼支持結(jié)構(gòu)松弛。 3、根據(jù)1990例患者不同的下瞼袋畸形特點,對應(yīng)每種手術(shù)方法的適應(yīng)證和禁忌癥,分別用①單純瞼緣皮膚切除下瞼袋整復術(shù);②皮瓣法下瞼袋整復術(shù);③微創(chuàng)結(jié)膜入路下瞼袋整復術(shù);④微創(chuàng)結(jié)膜入路結(jié)合單純瞼緣皮膚切除下瞼袋整復術(shù);⑤肌皮瓣法下瞼袋整復術(shù);⑥肌皮瓣法結(jié)合眼輪匝肌懸吊下瞼袋整復術(shù);⑦肌皮瓣法結(jié)合下瞼緣楔形切除下瞼袋整復術(shù)。對其中391例患者進行了平均為12.05個月的隨訪,隨訪中部分患者(共58例)有不同程度外形不良,但沒有下瞼外翻等嚴重并發(fā)癥出現(xiàn)。 四.結(jié)論 1、根據(jù)眶脂肪的來源和包膜特點,下瞼眶隔內(nèi)脂肪應(yīng)分為內(nèi)側(cè)眶隔脂肪、外側(cè)眶隔脂肪和外側(cè)贅生脂肪,其中外側(cè)眶隔脂肪又根據(jù)弓狀擴張部分為內(nèi)側(cè)葉和外側(cè)葉。 2、從解剖學角度,最佳的結(jié)膜入路切口應(yīng)該位于下瞼瞼板下緣2.5mm以內(nèi),行眶隔前入路。 3、下瞼袋的畸形可分為四個類型五個亞型:Ⅰ型為單純皮膚松弛,可伴有眼輪匝肌肥厚;Ⅱ型為單純眶隔脂肪突出,可伴有輕微皮膚松弛:Ⅱ_1型:內(nèi)側(cè)眶隔脂肪和外側(cè)眶隔脂肪內(nèi)側(cè)葉突出,Ⅱ_2型:內(nèi)側(cè)眶隔脂肪和外側(cè)眶隔脂肪均外突;Ⅲ型為松弛型眶隔脂肪疝出,眶隔脂肪疝出伴有下瞼皮膚、眼輪匝肌、眶隔的松馳;Ⅳ型為Ⅲ型伴下瞼支持結(jié)構(gòu)松弛。 4、我們針對下瞼袋畸形的具體特點,應(yīng)用①單純瞼緣皮膚切除下瞼袋整復術(shù);②皮瓣法下瞼袋整復術(shù);③微創(chuàng)結(jié)膜入路下瞼袋整復術(shù);④微創(chuàng)結(jié)膜入路結(jié)合單純瞼緣皮膚切除下瞼袋整復術(shù);⑤肌皮瓣法下瞼袋整復術(shù);⑥肌皮瓣法結(jié)合眼輪匝肌懸吊下瞼袋整復術(shù);⑦肌皮瓣法結(jié)合下瞼緣楔形切除下瞼袋整復術(shù)。共7種不同的手術(shù)方法進行治療,證明這些手術(shù)方法能解決相應(yīng)下瞼袋畸形特點,但從另一個方面講,這些方法亦存在著固有的缺點。因此,在臨床上要根據(jù)患者的要求、詳細的術(shù)前檢查其下瞼袋畸形的特征來選擇合適的手術(shù)方法,從而取得良好的手術(shù)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.
【學位授予單位】：中國協(xié)和醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2008
【分類號】：R779.6;R322
本文編號：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.
【學位授予單位】：中國協(xié)和醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2008
【分類號】：R779.6;R322
【參考文獻】
相關(guān)期刊論文 前10條
1 魯開化;艾玉峰;楊晉杰;;下瞼美容整形術(shù)有關(guān)診斷與術(shù)式選擇[J];中國美容醫(yī)學;1995年03期
2 陳 輝,趙新華,李小莉;眼袋整形的術(shù)式選擇和治療經(jīng)驗[J];中國美容醫(yī)學;2002年04期
3 張本壽;不同類型眼袋患者的相應(yīng)術(shù)式整復[J];中國美容醫(yī)學;2002年06期
4 張本壽,林子豪,趙躍中;下瞼袋分型及術(shù)式選擇[J];中國美容醫(yī)學;2003年02期
5 陳忠存;高尚;王永潔;王仲鋒;;經(jīng)外眥及結(jié)膜聯(lián)合入路下瞼年輕化美容整形術(shù)[J];中國美容醫(yī)學;2006年11期
6 王煒,王衛(wèi)峻,祁佐良,林曉曦,方建藺,林李嵩,鄒麗劍;眶區(qū)年輕化策略——王韌帶松解及提緊的瞼袋整形術(shù)(待續(xù))[J];中國實用美容整形外科雜志;2005年04期
7 王煒,王衛(wèi)峻,祁佐良,林曉曦,方建藺,林李嵩,鄒麗劍;眶區(qū)年輕化策略——王韌帶松解及提緊的瞼袋整形術(shù)(續(xù))[J];中國實用美容整形外科雜志;2005年05期
8 黃勇;邢新;;外眥錨著術(shù)及進展[J];中國美容整形外科雜志;2006年04期
9 周麗云;瞼袋整形方法的探討和常見并發(fā)癥的防治[J];實用美容整形外科;1995年03期
10 汪曉蕾,夏成俊,崔日香,羿士林,金鑄,高景恒;下瞼成形術(shù)的術(shù)式選擇[J];實用美容整形外科雜志;1997年03期
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