眶周及内外眦韧带的应用解剖研究

发布时间：2018-06-25 22:13

本文选题：眼睑 + 内眦韧带　；参考：《南方医科大学》2010年硕士论文

【摘要】： 研究背景眼作为五官之首,对于一个人的容貌有着重要的影响。从人类起源和人种学看,国人绝大部分都属于蒙古人种。蒙古人种拥有特殊的眼睑外貌,主要表现为单睑、内眦赘皮、饱满上睑和小睑裂。这种独特的眼睑外貌及中国文化的传承形成了关于眼及眼睑的中国传统审美观。在中国传统审美观中,人们较关注眼的曲线及眼与面部的整体比例,从而有三停五眼、单凤眼等提法,前者体现了眼与面部整体的比例,后者则体现了眼的曲线。因为在蒙古人种中普遍存在内眦赘皮及单睑,所以在传统的东方审美观中轻度内眦赘皮及单睑被认为是传统的内秀的东方美。尽管传统的西方审美观中也十分注重眼与面部的比例关系,但是由于内眦赘皮及单睑在高加索人种中较少遇见,所以传统的西方审美观并不认为内眦赘皮和单睑是美得表现。这种由于人种、文化背景造成的不同的审美观,随着东西方文化交流及审美观的相互融入,逐渐发生改变,形成新的审美观念。这种审美观表现为以原有文化为底蕴,交融其他文化背景,具有全球化的表现,较传统审美观而言有继承但更有改变。现在的中国社会普遍认为较宽的眼裂及流畅的重睑曲线是美的象征,而蒙古人种特有的上睑形态易产生没有精神、疲惫的外貌感觉,即单睑、饱满的上睑及内眦赘皮渐渐不符合现代的审美观点。蒙古人种的上睑一般比高加索人种的上睑要饱满,而且较多表现为单睑。由于这种饱满的上睑,使得眼部表现缺乏变化,立体及层次不分明,因而给人呆滞疲惫无神的感官印象。为改变这种过于饱满的上睑,很多人选择重睑手术并去除上睑眶隔脂肪予以改善,但术后仍有部分求美者并不满意。Y.Tanaka等提出蒙古人种过于饱满的上睑并不是由于脂肪过多引起,而是由于提上睑肌腱膜前脂肪低位造成,并提出上睑眶隔脂肪限制韧带的概念。我们通过对上睑的解剖研究,探寻国人产生饱满上睑的生理机制,并为临床手术提供解剖依据。内眦赘皮在蒙古人种中有着较高发生率,可达50%-70%,因而我国有较多寻求改善内眦赘皮的求美者,现行针对内眦赘皮的手术方式有许多种。但由于蒙古人种的特点,使内眦赘皮矫正术并发症时有发生。其并发症主要为手术切口瘢痕和术后效果易发生反弹,长期手术效果难以维持。并发症的产生限制了内眦赘皮矫正术的开展,而较多的手术方式正式对如何避免术后并发症的发生而产生。我们通过对内眦部的解剖研究及组织学观察,阐述内眦韧带在内眦赘皮产生中的作用,对降低内眦赘皮手术术后并发症及针对内眦韧带的合理处置提供解剖依据。年轻美丽外眦应表现为：外眦角高于内眦角,内外眦连线与水平夹角一般为10度左右,这种内外眦关系表现出年轻、妩媚。随着机体老化,外眦角逐渐下降,这是低垂的外眦角给人老态、奸诈等不好的感官印象,并且伴随外眦的下降会出现下睑内翻、外翻、睑球分离及溢泪等情况。随着生活质量的提高,越来越多的人们认识到外眦角下降至内眦角水平或低于内眦角是一种衰老的表现,以往仅仅通过睑袋矫正老龄化下睑的情况已逐渐不能满足现代人们的需求。现在除了对下睑局部的调整外,人们更加关注眼内外眦的平衡,所以通过调整外眦韧带来改善上述情况的诉求逐渐增加。尽管国外相关解剖较多,研究较深,但是由于其解剖和研究多基于高加索人种。而国内关于外眦部特别是外眦韧带的解剖较少,本研究试图通过对外眦部特别是外眦韧带的解剖描述及组织学观察,为临床提供解剖依据。目的通过对眼周解剖特别是内外眦韧带的解剖观察、测量及组织学研究,阐明内外眦区解剖层次、韧带走行、韧带与眶周解剖结构毗邻关系及组织学特点,阐述眼周解剖结构在整形外科中的应用,探寻饱满上睑和内眦赘皮矫正术并发症发生的解剖原因,及改善饱满上睑和降低眦赘皮矫正术并发症发生的手术方式,并为外眦区临床手术提供解剖依据。方法 1眼周解剖选取9具尸体标本(男6例,女3例),共18侧,进行大体和显微解剖,了解眼部解剖结构位置及在整形美容外科中的应用。 2.1.内眦区解剖观察选取9具尸体标本(男6例,女3例),共18侧,进行大体和显微解剖,观察各解剖层次的解剖结构、内眦韧带分支及走行、内眦韧带与眶周肌肉的毗邻关系、内眦韧带与泪囊鼻泪管的毗邻关系、内眦韧带与眶周血管的毗邻关系、内眦韧带与眶周神经的毗邻关系。 2.2.内眦区解剖测量采用上述标本,分别测量内眦韧带各个分支的长度,内眦韧带起点至眶缘距离、至降眉肌的距离、至皱眉肌的距离、至提上唇鼻翼肌的距离、至眶上神经的距离；各个分支止点之间距离,各个止点至眶缘距离、至降眉肌的距离、至皱眉肌的距离、至提上唇鼻翼肌的距离、至眶上神经的距离。 2.3.组织学观察对测量后标本进行V.G染色,观察韧带纤维构成及组织层次3.1.外眦区解剖观察选取9具尸体标本(男6例,女3例),共18侧,进行大体解剖和显微解剖,观察外眦韧带分支及走行、外眦韧带与lockwood韧带毗邻关系、与眶隔脂肪毗邻关系、与外直肌毗邻关系、与泪腺的毗邻关系 3.2.外眦区解剖测量采用上述标本,分别测量外眦韧带各个分支的长度与宽度,外眦韧带起点至眶缘的距离、外眦韧带至泪腺的距离。 3.3.组织学观察对测量后标本进行染色,观察韧带纤维构成及组织层次。结果 1.1内眦韧带前支长度为8.33mm±0.9mm,内眦韧带上支长度为6.41mm±1.09mm,内眦韧带后支长度为8.77mm±0.81mm,内眦韧带起点到上眶缘距离为21.06mm±2.82mm,到下眶缘距离为15.96mm±2.34mm,内眦韧带起点到降眉间肌的水平距离7.44mm±0.75mm,到滑车上神经血管束距离21.22mm±1.75mm,到内眦动静脉的距离9.33mm±1.15mm,内眦韧带前支止点到上支止点的距离12.85mm±1.33mm,内眦韧带前支止点到后支止点距离5.43mm±0.71mm,内眦韧带前支止点至上眶缘距离20.81mm±2.61mm,至下眶缘距离17.75mm±2.12mm,至降眉肌距离0.52mm±0.06mm,至滑车上神经血管束距离23.52mm±1.54mm,至内眦动静脉的距离0.79mm±0.14mm。 1.2内眦韧带前支是致密的胶原纤维构成,其与皮肤之间有明显的、疏松的纤维连接。 2.1.外眦韧带浅支长度9.83mm±0.55mm,外眦韧带深支长度12.89mm±1.09mm,外眦韧带深支宽度3.82mm±0.41mm,外眦韧带起点至上眶缘距离19.95mm±3.81mm,至下眶缘距离17.47mm±2.24mm,Whitnall结节至外侧眶缘距离为1.95mm±0.12mm,Whitnall结节至泪腺隐窝距离7.07mm±0.69mm。 2.2.外眦韧带浅支纤维较粗,排列疏松；外眦韧带深支纤维较细,排列紧密。结论 1.可以将眼及眼周解剖分为3个解剖层面,皮肤及皮下组织层,表情肌层,眶隔及眶内容物层,3个层次彼此间连接不紧密,无重要结构,是良好的手术平面。 2.眼周整形美容手术重点是对解剖结构的生理复位 3.错构的眼轮匝肌和内眦韧带前支纤维牵拉是内眦赘皮产生的主要原因。 4.矫正内眦赘皮应在明确病人所属内眦赘皮形态、程度的基础上,选择尽可能避免产生内眦部明显瘢痕并能取得明确手术效果的手术方式。 5.通过折叠内眦韧带前支降低内眦部皮肤张力,使内眦赘皮矫正术获得更好的手术效果。 6.外眦韧带分深浅2支,深支是外眦部悬吊的主要结构。 7.外眦韧带浅支主要由胶原纤维构成,夹有少量弹性纤维,纤维排列疏松,其中含有较多非胶原类结缔组织；外眦韧带深支主要有胶原纤维构成,可见弹性纤维分布于韧带周边,纤维排列紧密,非胶原类结缔组织含量很少。 8.外眦部老化的主要原因就是外眦韧带松弛导致眼睑悬吊的失衡。通过悬吊或者折叠外眦韧带深支可以有效的解决外眦部老化带来的并发症。
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

【参考文献】