外眦固定术在下睑松弛矫正术中的应用(1)
[摘要]目的：探讨外眦固定术在下睑松弛矫正术中的应用效果和可行性。方法：选择2016年3月-2017年12月笔者医院收治的78例(156眼)下睑松弛患者为研究对象，术前下睑牵拉实验测量睑缘与眼球的平均距离8mm，确定为下睑板松弛。采用常规皮肤入路行下睑松弛矫正术，为矫正下瞼板松弛，术中于外眦部分离眼轮匝肌，暴露外眦韧带，将下睑板外侧端固定缝合到外侧眶缘内侧骨膜上，同时将外眦韧带水平褥式缝合固定到外侧眶缘内侧骨膜上。如泪沟明显，将眶隔脂肪释放后重置于眶下缘，如泪沟不明显，则将自然疝出的眶隔脂肪去除。术后1d、5d、1个月、6个月来院复查随访，评估手术效果。结果：95%的患者对术后效果满意，6.5%患眼术后5d拆线时发生下睑退缩，术后3个月自行恢复。未发生外眦角变形或睑裂变小等并发症，无1例需行二次修复。结论：外眦固定术在下睑板或外眦松弛的下睑袋整形术中是一个操作简单，效果可靠的手术方式，可有效防止术后下睑退缩或下睑外翻的发生，值得在临床上推广应用。
[关键词]下睑松弛矫正术；外眦固定术；下睑外翻；下睑退缩
, 百拇医药
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)07-0007-04
Abstract： Objective To explore the effect and feasibility of lateral canthoplasty in the correction of lower eyelid laxity. Methods 78 patients (156 eyes) with lower eyelid laxity admitted in our hospital from March 2016 to December 2017 were selected as research subjects. Through the transcutaneous lower blepharoplasty， the orbital fat was dissected directly if there was no obvious atropy of the lower orbital wall. Otherwise， the orbital fat was released and repositoned to the lower orbital wall to augment the tear trough. To tighten the lower lid， the lateral edge of the inferior tarsus was sutured on the inner aspect of the lateral orbital wall. The lateral canthus was deployed deep to the orbit rim with horizontal mattress suture. The patients were followed at 1d， 5d， 1 month and 6 months postoperatively. Results A majority of patients (95%) were satisfied with the results. 6.5% lower eyelid retraction occurred after 5d， and recovered spontaneously 3 months after the operation. The complications such as lateral canthal angle disfiguration and eye shortening was not observed. No patients required secondary refinement. Conclusion Lateral canthoplasty could prevent lower eyelid laxity and ectropion effectively in lower blepheroplasty. The procedure is simple， deserving promoting clinically.
, http://www.100md.com
Key words： lower blepharoplasty； lateral canthoplasty； lower lid retraction； ectropion
随着年龄的增长，人的下睑开始出现退行性改变，皮肤及眼轮匝肌的张力降低，弹性变差，眶隔松弛，眶脂肪膨出。同时眶下缘骨质流失，发生萎缩，眶孔在垂直方向上距离增大，尤以外侧明显。上颌骨凸度降低，中面部软组织向下移位，进一步牵拉下睑向外下移位，形成下睑袋、泪沟等衰老外观。随着时间的延长，松弛下坠的软组织会使下睑睑板和外眦韧带发生松弛，容易造成睑球分离，患者出现眼刺激症状及溢泪等[1]。下睑松弛矫正术临床上又称下睑袋整形术，是整形外科最常开展的一种眼整形手术。目前下睑松弛矫正术以去除眶隔脂肪或眶隔脂肪重置联合松弛皮肤眼轮匝肌的去除为主，对于术前伴有下睑板松弛或外眦松弛的患者，由于未矫正松弛的睑板或外眦韧带，术后常会发生下睑退缩或下睑外翻[2-3]。笔者于2016年3月-2017年12月对78例患者156眼施行下睑松弛矫正术，术中联合外眦固定，效果良好。
1 外眦解剖结构
正常情况下外眦比内眦高2mm，睑裂倾斜角(外眦与内眦连线与水平线的角度)为6°，外眦角60°。与内眦韧带不同，外眦韧带没有明显的腱性结构，即使在术中切开直视下也不会发现[4-6]。外眦韧带起自睑板外侧端，外侧附着于眶外侧缘内侧的Whitnall’s结节，长约10mm。外眦韧带分深浅两支，浅支与眶隔连续，深支与上睑提肌腱膜外侧脚、外直肌支持韧带、上睑Whitnall’s韧带、下睑Lockwood’s韧带在外眦部融合[7]。外眦韧带深浅两支由Eisler’s隐窝中的脂肪进行分隔[8]。外眦韧带对下睑板正常位置的维持具有重要作用。, http://www.100md.com(李卫华 杨天赤 王震)
[关键词]下睑松弛矫正术；外眦固定术；下睑外翻；下睑退缩
, 百拇医药
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)07-0007-04
Abstract： Objective To explore the effect and feasibility of lateral canthoplasty in the correction of lower eyelid laxity. Methods 78 patients (156 eyes) with lower eyelid laxity admitted in our hospital from March 2016 to December 2017 were selected as research subjects. Through the transcutaneous lower blepharoplasty， the orbital fat was dissected directly if there was no obvious atropy of the lower orbital wall. Otherwise， the orbital fat was released and repositoned to the lower orbital wall to augment the tear trough. To tighten the lower lid， the lateral edge of the inferior tarsus was sutured on the inner aspect of the lateral orbital wall. The lateral canthus was deployed deep to the orbit rim with horizontal mattress suture. The patients were followed at 1d， 5d， 1 month and 6 months postoperatively. Results A majority of patients (95%) were satisfied with the results. 6.5% lower eyelid retraction occurred after 5d， and recovered spontaneously 3 months after the operation. The complications such as lateral canthal angle disfiguration and eye shortening was not observed. No patients required secondary refinement. Conclusion Lateral canthoplasty could prevent lower eyelid laxity and ectropion effectively in lower blepheroplasty. The procedure is simple， deserving promoting clinically.
, http://www.100md.com
Key words： lower blepharoplasty； lateral canthoplasty； lower lid retraction； ectropion
随着年龄的增长，人的下睑开始出现退行性改变，皮肤及眼轮匝肌的张力降低，弹性变差，眶隔松弛，眶脂肪膨出。同时眶下缘骨质流失，发生萎缩，眶孔在垂直方向上距离增大，尤以外侧明显。上颌骨凸度降低，中面部软组织向下移位，进一步牵拉下睑向外下移位，形成下睑袋、泪沟等衰老外观。随着时间的延长，松弛下坠的软组织会使下睑睑板和外眦韧带发生松弛，容易造成睑球分离，患者出现眼刺激症状及溢泪等[1]。下睑松弛矫正术临床上又称下睑袋整形术，是整形外科最常开展的一种眼整形手术。目前下睑松弛矫正术以去除眶隔脂肪或眶隔脂肪重置联合松弛皮肤眼轮匝肌的去除为主，对于术前伴有下睑板松弛或外眦松弛的患者，由于未矫正松弛的睑板或外眦韧带，术后常会发生下睑退缩或下睑外翻[2-3]。笔者于2016年3月-2017年12月对78例患者156眼施行下睑松弛矫正术，术中联合外眦固定，效果良好。
1 外眦解剖结构
正常情况下外眦比内眦高2mm，睑裂倾斜角(外眦与内眦连线与水平线的角度)为6°，外眦角60°。与内眦韧带不同，外眦韧带没有明显的腱性结构，即使在术中切开直视下也不会发现[4-6]。外眦韧带起自睑板外侧端，外侧附着于眶外侧缘内侧的Whitnall’s结节，长约10mm。外眦韧带分深浅两支，浅支与眶隔连续，深支与上睑提肌腱膜外侧脚、外直肌支持韧带、上睑Whitnall’s韧带、下睑Lockwood’s韧带在外眦部融合[7]。外眦韧带深浅两支由Eisler’s隐窝中的脂肪进行分隔[8]。外眦韧带对下睑板正常位置的维持具有重要作用。, http://www.100md.com(李卫华 杨天赤 王震)