中老年泪槽及睑颊沟畸形解剖学观察及手术整形方式探讨

发布时间：2018-03-05 11:05

本文选题：泪槽畸形　切入点：睑颊沟畸形　出处：《贵州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过对不同年龄段人体下睑局部解剖及下眼眶矢状面观察,对比泪槽和睑颊沟畸形,探讨中老年泪槽和睑颊沟畸形的解剖学特点,在临床上制定个性化整形手术方案。方法选取不同年龄的三组尸体标本(青年组、中年组、老年组),每组均为5例女性标本,3例男性标本。分别从下睑局部解剖及眼眶矢状面观察对比泪槽和睑颊沟畸形,并测量各组下睑皮肤厚度、颧部脂肪垫厚度、中年组和老年组眶隔脂肪突出下眶缘的距离,计算平均值及标准差。对我科近两年收集的泪槽和睑颊沟畸形30例临床病例(其中中老年病例26例)。以Hirmand分型标准为基础,根据不同年龄泪槽和睑颊沟畸形的程度、下睑薄弱松弛下垂的程度及眶隔脂肪膨出的程度等,分为六种类型。手术方法主要选择经皮入路松解眼轮匝肌限制韧带、眶隔脂肪瓣填充沟槽凹陷、去除眼袋、提升下睑手术。不同类型的畸形,具体的手术方式不同。结果通过对不同年龄泪槽和睑颊沟畸形的大体标本及组织切片观察测量,统计学计算结果:1.下眼睑皮肤厚度:青年组(0.35±0.08)mm;中年组(0.31±0.06)mm;老年组(0.26±0.05)mm。2.青年组颧部脂肪垫上缘覆盖于泪槽及睑颊沟,此处厚度为(3.18±0.15)mm;中年组颧部脂肪垫萎缩并下移,此处厚度为(1.16±0.13)mm;老年组,颧部脂肪垫萎缩明显下移,无脂肪覆盖于泪槽及睑颊沟。3.中年组观察到:下睑各层组织轻度薄弱、松弛和下移,眶隔脂肪轻度或中度松弛膨出,泪槽及睑颊沟轻度凹陷畸形;老年组观察到:下睑各层组织中度薄弱、松弛和下移,眶隔脂肪不同程度松弛膨出,泪槽及睑颊沟中重度凹陷畸形。此外,眼轮匝肌限制韧带在下睑内侧和外侧均与骨膜衔接紧密。临床观察结果:30例患者术后随访3至6个月,泪槽及睑颊沟凹陷畸形不同程度改善,同时达到去除眼袋、提升下睑的目的。术后随访根据Barton坡度分级、下睑提升效果分级及患者的满意度调查。客观评价术后结果:患者基本满意。但年龄越大,泪槽和睑颊沟畸形和下睑下垂改善效果较年轻患者差。结论在睑部和颧部组织厚薄过渡部位,随着年龄的增长,由于内侧和外侧眼轮匝肌限制韧带固定的力量,及下睑皮肤软组织受重力作用,出现泪槽及睑颊沟畸型。根据其发生的原因,再加上术前的客观评估及分型,选择不同的整形手术方式可达到较满意的效果。
[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 卤0.08mm in the young group, 0.31 卤0.06mm in the middle age group, 0.26 卤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 卤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 卤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.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

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