硬悬吊技术在东方人重睑成形术中的临床应用

硬悬吊技术在东方人重睑成形术中的临床应用

赵海福1 刘欢2 刘湘君 1 方柏荣1

本文来源：《中华整形外科杂志》2023年2月第39卷第2期

DOI:10. 3760 / cma.j.cn114453-20211125-00451

作者单位：1中南大学湘雅二医院整形美容（烧伤）外科，长沙410011； 2长沙美莱医疗美容医院整形外科，长沙410007

通信作者：方柏荣，Email：fbrfbr2004@csu.edu.cn

引用本文

赵海福，刘欢，刘湘君，等. 硬悬吊技术在东方人重睑成形术中的临床应用 [J] . 中华整形外科杂志, 2023, 39(2) : 154-160. DOI: 10.3760/cma.j.cn114453-20211125-00451.

【摘要】

目的探讨硬悬吊技术在东方人重睑成形术中的临床应用效果。

方法回顾性分析2019年 3月至2021年3月中南大学湘雅二医院整形美容（烧伤）外科、长沙美莱医疗美容医院整形外科收治的硬悬吊技术切开法重睑成形术患者的临床资料。在重睑成形术中，内固定方式采用硬悬吊技术，即将上睑提肌腱膜、眶隔残端及切口下唇眼轮匝肌固定于睑板上缘。术后随访观察重睑线的高度、弧度及切口瘢痕情况，手术医生、患者和第三方医生通过对比患者术前和术后3个月以上的照片，对手术效果进行评价，三方都满意为显著有效，两方满意为有效，一方满意为一般，都不满意为差。

结果共纳入 50例患者（100只眼），男3例，女47例，年龄17～45岁，平均25岁。所有患者均为先天性双侧单睑， 43例为初次行重睑术，7例为重睑修复术。术后随访3~12个月，平均6个月，所有患者切口均一期愈合，2例患者出现双侧重睑皱褶不对称，其余48例患者重睑皱褶形态稳定、弧度自然、高度和宽度适宜、双侧对称，无明显切口瘢痕。术后效果评价：显著有效42例，有效6例，一般2例，疗效满意度为96%（48/50）。

结论硬悬吊技术在东方人切开法重睑成形术中能够获得较满意的术后效果，并且重睑褶皱形态稳定。

【关键词】眼睑成形术；眼睑；整形；美容；年轻化；手术方法；重睑成形术；硬悬吊技术

Clinical application of firm-suspension technique in Oriental blepharoplasty

Zhao Haifu1, Liu Huan2, Liu Xiangjun1, Fang Bairong1

1Department of Plastic and Cosmetic ( Burn ) Surgery,the Second Xiangya Hospital，Central South University, Changsha 410011,China; 2Changsha Mylike Medical Cosmetic Hospital, Changsha 410007,China

Corresponding author: Fang Bairong, Email: fbrfbr2004@csu.edu.cn

【Abstract】

Objective To investigate the effectiveness of the firm-suspension technique in Oriental double eyelid blepharoplasty.

Methods From March 2019 to March 2021, the clinical data of patients undergoing incision double eyelid blepharoplasty with firm-suspension technique in the Department of Plastic and Cosmetic (Burn) Surgery of the Second Xiangya Hospital of Central South University and the Department of Plastic Surgery of Changsha Mylike Medical Cosmetic Hospital were retrospectively analyzed. All the internal fixation method in this study were firm-suspension technique: the levator aponeurosis, the remnants of the orbital septum, and the lower lip incision orbicularis oculi muscle were fixed to the upper edge of the tarsal plate. The height, curvature and incision scar of the double eyelid line were observed during the postoperative follow-up. The surgery doctor, patients and a third party surgeon compared photos before and more than 3 months after the operation to evaluate the effect of the operation. Three parties were satisfied as significantly effective, two parties were satisfied as effective, one party was satisfied as normal, and all were dissatisfied as poor.

Results A total of 50 patients (100 eyes) were included, including 47 females and 3 males, ranging in age from 17 to 45 years old, with an average age of 25 years. All the patients had congenital bilateral single eyelid, 43 cases underwent double eyelid surgery for the first time, and 7 patients underwent revision double eyelid surgery. The postoperative follow-up was 3 to 12 months, with an average of 6 months. All incisions were healed by primary intention. Two patients had asymmetric double eyelid folds, and the remaining 48 patients had stable double eyelid folds in shape, natural curvature, appropriate height and width, bilateral symmetry, no obvious scar, postoperative effect evaluation: 42 patients were significantly effective, 6 were effective, 2 were normal, and the satisfaction rate was 96% (48/50).

Conclusion The firm-suspension technique in Oriental blepharoplasty can obtain satisfactory postoperative appearance, and the double eyelid fold was stable.

【Key words】Blepharoplasty; Eyelids; Plastics; Cosmetics; Rejuvenation; Surgical method; Double eyelid blepharoplasty; Firm-suspension technique

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: This study was conducted in accordance with the Helsinki Declaration.

随着切开法重睑成形术的发展，国内外学者以内固定技术为核心创造了不同的术式。内固定技术的核心是模仿自然重睑形成机制［1］，用具有一定柔韧性的局部正常组织作为媒介，传递上睑提肌收缩力量至睑板前皮肤［2］。不同内固定技术目的都是试图产生灵动微痕、稳定持久的重睑效果。在内固定技术中，上睑提肌动力传导的媒介主要包括睑板、提肌腱膜、眶隔等。其中，睑板质地较硬，稳定性强，与睑板行内固定的技术被称为“硬悬吊”，与睑板前提肌腱膜、眶隔等质地较软的组织固定的技术被称为“软悬吊”［3-4］。由于提肌腱膜、眶隔等组织伸展性强，长期应力牵拉易变形，因此软悬吊类重睑技术易出现重睑线变浅下移的远期并发症，尤其是仅以提肌腱膜或眶隔一种组织作为固定媒介时。Pan等［3］在评估软悬吊重睑成形术效果时，发现软悬吊技术出现重睑线退化移位等远期并发症的概率高于传统的重睑术式。为了增加“软悬吊”重睑术后重睑线的长期稳定性，有学者采用2种以上组织作为媒介进行复合固定的技术，术后长期效果较稳定，并且不断有新的复合内固定术式出现［5-9］。我们对先天性双侧单睑患者行新的切开法硬悬吊内固定重睑成形术，即采用上睑提肌腱膜、眶隔残端、切口下唇眼轮匝肌、睑板上缘复合固定技术（硬悬吊技术），与文献报道的睑板固定方式不同［10］，部分细节与技术做了改进，获得较好效果，患者满意度高。

资料与方法

一、资料选择

回顾性分析2019年3月至2021年3月，中南大学湘雅二医院整形美容（烧伤）外科及长沙美莱医疗美容医院整形外科收治的硬悬吊重睑成形术患者的临床资料。纳入标准：初次行重睑成形术或者行软悬吊重睑成形术后修复患者，可伴有轻度上睑下垂或肌力尚正常，有大小眼畸形，或伴有上睑臃肿。排除标准：具有凝血功能障碍、妊娠期女性、心理障碍、血压及血糖控制不佳、中度或重度上睑下垂、手术效果期望值过高。

本研究已参考赫尔辛基宣言，术前详细告知患者手术风险，并签订知情同意书，同意将其资料用于本研究。

二、手术方法

术前常规设计重睑线并标记去皮量。行上睑局部浸润麻醉（2%利多卡因10ml+0.1%肾上腺素0.1 ml）。去除切口线内条形皮肤及眼轮匝肌，在切口下唇眼轮匝肌下层次向睑缘剥离，在切口上唇向眶隔方向分离暴露眶隔及眼轮匝肌后脂肪（retro-orbicularis ocucli fat , ROOF ）。根据患者上睑的臃肿程度，去除上睑适量ROOF条带，全层打开眶隔筋膜，去除疝出的眶隔脂肪，去除适量睑板前脂肪组织，暴露上睑提肌腱膜下缘并适度游离［11-13］。以 7.0 尼龙线或普里林线于角膜内侧缘、瞳孔中线、角膜外侧缘的3条纵线对应位置，依照患者是否具有上睑下垂及下垂程度，行上睑提肌腱膜下缘适度前徙或者折叠［14-16］，再与眶隔下端筋膜、睑板上缘纵向悬吊缝合，缝线打结不剪断，形成第1个固定环，缝针继续穿过切口下唇眼轮匝肌，缝线打结形成第2个固定环，并剪断缝线。嘱患者配合睁眼平视，观察睫毛自然上翘，重睑宽度适中、形态自然后，以7.0 尼龙线行切口下唇皮肤、切口下唇眼轮匝肌、上睑提肌腱膜游离缘、切口上唇眼轮匝肌、切口上唇皮肤间断缝合固定（图1， 2）。用金霉素眼膏涂擦伤口，以敷料适当包扎。

三、术后处理

术后常规给予消肿、冰敷等处理。术后1 d拆除敷料，术后3 d内每日隔1~2 h冰敷1次，每次冰敷30min左右，术后7~8d拆线。

四、术后随访及效果评价

所有患者均于术前、术后即刻、术后7d门诊拍摄照片。术后3、6、12个月通过门诊复查、电话或微信等方式随访观察重睑线的高度、弧度及切口瘢痕情况。手术医生、患者和第三方医生分别进行效果评价，评价内容包括重睑皱褶弧度是否自然，重睑褶皱的长度和宽度是否合适，双侧重睑线是否对称，上睑下垂是否矫正，切口瘢痕是否明显。三方都满意为显著有效，两方满意为有效，一方满意为一般，都不满意为差。

疗效满意度=（显著有效例数+有效例数）/总例数×100%

结果

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