眶隔脂肪重置联合眼轮匝肌瓣转位矫正泪沟畸形疗效分析

The clinical analysis of orbital septum fat replacement combined with orbicularis oculi muscle flap transposition in correction of tear trough deformity

目的探讨眶隔脂肪重置联合眼轮匝肌瓣转位矫正泪沟畸形的疗效。方法回顾性分析福建医科大学附属协和医院2009年1月至2020年1月采用手术矫治的泪沟畸形患者临床资料,根据手术方式分为联合组(行眶隔脂肪重置联合眼轮匝肌瓣转位术)及单纯组(单纯行眶隔脂肪重置术)。手术方法:采用经皮入路,于眼轮匝肌下分离重置眶隔脂肪填充泪沟凹陷,联合组加行转移蒂在内侧的眼轮匝肌瓣填充泪沟内侧凹陷。术前和术后6个月采用Hirmand泪沟等级量表对患者下睑进行评级(Ⅰ、Ⅱ、Ⅲ级,从内侧至外侧程度依次加重),并将下睑由内侧至外侧均无明显泪沟评为0级,计算2组中各级的改善率(术后评级改善例数占该级中总例数的百分率)和完全改善率(术后评级改善至0级例数占该级中总例数的百分率);术后1个月内对相关并发症进行随访记录。组间Hirmand各级改善率、完全改善率比较采用χ^(2)检验或Fisher精确检验,P<0.05为差异有统计学意义。结果共纳入175例患者(350只下睑),其中联合组104例(208只下睑),男16例,女88例,年龄(34.3±8.3)岁,术前下睑HirmandⅠ级47只,Ⅱ级54只,Ⅲ级107只;单纯组71例(142只下睑),男7例,女64例,年龄(33.2±8.6)岁,下睑术前HirmandⅠ级24只,Ⅱ级32只,Ⅲ级86只。术后6个月,联合组中Ⅰ级病例改善率为91.5%(43/47),高于单纯组的54.2%(13/24)(P<0.01),而2组中Ⅱ、Ⅲ级病例改善率比较差异无统计学意义(P>0.05);联合组中Ⅰ、Ⅱ、Ⅲ级病例完全改善率分别为91.5%(43/47)、77.8%(42/54)、72.0%(77/107),均高于单纯组的54.2%(13/24)、25.0%(8/32)、24.4%(21/86),差异均有统计学意义(P均<0.01)。术后并发症包括睑外翻、血肿、淤斑、局部水肿超过2周,2组并发症发生率比较,差异均无统计学意义(P>0.05)。结论眶隔脂肪重置联合眼轮匝肌瓣转位术对各级泪沟畸形均有改善,而且对泪沟内侧凹陷的改善效果明显优于单纯眶隔脂肪重置术。

Objective To investigate the effect of orbital septal fat replacement combined with orbicularis oculi muscle flap transposition in correction of tear trough deformity.Methods The clinical data of patients with tear trough deformity underwent surgical correction admitted to Fujian Medical University Union Hospital from January 2009 to January 2020 were retrospectively analyzed.According to the surgical methods,they were divided into the combined group(orbital septal fat replacement combined with orbicularis oculi muscle flap transpose)and the simple group(orbital septal fat replacement).Surgical methods:using percutaneous approach,the orbital septum fat was separated and replaced under the orbicularis oculi muscle to fill the tear trough deformity,and the orbicularis oculi muscle flap with the transfer pedicle on the medial side was added to fill the medial tear trough deformity in the combined group.Before and 6 months after surgery,Hirmand scale was used to rate the tear trough deformity(gradeⅠ,Ⅱ,Ⅲ,severity is increasing from medial to lateral),and the lower eyelid without obvious tear trough deformity was rated as grade 0.The improvement rate and the complete improvement rate were calculated in the two groups.The related complications were followed up within 1 month after operation.Chi-square test or Fisher’s exact test was used to compare Hirmand improvement rate at all levels and complete improvement rate between groups.P<0.05 was considered statistically significant.Results A total of 175 patients(350 lower eyelids)were enrolled.There were 104 patients(208 lower eyelids)in the combined group[16 males and 88 females,aged(34.3±8.3)years old],including 47 cases of Hirmand gradeⅠ,54 cases of Hirmand gradeⅡand 107 cases of Hirmand gradeⅢbefore operation.There were 71 patients(142 lower eyelids)in simple group[7 males and 64 females,aged(33.2±8.6)years old],including 24 cases of Hirmand gradeⅠ,32 cases of Hirmand gradeⅡand 86 cases of Hirmand gradeⅢbefore operation.At 6 months after operation,the improvement rate of gradeⅠcases in the combined group was 91.5%(43/47),which was higher than that in the simple group(54.2%,13/24)(P<0.01),while there was no significant difference in the improvement rate of gradeⅡandⅢcases between the two groups(P>0.05).The complete improvement rates of gradeⅠ,ⅡandⅢcases in the combined group were 91.5%(43/47),77.8%(42/54)and 72.0%(77/107),respectively,which were higher than those in the simple group[54.2%(13/24),25.0%(8/32)and 24.4%(21/86)],and the differences were statistically significant(all P<0.01).Postoperative complications included ectropion,hematoma,ecchymosis,and local edema for more than 2 weeks.There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions Orbital septal fat replacement combined with orbicularis oculi muscle flap transposition can improve all levels of tear trough deformity,and the improvement effect of medial lacrimal groove depression is significantly better than that of orbital septal fat replacement alone.