眼轮匝肌节制韧带辅助修复下睑缺损  

Orbicularis retaining ligament to assist in the repair of lower eyelid defects

作　　者：黄成 吕璘 孙笛 顾钏 金锐 罗旭松 石杰 HUANG Cheng;LYU Lin;SUN Di;GU Chuan;JIN Rui;LUO Xu-song;SHI Jie(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科 [2]辽宁省人民医院整形外科

出　　处：《中国美容整形外科杂志》2019年第12期740-742,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨在下睑缺损修复中,通过增加对眶周眼轮匝肌节制韧带(orbicularis retaining ligament,ORL)的处理,简化手术设计,提升修复效果。方法回顾自2018年6月至2019年6月收治的15例下睑缺损患者,下睑缺损宽度为睑裂宽度的1/3至全长。术中通过松解眶下缘ORL,充分动员剩余下睑-中面部皮肤软组织,降低向下的牵扯力;同时利用外眦处ORL和眉外侧ORL增厚区域,对于修复区域的下睑眼轮匝肌以及眼轮匝肌下脂肪进行向上悬吊,增加向上的提升力。下睑区域力学基础恢复后,部分患者下睑缺损可完全关闭,其余患者下睑缺损有不同程度的缩小,再根据具体情况选用各类皮瓣或植皮覆盖缺损。结果术后随访3~12个月,患者对下睑修复的形态较满意,无眼睑闭合不全,未见明显的睑外翻及退缩。结论ORL是连结眼睑、眼周深层与浅层的重要结构,是下睑区域力学稳定与平衡的基础。在下睑缺损的修复中注意对其进行针对性的处理,对于减少修复代价、提升修复效果有着重要的意义。Objective To explore the feasibility oforbicularis retaining ligament(ORL)as an assist treatment in the repair of lower eyelid defects,so as to simplify the surgical design and improve the repair efficacy.Methods From June 2018 to 2019,15 patients with lower eyelid defects were chosen.The width of lower eyelid defects ranged from 1/3 to overall length of fissurae palpebrae.The remaining lower eyelid and middle facial soft tissue were fully mobilized by releasing the inferior ORL.The lateral canthus and lateral eyebrow ORL thickening area was used to suspend the orbicularis oculi muscle of lower eyelid and suborbicularis oculi fat pad in the repair area and increase the upward lifting force.After biomechanical basis of lower eyelid restored,defects of lower eyelid can be completely closed in some patients.There were varying degrees of reduction of lower eyelid defects in other patients,and a variety of flaps or skin grafts can be selected according to the actual conditions in the defect areas.Results All patients were followed up from 3 to 12 months.The postoperative efficacy was satisfactory.No obvious ectropion palpebrarum or retraction of eyelid was observed.Conclusion ORL was an important structure for connecting the eyelid and deep and superficial layers of periorbital zone,which was the basis of mechanical stability and balance in the lower eyelid region.Directed treatment in the repair of eyelid defects was helpful to improve the efficacy.

关 键 词：眼轮匝肌节制韧带 下睑缺损 创面修复 

分 类 号：TP3[自动化与计算机技术—计算机科学与技术]