發(fā)布時(shí)間：2018-06-25 22:13

  本文選題：眼瞼 + 內(nèi)眥韌帶�。� 參考：《南方醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 研究背景 眼作為五官之首,對于一個(gè)人的容貌有著重要的影響。從人類起源和人種學(xué)看,國人絕大部分都屬于蒙古人種。蒙古人種擁有特殊的眼瞼外貌,主要表現(xiàn)為單瞼、內(nèi)眥贅皮、飽滿上瞼和小瞼裂。這種獨(dú)特的眼瞼外貌及中國文化的傳承形成了關(guān)于眼及眼瞼的中國傳統(tǒng)審美觀。在中國傳統(tǒng)審美觀中,人們較關(guān)注眼的曲線及眼與面部的整體比例,從而有三停五眼、單鳳眼等提法,前者體現(xiàn)了眼與面部整體的比例,后者則體現(xiàn)了眼的曲線。因?yàn)樵诿晒湃朔N中普遍存在內(nèi)眥贅皮及單瞼,所以在傳統(tǒng)的東方審美觀中輕度內(nèi)眥贅皮及單瞼被認(rèn)為是傳統(tǒng)的內(nèi)秀的東方美。盡管傳統(tǒng)的西方審美觀中也十分注重眼與面部的比例關(guān)系,但是由于內(nèi)眥贅皮及單瞼在高加索人種中較少遇見,所以傳統(tǒng)的西方審美觀并不認(rèn)為內(nèi)眥贅皮和單瞼是美得表現(xiàn)。這種由于人種、文化背景造成的不同的審美觀,隨著東西方文化交流及審美觀的相互融入,逐漸發(fā)生改變,形成新的審美觀念。這種審美觀表現(xiàn)為以原有文化為底蘊(yùn),交融其他文化背景,具有全球化的表現(xiàn),較傳統(tǒng)審美觀而言有繼承但更有改變�，F(xiàn)在的中國社會(huì)普遍認(rèn)為較寬的眼裂及流暢的重瞼曲線是美的象征,而蒙古人種特有的上瞼形態(tài)易產(chǎn)生沒有精神、疲憊的外貌感覺,即單瞼、飽滿的上瞼及內(nèi)眥贅皮漸漸不符合現(xiàn)代的審美觀點(diǎn)。 蒙古人種的上瞼一般比高加索人種的上瞼要飽滿,而且較多表現(xiàn)為單瞼。由于這種飽滿的上瞼,使得眼部表現(xiàn)缺乏變化,立體及層次不分明,因而給人呆滯疲憊無神的感官印象。為改變這種過于飽滿的上瞼,很多人選擇重瞼手術(shù)并去除上瞼眶隔脂肪予以改善,但術(shù)后仍有部分求美者并不滿意。Y.Tanaka等提出蒙古人種過于飽滿的上瞼并不是由于脂肪過多引起,而是由于提上瞼肌腱膜前脂肪低位造成,并提出上瞼眶隔脂肪限制韌帶的概念。我們通過對上瞼的解剖研究,探尋國人產(chǎn)生飽滿上瞼的生理機(jī)制,并為臨床手術(shù)提供解剖依據(jù)。 內(nèi)眥贅皮在蒙古人種中有著較高發(fā)生率,可達(dá)50%-70%,因而我國有較多尋求改善內(nèi)眥贅皮的求美者,現(xiàn)行針對內(nèi)眥贅皮的手術(shù)方式有許多種。但由于蒙古人種的特點(diǎn),使內(nèi)眥贅皮矯正術(shù)并發(fā)癥時(shí)有發(fā)生。其并發(fā)癥主要為手術(shù)切口瘢痕和術(shù)后效果易發(fā)生反彈,長期手術(shù)效果難以維持。并發(fā)癥的產(chǎn)生限制了內(nèi)眥贅皮矯正術(shù)的開展,而較多的手術(shù)方式正式對如何避免術(shù)后并發(fā)癥的發(fā)生而產(chǎn)生。我們通過對內(nèi)眥部的解剖研究及組織學(xué)觀察,闡述內(nèi)眥韌帶在內(nèi)眥贅皮產(chǎn)生中的作用,對降低內(nèi)眥贅皮手術(shù)術(shù)后并發(fā)癥及針對內(nèi)眥韌帶的合理處置提供解剖依據(jù)。 年輕美麗外眥應(yīng)表現(xiàn)為：外眥角高于內(nèi)眥角,內(nèi)外眥連線與水平夾角一般為10度左右,這種內(nèi)外眥關(guān)系表現(xiàn)出年輕、嫵媚。隨著機(jī)體老化,外眥角逐漸下降,這是低垂的外眥角給人老態(tài)、奸詐等不好的感官印象,并且伴隨外眥的下降會(huì)出現(xiàn)下瞼內(nèi)翻、外翻、瞼球分離及溢淚等情況。隨著生活質(zhì)量的提高,越來越多的人們認(rèn)識(shí)到外眥角下降至內(nèi)眥角水平或低于內(nèi)眥角是一種衰老的表現(xiàn),以往僅僅通過瞼袋矯正老齡化下瞼的情況已逐漸不能滿足現(xiàn)代人們的需求�，F(xiàn)在除了對下瞼局部的調(diào)整外,人們更加關(guān)注眼內(nèi)外眥的平衡,所以通過調(diào)整外眥韌帶來改善上述情況的訴求逐漸增加。盡管國外相關(guān)解剖較多,研究較深,但是由于其解剖和研究多基于高加索人種。而國內(nèi)關(guān)于外眥部特別是外眥韌帶的解剖較少,本研究試圖通過對外眥部特別是外眥韌帶的解剖描述及組織學(xué)觀察,為臨床提供解剖依據(jù)。 目的 通過對眼周解剖特別是內(nèi)外眥韌帶的解剖觀察、測量及組織學(xué)研究,闡明內(nèi)外眥區(qū)解剖層次、韌帶走行、韌帶與眶周解剖結(jié)構(gòu)毗鄰關(guān)系及組織學(xué)特點(diǎn),闡述眼周解剖結(jié)構(gòu)在整形外科中的應(yīng)用,探尋飽滿上瞼和內(nèi)眥贅皮矯正術(shù)并發(fā)癥發(fā)生的解剖原因,及改善飽滿上瞼和降低眥贅皮矯正術(shù)并發(fā)癥發(fā)生的手術(shù)方式,并為外眥區(qū)臨床手術(shù)提供解剖依據(jù)。 方法 1眼周解剖 選取9具尸體標(biāo)本(男6例,女3例),共18側(cè),進(jìn)行大體和顯微解剖,了解眼部解剖結(jié)構(gòu)位置及在整形美容外科中的應(yīng)用。 2.1.內(nèi)眥區(qū)解剖觀察 選取9具尸體標(biāo)本(男6例,女3例),共18側(cè),進(jìn)行大體和顯微解剖,觀察各解剖層次的解剖結(jié)構(gòu)、內(nèi)眥韌帶分支及走行、內(nèi)眥韌帶與眶周肌肉的毗鄰關(guān)系、內(nèi)眥韌帶與淚囊鼻淚管的毗鄰關(guān)系、內(nèi)眥韌帶與眶周血管的毗鄰關(guān)系、內(nèi)眥韌帶與眶周神經(jīng)的毗鄰關(guān)系。 2.2.內(nèi)眥區(qū)解剖測量 采用上述標(biāo)本,分別測量內(nèi)眥韌帶各個(gè)分支的長度,內(nèi)眥韌帶起點(diǎn)至眶緣距離、至降眉肌的距離、至皺眉肌的距離、至提上唇鼻翼肌的距離、至眶上神經(jīng)的距離；各個(gè)分支止點(diǎn)之間距離,各個(gè)止點(diǎn)至眶緣距離、至降眉肌的距離、至皺眉肌的距離、至提上唇鼻翼肌的距離、至眶上神經(jīng)的距離。 2.3.組織學(xué)觀察 對測量后標(biāo)本進(jìn)行V.G染色,觀察韌帶纖維構(gòu)成及組織層次3.1.外眥區(qū)解剖觀察 選取9具尸體標(biāo)本(男6例,女3例),共18側(cè),進(jìn)行大體解剖和顯微解剖,觀察外眥韌帶分支及走行、外眥韌帶與lockwood韌帶毗鄰關(guān)系、與眶隔脂肪毗鄰關(guān)系、與外直肌毗鄰關(guān)系、與淚腺的毗鄰關(guān)系 3.2.外眥區(qū)解剖測量 采用上述標(biāo)本,分別測量外眥韌帶各個(gè)分支的長度與寬度,外眥韌帶起點(diǎn)至眶緣的距離、外眥韌帶至淚腺的距離。 3.3.組織學(xué)觀察 對測量后標(biāo)本進(jìn)行染色,觀察韌帶纖維構(gòu)成及組織層次。 結(jié)果 1.1內(nèi)眥韌帶前支長度為8.33mm±0.9mm,內(nèi)眥韌帶上支長度為6.41mm±1.09mm,內(nèi)眥韌帶后支長度為8.77mm±0.81mm,內(nèi)眥韌帶起點(diǎn)到上眶緣距離為21.06mm±2.82mm,到下眶緣距離為15.96mm±2.34mm,內(nèi)眥韌帶起點(diǎn)到降眉間肌的水平距離7.44mm±0.75mm,到滑車上神經(jīng)血管束距離21.22mm±1.75mm,到內(nèi)眥動(dòng)靜脈的距離9.33mm±1.15mm,內(nèi)眥韌帶前支止點(diǎn)到上支止點(diǎn)的距離12.85mm±1.33mm,內(nèi)眥韌帶前支止點(diǎn)到后支止點(diǎn)距離5.43mm±0.71mm,內(nèi)眥韌帶前支止點(diǎn)至上眶緣距離20.81mm±2.61mm,至下眶緣距離17.75mm±2.12mm,至降眉肌距離0.52mm±0.06mm,至滑車上神經(jīng)血管束距離23.52mm±1.54mm,至內(nèi)眥動(dòng)靜脈的距離0.79mm±0.14mm。 1.2內(nèi)眥韌帶前支是致密的膠原纖維構(gòu)成,其與皮膚之間有明顯的、疏松的纖維連接。 2.1.外眥韌帶淺支長度9.83mm±0.55mm,外眥韌帶深支長度12.89mm±1.09mm,外眥韌帶深支寬度3.82mm±0.41mm,外眥韌帶起點(diǎn)至上眶緣距離19.95mm±3.81mm,至下眶緣距離17.47mm±2.24mm,Whitnall結(jié)節(jié)至外側(cè)眶緣距離為1.95mm±0.12mm,Whitnall結(jié)節(jié)至淚腺隱窩距離7.07mm±0.69mm。 2.2.外眥韌帶淺支纖維較粗,排列疏松；外眥韌帶深支纖維較細(xì),排列緊密。 結(jié)論 1.可以將眼及眼周解剖分為3個(gè)解剖層面,皮膚及皮下組織層,表情肌層,眶隔及眶內(nèi)容物層,3個(gè)層次彼此間連接不緊密,無重要結(jié)構(gòu),是良好的手術(shù)平面。 2.眼周整形美容手術(shù)重點(diǎn)是對解剖結(jié)構(gòu)的生理復(fù)位 3.錯(cuò)構(gòu)的眼輪匝肌和內(nèi)眥韌帶前支纖維牽拉是內(nèi)眥贅皮產(chǎn)生的主要原因。 4.矯正內(nèi)眥贅皮應(yīng)在明確病人所屬內(nèi)眥贅皮形態(tài)、程度的基礎(chǔ)上,選擇盡可能避免產(chǎn)生內(nèi)眥部明顯瘢痕并能取得明確手術(shù)效果的手術(shù)方式。 5.通過折疊內(nèi)眥韌帶前支降低內(nèi)眥部皮膚張力,使內(nèi)眥贅皮矯正術(shù)獲得更好的手術(shù)效果。 6.外眥韌帶分深淺2支,深支是外眥部懸吊的主要結(jié)構(gòu)。 7.外眥韌帶淺支主要由膠原纖維構(gòu)成,夾有少量彈性纖維,纖維排列疏松,其中含有較多非膠原類結(jié)締組織；外眥韌帶深支主要有膠原纖維構(gòu)成,可見彈性纖維分布于韌帶周邊,纖維排列緊密,非膠原類結(jié)締組織含量很少。 8.外眥部老化的主要原因就是外眥韌帶松弛導(dǎo)致眼瞼懸吊的失衡。通過懸吊或者折疊外眥韌帶深支可以有效的解決外眥部老化帶來的并發(fā)癥。
[Abstract]:Research background
As the first of the five senses, the eye has an important influence on the appearance of a person. From the origin of human beings and ethnography, most of the people belong to the Mongolia people. The Mongolian species has a special eyelid appearance, which mainly includes the single eyelid, the inner canthus skin, the full eyelid and the small lid fissure. This unique eyelid appearance and the inheritance of Chinese culture are formed. In the traditional Chinese aesthetic view of eye and eyelid, in the traditional Chinese aesthetic view, people pay more attention to the curve of the eye and the proportion of the eye to the face, so there are three stops and five eyes, single phoenix eye, the former embodies the proportion of the eye to the face as a whole, the latter embodies the curve of the eye, because there is a general existence of the inner canthus and the single in the Mongolia population. In the traditional oriental aesthetic, the mild inner canthus and the single eyelids are considered to be the eastern beauty of the traditional inner show. Although the traditional western aesthetic view also pays much attention to the proportion of eyes to the face, the traditional western aesthetic view does not think of the inner canthus because the inner canthus and the single eyelids are less encountered in the Caucasus. The different aesthetic values caused by the culture and the cultural background, with the cultural exchange of the East and the West and the integration of the aesthetic view, gradually change and form a new aesthetic concept. This aesthetic concept is characterized by the integration of the original culture and the integration of other cultural backgrounds, with the performance of globalization and the tradition. The Chinese society generally believes that the wider eye crack and the smooth eyelid curve are the symbol of beauty, and the peculiar form of the upper eyelid of Mongolia people is easy to produce no spirit and tired appearance feeling, that is, the eyelids, the full upper eyelids and the inner canthus are gradually unconforming to the modern aesthetic viewpoint.
The upper eyelids of the people of Mongolia are generally full and more of a single eyelid than the Caucasian upper eyelids. Because of this full upper eyelid, the eyes are not changed, the stereoscopic and the levels are not clear, thus giving people a dull, tired and indistinct impression. In order to change this too full upper eyelid, many people choose to operate on the eyelids and remove the upper eyelids. The fat of the eyelid orbital septum is improved, but there is still some beauty who is not satisfied with the.Y.Tanaka and so on. It is not due to excessive fat, but the low fat position of the anterior palpebral aponeurosis, and the concept of the fat Limited ligaments of the upper eyelid septum. The physiological mechanism of Chinese people to produce full eyelids and provide anatomical basis for clinical operations.
There is a high incidence of inner canthus in Mongolia people, up to 50%-70%, so there are more people in our country seeking to improve the beauty of the inner canthus. There are many kinds of surgical methods for the medial canthus. But because of the characteristics of the Mongolia people, the complications of the medial canthus correction are occurred. The main complications are surgical incision scar and operation. The post effect is easy to rebound, and the effect of long-term operation is difficult to maintain. The occurrence of complications restricts the development of the correction of canthus, and more surgical methods are formally produced to avoid the occurrence of postoperative complications. Through the anatomical study of the inner canthus and histological observation, we describe the production of the inner canthus ligament in the inner canthus. It can provide anatomical basis for reducing postoperative complications of inner canthus and proper treatment of medial canthus ligament.
The young and beautiful outer canthus should be shown as: the outer canthus angle is higher than the inner canthus angle, the inner canthus connection and the horizontal angle are generally about 10 degrees. The inner and outer canthus relationship shows young and charming. With the aging of the body, the outer canthus angle gradually decreases, which is the bad sensory impression of the old and treacherous angle of the outer canthus, and the decline of the outer canthus will appear. With the improvement of the quality of life, more and more people have realized that the lateral canthus angle descending to the inner canthus level or below the inner canthus angle is a kind of senescence. In addition to the local adjustment of the lower eyelid, people are more concerned with the balance of the outer canthus, so the demand for improving the above situation is gradually increasing by adjusting the toughening of the outer canthus. Although foreign related anatomy and research are more deep, the anatomy and research are mostly based on the Caucasus, and the internal canthus, especially the outer canthus ligament, are less dissected in China. The purpose of this study is to provide anatomical basis for clinical study through anatomical description and histological observation of the lateral canthus, especially the lateral canthus ligament.
objective
By anatomical observation, measurement and histology, the anatomy of the inner and outer canthus area, the line of the ligaments, the adjacent relationship between the ligaments and the orbital anatomical structures and the histological features were clarified, and the application of the anatomical structure of the peric anatomic structure in plastic surgery was expounded, and the complications of the plump upper eyelid and canthus correction were explored. It also provides anatomical basis for clinical operation in the lateral canthus.
Method
1 eye dissection
A total of 9 corpses (6 males and 3 females) were selected, and 18 sides were examined for gross and microscopic anatomy.
Anatomic observation of the inner canthus area of 2.1.
A total of 9 cadaver specimens (6 males and 3 females) and 18 sides were dissected to observe the anatomical structure of the anatomic layers, the branches of the inner canthus ligament and the walking, the adjacent relationship between the medial canthus ligament and the periorbital muscles, the adjacent relationship between the medial canthus ligament and the lacrimal sac nasolacrimal duct, the adjacent relationship between the medial canthus ligament and the periorbital vessels, the medial canthus ligaments and orbital deity. The adjacent relationship of the meridian.
Anatomic measurement of 2.2. inner canthus region
The length of the branches of the medial canthus ligament, the distance of the medial canthus and the orbital margin, the distance to the eyebrow muscle, the distance from the brow muscle, the distance between the upper lip and the alar muscles, the distance to the orbital nerve, the distance between the points of the branches, the distance from each stop to the orbital margin, the distance to the eyebrow muscle, the distance of the eyebrow muscle and the scowl muscle, were measured respectively. The distance from the upper lip to the alar muscle to the superior orbital nerve.
2.3. histology observation
V.G staining was used to observe the fibrous structure and histological level of the ligaments. The anatomy of the lateral canthus of 3.1. was observed.
9 cadaver specimens (6 male and 3 female) were selected for gross anatomy and microdissection. The lateral canthus ligament and the Lockwood ligament were adjacent relations, the adjacent relationship with the orbital septum, the adjacent relationship with the external rectus, and the adjacent relationship with the lacrimal gland.
Anatomic measurement of the outer canthus area of 3.2.
The length and width of the branches of the lateral canthus ligaments, the distance from the origin of the lateral canthus ligament to the orbital margin, and the distance from the lateral canthus ligament to the lacrimal gland were measured by the above specimens.
3.3. histology observation
The specimens were stained to observe the fiber composition and tissue level.
Result
1.1 the length of the anterior lateral canthus ligament was 8.33mm + 0.9mm, the length of the upper medial canthus ligament was 6.41mm + 1.09mm, the length of the posterior medial canthus ligament was 8.77mm 0.81mm, the distance from the starting point of the medial canthus ligament to the upper orbital margin was 21.06mm + 2.82mm, and the distance from the lower orbital margin was 15.96mm + 2.34mm, the horizontal distance from the medial canthus ligament to the horizontal distance of the brow muscle was 7.44mm + 0.75mm, to the trochlea. The distance between the vascular bundle was 21.22mm + 1.75mm, the distance from the medial canthus to the arteriovenous distance was 9.33mm + 1.15mm, the distance between the anterior branch of the medial canthus ligament and the point of the upper branch was 12.85mm 1.33mm, the distance between the anterior branch of the medial canthus and the posterior branch was 5.43mm + 0.71mm, the anterior branch of the medial canthus and the distance from the orbital margin to the orbital margin was 20.81mm + 2.61mm, to the lower orbital margin, to 17.75mm 2.12mm, to descending. The distance from the eyebrow muscle to 0.52mm + 0.06mm, to the upper trochlear nerve bundle is from 23.52mm + 1.54mm to the internal canthus arteriovenous distance 0.79mm + 0.14mm..
1.2 the anterior branch of the medial canthus ligament is composed of dense collagenous fibers with obvious loose fiber connections with the skin.
The length of the superficial lateral canthus ligament of 2.1. is 9.83mm + 0.55mm, the length of the deep branch of the outer canthus ligament is 12.89mm + 1.09mm, the width of the deep branch of the outer canthus ligament is 3.82mm + 0.41mm, the starting point of the outer canthus ligament is 19.95mm + 3.81mm from the orbit to the orbital margin, and the distance from the lower orbit to the 17.47mm + 2.24mm, the distance between the Whitnall nodules and the lateral orbital margin is 7 7mm + 0.69mm.
The superficial branches of 2.2. lateral canthus ligament are thick and loose, and the deep branches of the lateral canthus ligament are thin and closely arranged.
conclusion
1. it can be divided into 3 anatomical layers: skin and subcutaneous tissue layer, facial expression layer, orbital septum and orbital content layer. The 3 levels are not closely connected to each other and have no important structure. It is a good surgical plane.
2. eye plastic surgery focuses on the physiological reduction of anatomical structure.
3. the fibers of the orbicularis oculi and the anterior branch of the medial canthus ligament are the main causes of the formation of the inner canthus.
4. the correction of the medial canthus should be made on the basis of the degree of the form of the canthus which the patient belongs to, and to avoid the appearance of the inner canthus scar as far as possible.
5., by folding the anterior branch of the medial canthus ligament and decreasing the skin tension of the inner canthus, the operation can achieve better results.
6. the lateral canthus ligament is divided into 2 shallow and shallow branches. The deep branch is the main structure of the lateral canthus suspension.
7. the superficial branches of the lateral canthus ligament are mainly composed of collagen fibers, with a small amount of elastic fibers and loose fibers, which contain more non collagenous connective tissue, and the deep branches of the outer canthus ligament are mainly composed of collagen fibers. It can be seen that the elastic fibers are distributed around the ligaments, the fibers are arranged closely, and the non collagenous connective tissue is very small.
8. the main reason for the aging of the outer canthus is the imbalance of the eyelid suspension caused by the relaxation of the outer canthus ligament. The complications of the outer canthus aging can be effectively solved by suspending or folding the deep branch of the outer canthus ligament.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 潘安娜,郭京麗,王麗娟,李幼瓊;眼輪匝肌下脂肪墊的解剖結(jié)構(gòu)及應(yīng)用[J];吉林大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2004年06期

2 范希玲,鄭群,田楓,張菊芳;下瞼局部解剖在眼袋整復(fù)術(shù)中的臨床意義[J];中國解剖與臨床;2000年01期

3 李薇薇,王玉榮,孫家明;眼瞼松弛癥合并淚腺脫垂的手術(shù)治療[J];中國美容醫(yī)學(xué);2005年05期

4 胡建中;岳穎;趙伯蝠;;重瞼術(shù)后繼發(fā)上瞼下垂的成因及防治[J];中國美容醫(yī)學(xué);2006年01期

5 閻曉輝;徐紅霞;于燕;薛艷斌;張勇;;淚腺脫垂復(fù)位固定聯(lián)合重瞼成形術(shù)38例臨床經(jīng)驗(yàn)[J];中國美容醫(yī)學(xué);2009年02期

6 文軍慧,季正倫,盧范,郭恩覃;皺眉肌與降眉肌的臨床解剖學(xué)研究[J];實(shí)用美容整形外科雜志;2001年01期

7 宋建星,劉軍,陳江萍,孫美慶,郭恩覃;鼻側(cè)腱膜固定法矯正內(nèi)眥贅皮[J];實(shí)用美容整形外科雜志;2001年02期

8 張余光,楊群,汪希,章一新,錢云良;眼輪匝肌的解剖結(jié)構(gòu)和力學(xué)方向?qū)ι喜�形態(tài)的影響[J];中國實(shí)用美容整形外科雜志;2004年02期

9 鮑新建,楊紅華;改良的“Z”瓣轉(zhuǎn)移矯正內(nèi)眥贅皮[J];天津醫(yī)科大學(xué)學(xué)報(bào);2004年04期

10 安金剛,張益,孫勇剛,張震康;內(nèi)眥韌帶的應(yīng)用解剖及組織學(xué)研究[J];現(xiàn)代口腔醫(yī)學(xué)雜志;2004年03期

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