经结膜入路眶隔脂肪释放法矫正泪槽畸形的效果分析

Effect of transconjunctival lower eyelid blepharoplasty with release of tear trough ligament and orbital septum fat reposition for correction of tear trough deformity

目的探讨经结膜入路眶隔脂肪释放手术矫正无眶隔脂肪膨出的泪槽畸形的疗效。方法回顾性分析2019年9月至2020年4月上海交通大学医学院附属第九人民医院整复外科治疗的无眶隔脂肪膨出的泪槽畸形的患者资料。手术均经结膜入路释放眶隔脂肪、松解泪槽韧带、分离颧前间隙-上颌前间隙, 将眶隔脂肪瓣内固定于此间隙中, 以矫正泪槽畸形。依据数码电子照片, 术前对泪槽畸形进行Hirmand分型。术前、术后根据Sadick泪槽评价量表(TTRS), 分别对泪槽凹陷深度、色素沉着程度、颧部脂肪下垂以及下睑皮肤皱褶程度进行评分;根据Barton的睑颊部美学评估分级标准, 对眶-颊结合部的形态进行评级;同时结合术后患者的满意度自评表, 综合分析泪槽畸形矫正的美学效果。术后对患者进行随访, 记录相关并发症。采用SPSS 20.0软件进行统计学分析, 对术前、术后TTRS评分比较采用配对样本t检验。结果共纳入79例不伴眶隔脂肪膨出的泪槽畸形患者, 均为双侧。男性24例, 女性55例, 年龄19~38岁, 平均25.7岁。术后3 d所有患者均出现结膜水肿, 11例出现皮下淤斑、下睑肿胀或不对称, 通过局部冷敷和口服地塞米松等, 1~2周内均恢复, 未见其他并发症发生。随访5~13个月, 平均8.5个月。TTRS术前、术后评分比较, Hirmand Ⅰ型差异无统计学意义(P>0.05), Hirmand Ⅱ和Ⅲ型的差异均有统计学意义(P<0.01)。Barton评级:Hirmand Ⅰ型33例, 均由术前的1级改善为术后的0级;Hirmand Ⅱ型35例, 由术前的1级(7例)、2级(25例)和3级(3例)改善为术后的0级(30例)和1级(5例);Hirmand Ⅲ型11例, 由术前的2级(6例)和3级(5例)改善为术后的0级(2例)、1级(5例)和2级(4例)。患者自评满意度:满意为78.5%(62/79), 基本满意为17.7%(14/79), 不满意为3.8%(3/79)。结论经结膜入路眶隔脂肪释放术, 能有效矫正不同程度的无眶隔脂肪膨出泪槽畸形, 达到提升下睑年轻化的美学效果。

Objective To evaluate the cosmetic outcomes of non-eyebag associated tear trough deformities(TTDs)using the transconjunctival lower eyelid blepharoplasty with release of the tear trough ligament(TTL)and orbital septum fat reposition.Methods Non-eyebag associated TTDs patients who received the transconjunctival lower eyelid blepharoplasty with release of TTL and with reposition of the orbital septum fat flap internally fixed to the premaxillary-prezygomatic space were retrospectively reviewed at the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2019 to April 2020.The"Hirmand"types of TTDs were classified preoperatively based on the digital photography.Tear trough rating scale(TTRS)introduced by Sadick was used to assess TTDs before and after surgeries based on depth of the trough,hyperpigmentation,prolapse of nasal fat pads/pockets,and lower eyelid skin rhytidosis."Barton"grading system was used to evaluate demarcation of orbit-cheek junction area preoperatively and postoperatively.Ultimate surgical outcomes of TTDs were assessed by TTRS,Barton and patient self-assessment scores.Patients were followed up postoperatively and the complications were filed.Matched samples t-test(SPSS 20.0 software)was used for statistical analysis to compare TTRS scores pre-and post-surgery.Results A total of 79 patients with bilateral TTDs were enrolled,including 24 men and 55 women.Their age ranged from 19 to 38 years old(average,25.7 years old).Edema or congestion in conjunctiva presented in all patients within 3 days after surgery.Slight eyelid skin ecchymosis,lower eyelid edema or asymmetry was presented in 11 cases,and they all recovered in 1-2 weeks.No other complications occurred.The follow-up period ranged from 5 to 13 months(average,8.5 months).TTRS scores between pre-and post-surgeries demonstrated no significant difference in Hirmand typeⅠ(P>0.05),but presenting significant difference both in Hirmand typeⅡand Hirmand typeⅢ(P<0.01).All cases(33)in Hirmand typeⅠgraded as Barton 1 pre-surgery were improved to grade 0 post-surgery.There were 35 cases categorized as Hirmand typeⅡ.Among them,7(20%),25(71.4%)and 3 cases(8.6%)were graded as Barton 1,2 and 3 pre-surgery,respectively.Postoperatively,they were improved to Barton 0(30 cases,85.7%)and 1(5 cases,14.3%),accordingly.There were 11 cases categorized as Hirmand typeⅢ,which included 6 cases graded as Barton 2 and 5 cases graded as Barton 3.After surgery,they were improved to Barton 0(2 cases,18.2%),Barton 1(5 cases,45.5%)and Barton 2(4 cases,26.3%).As to overall cosmetic satisfaction,78.5%(62/79),17.7%(14/79)and 3.8%(3/79)were self-assessed as good,moderate and poor by the patients,respectively.Conclusions Transconjunctival lower eyelid blepharoplasty with release of tear trough ligament and fat reposition can achieve satisfactory lower eyelid rejuvenation in tear trough deformities not associated with eyebags.