内路法眶隔脂肪移植在矫正泪槽畸形中的应用

Clinical application of orbital fat autograft for tear trough deformity through tranconjunctival approach

目的 探索内路法眶隔脂肪游离移植矫正下睑袋伴有泪槽畸形的临床效果.方法 选择年龄≤40岁、下睑皮肤无明显松弛、Snap试验≤1 s、经Hirmand法分型为Ⅰ、Ⅱ型的32例下睑袋伴泪槽畸形患者,行经结膜内路法下睑袋成形术,松解泪槽韧带,去除眶隔疝出的脂肪,并将其修剪成颗粒状,游离移植于下睑凹陷处眶骨骨膜上,以矫正泪槽畸形.术后采用患者自评、医生判断和第三方评价的形式,通过泪槽畸形等级量表（TTRS）及满意度调查评价手术效果.结果 术后3例Ⅱ型患者效果不佳,其中2例下睑袋效果良好,但泪槽畸形改善有限,恢复为Ⅰ型术前状态,予以注射玻尿酸填充修复后效果较好;1例下睑袋及泪槽畸形均复发,予以皮肤入路下睑袋矫正术进行修复.其余29例术后效果较好,下睑袋及泪槽畸形消失,无下睑凹陷,表面平整,无睑缘退缩等.术后6个月TTRS评分均低于术前,差异有统计学意义（P＜0.01）.Ⅰ、Ⅱ型患者术后满意度分别为100％（14/14）和83.3％（15/18）.结论 对于中青年患者采用内路法下睑袋修复术及眶隔脂肪游离移植,既可修复下睑袋,又可矫正泪槽畸形,实现眶周年轻化的治疗效果.

Objective To discuss the orbital fat autograft for lower baggy eyelid with tear trough deformity and its therapeutic effect through tranconjunctival approach.Methods The patients with lower eyelid bag and tear trough deformity were included into the study.The included 32 patients met the following criterias：①less than 40 years old;②lower eyelid skin was not relaxed;③less than 1 s in Snap test;④Hirmand type Ⅰ and Ⅱ.They were treated with tranconjunctival lower blepharoplasty combined with the tears ligament relaxation.The orbital fat was repositioned on the depression site above orbital periosteum to correct tear trough deformity.The effect was evaluated through Tear Trough Rating Scale （TTRS） and satisfaction degree.Results Three cases with Hirmand type Ⅱ didn＇t have good effect.Among them,the baggy eyelid was corrected in 2 cases,while the tear trough deformity need additional hyaluronic acid injection.One patient underwent secondary lower blepharoplasty through cutaneous incision.Good effect was achieved in the other 29 cases with no depression deformity and eyelid withdrawal.The TTRS scores 6 months after operation was significantly improved（P 〈 0.01）.Satisfaction degree was 100% （14/14） and 83.3% （15/18） in type Ⅰ and Ⅱ patients.Conclusions The technique can simultaneously improve lower eyelid bag and the tear trough deformity.It can be applied in periorbital rejuvenation for middle-aged and young patients.