摘要
目的探讨单点内折固定眼轮匝肌上睑整形术矫正中老年人上睑皮肤松垂的效果。方法对2016年5月到2019年2月期间来苏北人民医院医学美容中心就诊的上睑皮肤松垂的109例患者(男16例,女93例,年龄36~72岁)资料进行回顾分析。手术均采用眉下切口切除皮肤,保留眼轮匝肌,并通过眶缘小切口将外下侧眼轮匝肌向深处折叠,并向外上侧放射状单点悬挂固定在骨膜上。术中不做任何骨膜上的剥离,术后常规护理。采用主观问卷调查及手术前、后照片数据采集客观统计分析的方式,对上睑皮缘高度及眉位置进行评估(以患者虹膜直径为1个单位),正态分布数据采用重复测量t检验;偏态分布数据采用非参数Wilcoxon秩和检验进行统计分析,P<0.05为差异具有统计学意义。结果109例患者切口均一期愈合,术后随访(9.57±6.13)个月(3~36个月),有效随访6个月以上者占85.3%(93/109)。术后4周主观问卷调查显示满意率为99.1%(108/109)。额部感觉、眉部活动、睁闭眼功能等均未出现明显异常。术后6个月基准线各测量点距上睑皮肤边缘距离(上睑皮缘高度)与术前相比均有明显地提升,瞳孔中点处的皮缘高度由(0.466±0.149)单位提升至(0.600±0.126)单位(t=-16.186,P<0.001),虹膜外侧缘点处的皮缘高度由(0.387±0.156)单位提升至(0.568±0.166)单位(t=-31.882,P<0.001),外眦点处的皮缘高度由(0.214±0.087)单位提升至(0.446±0.098)单位(t=-49.332,P<0.001),差异均具有统计学意义。有效随访6个月且术中未调整眉位置的患者共86例,统计基准线各测量点距眉下缘的数据显示,与术前相比术后6个月时眉高度均略有下降,但差异均无统计学意义(P>0.05)。术后的眼周外观形态及功能均得到了明显的改善。结论通过单点内折固定眼轮匝肌进行上睑皮肤松弛矫正术能明显改善眼周组织的松弛老化且不影响眉的形态,手术操作简单,创伤小,术后效果稳定。
Objective To investigate the clinical effect of the subbrow blepharoplasty by fixing and folding inward the orbicularis oculi muscle in a single point to improve the upper eyelid skin laxity.Methods From May 2016 to February 2019,109 patients(16 males and 93 females)underwent subbrow blepharoplasty combined with single point orbicularis oculi muscle fixing and folding(SBB-soff)in the Outpatient Department of Plastic Surgery Northern Jiangsu People’s Hospital.During the operation,the spindle skin below the eyebrow was excised,and the orbicularis oculi muscle(OOM)was retained.Then we made a small incision at the supraorbital rim,deep down to the periosteum.The OOM was folded inward and fixed on the periosteum in a single point through this small incision.The effect of the operation was evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs.The height margins of the upper eyelids and eyebrow position were evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs(use the iris diameter as one unit).Repeated measures t test was used for analyzing normal distribution data,the non-parametric Wilcoxon test was used for statistical analysis of abnormal distribution data,and P<0.05 was considered to be statistically significant.Results The incisions of all the 109 cases had primary healing.The postoperative follow-up period averaged a period of(9.57±6.13)months(3 months to 3 years).85.3% of patients(93 of 109)were followed up for more than 6 months.The subjective questionnaire survey showed that patients’satisfaction rate was 99.1%(108 of 109)at one month postoperatively,and there were no serious postoperative complications in the sensory function of the forehead,the motor function of eyebrows and upper eyelids,etc.The upper eyelid margins at the sites above the mid pupil points elevated from(0.466±0.149)units to(0.600±0.126)units(t=-16.186,P<0.001).The upper eyelid margins at the sites above the lateral limbus elevated from(0.387±0.156)units to(0.568±0.166)units(t=-31.882,P<0.001).The upper eyelid margins at the sites above the lateral canthus elevated from(0.214±0.087)units to(0.446±0.098)units(t=-49.332,P<0.001).In addition,all the differences were statistically significant.A total of 86 patients were followed up for 6 months without intraoperative eyebrow position adjustment.The data from each measuring point of the statistical baseline to the inferior edge of the eyebrow showed that the eyebrow height at 6 months postoperatively descended slightly,but the difference was not statistically significant(P>0.05).The periodic appearance and function were significantly improved after the operation.Conclusions SBB-soff can improve the dermatochalasis and aging signs of the upper eyelid tissue and make no negative effects on the position of eyebrows.In addition,it has the advantages of uncomplicated operation,less trauma,and persistent effect.
作者
马坤
李平松
胡再昌
侯团结
陈啸
马乐
Ma Kun;Li Pingsong;Hu Zaichang;Hou Tuanjie;Chen Xiao;Ma Le(Clinical Medical College Yangzhou University,Yangzhou 225001,China;The Department of Medical Cosmetology,Affiliated Northern Jiangsu People’s Hospital of Yangzhou University,Yangzhou 225001,China)
出处
《中华整形外科杂志》
CSCD
北大核心
2020年第12期1315-1323,共9页
Chinese Journal of Plastic Surgery
关键词
皮肤松垂
眼睑成形术
固位
眼轮匝肌悬吊术
Anetoderma
Blepharoplasty
Immobilization
Suspension operation of orbicularis
