"8"字缝合锚着仿生重睑术

"8"字缝合锚着仿生重睑术

胡维君1 刘阳2 蔡阳群1 宋上1 吕徐灵1

本文来源：《中华整形外科杂志》2023年7月第39卷第7期

DOI:10. 3760 / cma.j.cn114453-20230104-00002

作者单位：1浙江省金华市人民医院（温州医科大学附属金华医院）整形外科，金华321000；2上海交通大学医学院附属第九人民医院整复外科，上海200011

通信作者：刘阳，Email:drliuyang9@163.com

引用本文

胡维君,刘阳,蔡阳群,等. "8"字缝合锚着仿生重睑术[J]. 中华整形外科杂志,2023,39(07)：755-761. DOI:10.3760/cma.j.cn114453-20230104-00002

【摘要】

目的探讨"8"字缝合锚着仿生重睑术的手术方法及临床疗效。

方法回顾性分析2016年11月至2020年10月浙江省金华市人民医院(温州医科大学附属金华医院)整形外科应用"8"字缝合锚着法行切开重睑术患者的临床资料。术中解剖梳理上睑层次，模拟东方人生理性重睑结构，复位组织并酌情增减；采用"8"字缝合锚着技术，通过水平褥式"8"字缝合，将眶隔-上睑提肌腱膜复合体(A)、切口下唇眼轮匝肌(M)在睑板(含睑板前筋膜)(T)上重新定位愈合，重建东方人生理性重睑动力学结构。术后随访观察上睑平整度、上视野、眉眼间距、睁眼费力感、双侧对称性、重睑弧度、稳定度、睫毛翘度、瘢痕情况、并发症发生情况，对术后效果进行评价。

结果共纳入103例患者，男5例，女98例，平均年龄29.5岁(17~65岁)。术后随访6~24个月，上睑平整、丰盈适度，上视野较术前增加，额肌放松，眉眼间距较术前相对缩短，睁眼有力，双侧基本对称，重睑线自然流畅，效果稳定，睫毛微翘，切口瘢痕不明显，未出现感染、上睑下垂等并发症。

结论 "8"字缝合锚着仿生重睑术中，对上睑层次梳理清晰，使组织增减、复位精准，固定确切，力学结构稳定，术后上睑形态自然传神，效果持久稳定。

【关键词】眼睑成形术；上睑提肌腱膜；睑板；眼睑下垂；生理性；眼睑结构

基金项目：金华市科学技术局重点项目(2020-3-058)

Bionic double eyelid operation with “8”-shaped suture and anchorage

Hu Weijun1， Liu Yang2， Cai Yangqun1， Song Shang1， Lyu Xuling1

1Department of Plastic Surgery, People’s Hospital of Jinhua City, Zhejiang Province （Jinhua Hospital Affiliated to Wenzhou Medical University）, Jinhua 321000，China; 2Department of Plastic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011，China

Corresponding author: Liu Yang, Email:drliuyang9@163.com

【Abstract】

Objective To explore the surgical method and clinical effect of bionic double eyelid operation with "8" suture and anchoring.

Methods A retrospective study was conducted on the received double eyelid operation with "8" -shaped suture and anchor in the Department of Plastic Surgery People’s Hospital of Jinhua City, Zhejiang Province (Jinhua Hospital Affiliated to Wenzhou Medical University) during November 2016 to October 2020. The upper eyelid layer is dissected, the normal double eyelid structure of oriental is simulate. Using "8" -shaped suture anchorage technique, through horizontal mattress "8" -shaped suture, the orbital septum-upper eyelid levator aponeurosis complex (A) and the orbicularis oculi muscle (M) of the lower lip of the incision were relocated and healed on the tarsal plate (including pretarsal fascia) (T) the dynamic structure of the oriental double eyelid was reconstructed. In follow up, the upper eyelid flatness, the upper eyesight extent, the distance between the eye and eyebrow, the forced sensation of opening the eyes, bilateral eyes’ symmetry, the curve and the stability of the double eyelid, the eyelash curl, incisional scar and complications were recorded and evaluated.

Results A total of 103 patients, 5 males and 98 females, with a mean age of 29.5 years (17-65 years), were included. After the postoperative follow-up of 6 to 24 months, the upper eyelid was smooth, plump and moderate, the upper vision increased, the distance between the eyebrow and eyes was relatively shorter than the preoperative, the eyes openings were widened, the two sides were basically symmetrical, the double eyelid line was natural and smooth, the crease was stable, the eyelashes were slightly curled, the incision scar was not obvious. complications, such as infection and ptosis did occur.

Conclusion The "8" -shaped suture anchoring bionic double eyelid operation introduces the concept of "breaking" then "building", the upper eyelid can be dissected clearly, the reduction is accurate, the fixation is accurate, and the mechanical structure is stable. Postopertively, the shape of the upper eyelid was natural and stable.

【Key words】Blepharoplasty; Aponeurosis of levator palpebrae superioris muscle; Tarsal plate; Blepharoptosis; Physiologic; Eyelid structure

Fund program: A key program supported by Jinhua Science and Technology Bureau（2020-3-058）

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

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of People’s Hospital of Jinhua City（IBR-2020029-R）.

长期以来，重睑术一直是东亚人群最常见的美容手术[ 1 ]，随着社会生活水平的提高，人们对重睑手术效果提出了"睁眼有神、闭眼无痕"的仿真需求。传统切开法重睑术因过度切除重睑切口以下(后文简称下唇)的肌肉及睑板前组织，容易导致较深的凹陷性皱褶、瘢痕、"肉条"外观[ 2 ]。以Park法(眼轮匝肌-上睑提肌腱膜固定技术)为代表的现代重睑术由于忽略了上睑提肌腱膜在硬性结构睑板上的定位，术后易造成重睑宽窄不一、深浅不稳定[ 3 , 4 ]。本研究在重睑术中，引入先"破"后"立"理念，经重睑切口解剖梳理上睑层次，模拟东方人生理性重睑自然结构，复位组织并酌情增减。采用"8"字缝合锚着技术，将眶隔-上睑提肌腱膜复合体、切口下唇眼轮匝肌，在带有睑板前筋膜组织的睑板上重新定位愈合，重建生理性重睑动力学结构，取得了良好的效果。

资料与方法

一、资料选择

回顾性分析2016年11月至2020年10月，浙江省金华市人民医院(温州医科大学附属金华医院)整形外科应用"8"字缝合锚着法行切开重睑术的患者的临床资料。纳入标准：(1)年龄≥18岁；(2)既往未做过切开重睑术。排除标准：(1)随访时间<6个月；(2)不同意将临床资料用于本研究；(3)术前诊断为上睑提肌功能障碍所致的上睑下垂。本研究经金华市人民医院伦理委员会批准(IBR-2020029-R)，并与患者签署知情同意书。

二、方法

(一)术前设计

术前与患者充分沟通。患者取坐位，放松眉毛，根据患者需求及皮肤松弛情况，距睑缘6~8 mm设计重睑线(低于睑板上缘高度)及皮肤切口范围，宽1~5 mm。

(二)手术方法

患者平仰卧，常规消毒铺巾，含1∶100 000肾上腺素+2%盐酸利多卡因与1%盐酸罗哌卡因混合液(按1∶1配比)皮下局部浸润麻醉。

1．眼轮匝肌下、眶隔脂肪后平面分离

按设计线切开皮肤、眼轮匝肌，切除设计切口线间皮肤及相应的眼轮匝肌。针形电刀辅助下，切口线向下(下唇)至睑缘上1~2 mm，切口线向上(上唇)5~10 mm，在眼轮匝肌下平面分离，形成眼轮匝肌皮瓣(M)。保留睑板前筋膜组织，形成带睑板前筋膜组织的睑板(T)。在眶隔膜低位(一般为外侧)切开，沿上唇切口线水平由外侧向内侧剪开眶隔，眶隔脂肪后平面分离，松解上睑提肌腱膜表面纤维条索。

2．制备眶隔-上睑提肌腱膜复合体组织瓣(A)

保留眶隔膜残端，在眶隔膜和上睑提肌腱膜汇合部将眶隔上睑提肌腱膜联合增厚区(septoaponeurosis junctional thickening，SAJT)腹侧分离，形成一个连接上睑提肌腱膜的复合体组织瓣(A)，在后续操作中，将其锚着于睑板，延续上睑提肌腱膜止于睑板的动力传导作用。

3．"8"字缝合锚着( 图1 ，图2 )

按术前设计折痕高度标记固定点1(瞳孔内侧缘对应点)、2(瞳孔外侧缘对应点)、3(外侧角巩膜缘对应点)、4(折痕外缘)、5(折痕内缘)。其中1、2点位置决定重睑高度及睑缘位置，行"8"字缝合锚着术：以6-0尼龙线水平褥式缝合法将A锚着到下唇切口上缘相对应的睑板，缝针穿过睑板前筋膜、部分睑板组织后打结，不剪断缝线，同线水平褥式缝合切口下缘眼轮匝肌后打结，3点位置睑板变窄，可仅做A和M固定，另依据重睑弧度情况于内、外侧、中间间断追加固定3~5针。根据眶隔脂肪分布情况，酌情调整脂肪位置、脂肪量，眶隔脂肪下缘以6-0普迪思(PDS)线间断缝合固定上睑提肌腱膜反折残端处。嘱患者睁眼观察上睑形态和重睑效果满意后，用7-0可吸收线对应缝合眼轮匝肌层3~5针，7-0尼龙线间断3~5针后，连续缝合皮肤层。

(三)术后处理及随访观察指标

术后以纱布覆盖伤口1 d，术后7 d拆除缝线[ 5 ]。术后随访观察上睑平整度、上视野、眉眼间距、睁眼费力感、双侧对称性、重睑弧度、稳定度、睫毛翘度、瘢痕情况、并发症发生情况，进行疗效评价。

结果

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