CAJ | 학술논문

目的通过对泪槽区域进行解剖学研究,探讨泪槽畸形老化特征的发生机制.方法选取13具(26侧)10％甲醛固定的成人尸头标本,其中男性9具(18侧),女性4具(8侧),年龄22～78岁.以显微手术器械,在10×解剖显微镜下逐层解剖眼周,重点解剖泪槽区域,观察并描述各区的解剖学层次.解剖并显露下睑眼轮匝肌支持韧带,认真记录支持结构的解剖学位置并照相保存.结果 ①泪槽区域的解剖层次分为:皮肤层、皮下组织层、眼轮匝肌层、骨膜层,泪槽以上皮肤层下为无脂肪区,泪槽以下皮肤层下为有脂肪区,其脂肪为颧脂肪垫.②下睑眼轮匝肌眶隔部与眼轮匝肌眶部在眶骨内侧表面有自然的分界线,其体表投影对应于泪槽,该分界在内眦角垂线上的宽度为(2.06±0.15) mm,在鼻翼外缘垂线上的宽度为(3.25±0.12)mm,眼轮匝肌眶隔部与眼轮匝肌眶部在距内眦角(16.56±0.51) mm处开始融合.③眶内侧、眶上下侧有眼轮匝肌支持韧带,眶外侧无眼轮匝肌支持韧带.下睑眼轮匝肌支持韧带分为2层.④下睑眼轮匝肌支持韧带上层内侧起于眶缘,向外在距眶外缘以内(16.10±0.43) mm处起于眶骨前壁,韧带穿过眼轮匝肌止于皮肤.下睑眼轮匝肌支持韧带下层起于眶骨前壁,穿过眼轮匝肌及眼轮匝肌浅面的脂肪层止于皮肤.结论泪槽的水平长度为(16.56±0.51) mm,泪槽在内眦角垂线及鼻翼外缘垂线上的宽度分别为(2.06±0.15)mm、(3.25±0.12) mm.泪槽畸形的形成原因主要是下睑眼轮匝肌支持韧带松弛,导致其下层穿过的脂肪下降或萎缩,使眼轮匝肌支持韧带上下层之间距离增大所致.
목적 통과대루조구역진행해부학연구,탐토루조기형노화특정적발생궤제.방법 선취13구(26측)10％갑철고정적성인시두표본,기중남성9구(18측),녀성4구(8측),년령22～78세.이현미수술기계,재10×해부현미경하축층해부안주,중점해부루조구역,관찰병묘술각구적해부학층차.해부병현로하검안륜잡기지지인대,인진기록지지결구적해부학위치병조상보존.결과 ①루조구역적해부층차분위:피부층、피하조직층、안륜잡기층、골막층,루조이상피부층하위무지방구,루조이하피부층하위유지방구,기지방위권지방점.②하검안륜잡기광격부여안륜잡기광부재광골내측표면유자연적분계선,기체표투영대응우루조,해분계재내자각수선상적관도위(2.06±0.15) mm,재비익외연수선상적관도위(3.25±0.12)mm,안륜잡기광격부여안륜잡기광부재거내자각(16.56±0.51) mm처개시융합.③광내측、광상하측유안륜잡기지지인대,광외측무안륜잡기지지인대.하검안륜잡기지지인대분위2층.④하검안륜잡기지지인대상층내측기우광연,향외재거광외연이내(16.10±0.43) mm처기우광골전벽,인대천과안륜잡기지우피부.하검안륜잡기지지인대하층기우광골전벽,천과안륜잡기급안륜잡기천면적지방층지우피부.결론 루조적수평장도위(16.56±0.51) mm,루조재내자각수선급비익외연수선상적관도분별위(2.06±0.15)mm、(3.25±0.12) mm.루조기형적형성원인주요시하검안륜잡기지지인대송이,도치기하층천과적지방하강혹위축,사안륜잡기지지인대상하층지간거리증대소치.
Objective To explore the mechanism of the aging deformity of tear trough through the anatomic study of the tear trough region.Methods 13 adult cadaveric heads (26 sides),including 9 male heads(18 sides) and 4 female heads (8 sides),aged 22-78 years old,were used.Anatomic study was performed around the orbital,especially tear trough region,with microsurgery instrument under microscope(× 10 times).The lower orbicularis retaining ligament was dissected and exposed.The anatomic location was recorded and photographed.Results ① The anatomic layers of the tear trough region contains skin,subcutaneou tissue,orbicularis oculi muscle,periosteal membrane.There is no subcutaneous fat above the tear trough,while it exists below the tear trough,called malar fat pad.②There is a natural boundary between the septal and the orbital portions of the orbicularis oculi muscle of lower eyelid at surface of the orbital bone.The natural boundary,projected on the body surface corresponds to tear trough.The width of boundary is (2.06 ± 0.15) mm on the vertical line through inner canthus and (3.25 ±0.12) mm on the vertical line through the lateral margin of the ala.The septal portion and the orbital portion of the orbicularis oculi muscle began to merge in(16.56 ±0.51) mm to inner canthus.③ There is ligament attachment in the medial,upper and lower orbital and no ligament attachment in the lateral orbital.Orbicularis retaining ligament of lower eyelid is divided into two layers.④The medial of the upper layer of the orbicularis retaining ligament in lower eyelid originates from orbital margin and from preorbital walls laterally in (16.10 ± 0.43) mm to the medial of lateral orbital margin,through orbicularis oculi muscle and ends at the skin.The lower layer of the orbicularis retaining ligament of lower eyelid originates from preorbital walls through orbicularis oculi muscle and its superficial fat,then ends at the skin.Conclusions The length of tear trough is(16.56 ±0.51) mm,the width of tear trough is(2.06 ± 0.15) mm and(3.25 ±0.12) mm on the vertical line through inner canthus and the lateral margin of the ala nasi respectively.The main reason of the aging deformity of tear trough attributes to the increased distance between the upper and lower layers of the orbicularis retaining ligament in lower eyelid,which is caused by loose of the orbicularis retaining ligament and its underlying fat atrophy or decline.