【作者】 张培培；

【导师】 邢新；

【作者基本信息】 第二军医大学 ， 外科学， 2011， 硕士

【摘要】 目的:了解上海市15～94岁汉族人不同性别不同年龄段泪槽及睑颊沟的发生率。方法:采用多阶段分层等容量随机抽样的方法,对3200例上海市15～94岁的汉族人泪槽及睑颊沟的发生情况进行调查。将上海市15～94岁的汉族人以5岁为一个年龄组共分成16组,每个年龄组分别随机选择200例的第二代居民身份证照片,男女各半,共3200例。三人独立观察并记录统计泪槽和睑颊沟的发生情况,高年资医师确认。各组数据综合列表,运用SPSS17.0和SPSS18.0统计分析软件,通过配对t检验,卡方检验,Spearman秩相关,McNemar检验,Kappa系数检验,拟合曲线,进行统计学分析;作出发生率随年龄变化线图,并描述分析。结果:1.上海市15至94岁汉族人群总体泪槽标准化发生率为57.20%,睑颊沟标准化发生率为21.84%,同侧两种体征并存的标准化发生率为21.20%;其中男性和女性泪槽标准化发生率分别为55.63%和58.74%;睑颊沟标准化发生率分别为21.38%和22.52%;同侧两种体征并存的标准化发生率分别为20.88%和21.72%。2.男女两性总体比较,泪槽、睑颊沟及同侧两种体征并存的发生率均无显著差异(t=0.484、0.171、0.172, P均>0.05)。3.男性、女性及男女合计人群泪槽发生率均显著高于睑颊沟(t=10.127、7.420、8.873, P均<0.001;统计量(S)分别为468.2927,460.1361,928.2973,P均<0.001);男性、女性及男女合计人群的泪槽与睑颊沟两体征的一致性均不高,Kappa系数分别为0.4307(0.3958,0.4655);0.4130(0.3779,0.4481);0.4219(0.3971,0.4466)。4.男性、女性及男女合计人群的泪槽、睑颊沟、同侧两种体征并存的发生率与年龄均存在正相关关系(P<0.001)。5.泪槽、睑颊沟及同侧两种体征并存的发生率随年龄的变化曲线图示:泪槽、睑颊沟、同侧两种体征并存的发生率均随年龄增长而逐渐增加,其中泪槽发生率自25岁开始呈快速攀升之势,至45岁之后增长趋于平缓;睑颊沟和同侧两种体征并存的发生率则均自35岁后开始快速攀升,至60岁以后增长趋于平缓。6.无论是男性还是女性人群,均有半数个体在33岁、59岁和61岁左右分别出现泪槽、睑颊沟和同侧两种体征并存情况,且在52岁以后80%以上的个体存在泪槽。结论:上海市15至94岁汉族人群泪槽、睑颊沟及同侧两体征并存发生率无显著性别差异;各年龄组泪槽发生率均高于睑颊沟,且较后者出现早;泪槽与睑颊沟的发生率随年龄增长而逐渐增加;泪槽与睑颊沟是伴随年龄增长出现的衰老征象。目的:研究泪槽及睑颊沟解剖学方面的形成机制,为临床治疗泪槽及睑颊沟提供解剖学基础。方法:对6具60岁以上泪槽畸形及睑颊沟畸形明显的尸体标本(男性3具,女性3具,平均年龄67.2岁)及6具30岁以下无明显泪槽及睑颊沟的尸体标本(男性3具,女性3具,平均年龄23.5岁)的下睑及眶周区域做逐层解剖及断层解剖,通过对比大体标本及组织切片观察两组间差异。结果:1.逐层解剖:泪槽及睑颊沟处于眼睑较薄皮肤与颧颊部较厚皮肤的交界处,皮肤与眼轮匝肌附着较紧密;颧部脂肪上缘覆盖于眼轮匝肌睑部与眶部的结合部,并与泪槽及睑颊沟的位置相对应,颧部脂肪上缘不随颧脂肪垫下移;内侧眼轮匝肌眶部与提上唇鼻翼肌之间隙与泪槽位置不对应;眼轮匝肌限制韧带起于眶下缘并止于眼轮匝肌睑部与眶部的结合部,外宽内窄,在内侧1/3延续为内眦部深层眼轮匝肌,直接贴附于眶下缘骨面;眼轮匝肌下脂肪位于眶部外下方,薄且松弛;眶隔附着于眶下缘,眶脂肪向前下方膨出。2.断层解剖:老年标本皮肤、眼轮匝肌较年轻标本萎缩、松弛,在眼睑较薄皮肤与颧颊部较厚皮肤的交界处形成泪槽与睑颊沟畸形;年轻人颧部脂肪上缘高于眼轮匝肌睑部与眶部的结合部,老年人颧部脂肪上缘处于眼轮匝肌睑部与眶部的结合部,此处与泪槽及睑颊沟的位置相对应;眼轮匝肌限制韧带起于眶下缘并止于眼轮匝肌睑部与眶部的结合部及眶部眼轮匝肌,老年人较年轻人松弛;眼轮匝肌下脂肪垫在两组间无显著差异。结论:泪槽和睑颊沟畸形形成是衰老所致各层组织松弛、萎缩和下移等综合因素共同作用的结果;颧部脂肪上部的萎缩与下移致使皮下脂肪的减少缺失、眼轮匝肌下脂肪垫的萎缩、眶脂肪的膨出,眶隔和内侧附着于骨面的眼轮匝肌及外侧的眼轮匝肌限制韧带限制组织下移可能是泪槽和睑颊沟日益凸显的原因。更多还原

【Abstract】 Objective: To investigate the prevalence of tear trough and palpebromalar groove among Han population of different ages and different gender aged 15~94 in Shanghai.Methods: The multi-stage stratified and isometric random sampling was used to select 3200 Han population aged from 15 to 94 in Shanghai, 1600male,1600femal .The investigation was conducted based on original "Second-Generation Resident ID Card Photo”. According to their age, they were devided into 16 age groups by per 5 years . Each photo are observed by three person independently, and the cases those were considered had tear trough or palpbromalar groove by all observers were positive. As further investigate,the controversial photos would be identified by two experienced plastic surgeons independently, and the cases those were considered had tear trough or palpbromalar groove by four or three out of all five observers were positive. Statistical analysis was executed by SPSS 17.0 and SPSS 18.0 software ,and the results were tested and analyzed by matching t test, chi-square test, McNemar test and Kappa coefficient, Spearman rank correlation, curve-fitting statistical methods,etc.Results: 1 The standardized prevalence rate of tear trough among Han population aged 15-94 in Shanghai was 57.20%, which in male is 55.63% and in female is 58.74%.The standardized prevalence rate of palpebromalar groove and ipsilateral coexistence of both signs were 21.84% and 21.20%,which in male were 21.38% and 20.88% and in female were 22.52% and 21.72%.2 There was no significant difference between male and female in all three parameters: the prevalence of tear trough , palpebromalar groove and ipsilateral coexistence of both signs (t = 0.484,0.171,0.172 , P > 0.05).3 The prevalence of tear trough was significantly higher than palpebromalar groove among male, female and total population (t = 10.127, 7.420, 8.873, P <0.001;statistic (S) were 468.2927, 460.1361, 928.2973,P <0.001).There was not a good concordance between tear trough and palpebromalar groove among male, female and total population from Kappa coefficient ,0.4307 (0.3958,0.4655); 0.4130 (0.3779,0.4481); 0.4219 (0.3971, 0.4466).4 The prevalence of all three parameters among male, female and total population had a positive correlation with age (P <0.001) . with age, the incidence increased.5 According to the curve, the prevalence of tear trough, palpbromalar groove and ipsilateral signs of both were increased with age. The prevalence of tear trough was increased significantly after the age of 25 years, and showed gently increasing trends after the age of 45 years; The prevalence of palpebromalar groove and ipsilateral coexistence of the two signs were increased significantly after the age of 35 years, and showed a gently increasing trend after the age of 60 years.6 About half of the male or female population had tear trough at the age of 33 years, palpebromalar groove at the age of 59 years ,and ipsilateral coexistence of the two signs at the age of 61 years respectively. More than eighty percent of them had tear trough after the age of 52 years.Conclusion: There were no significant gender differences between male and female when the prevalence of tear trough and palpebromalar groove were concerned in Han population in Shanghai. The prevalence of tear trough was higher than that of palpebromalar groove, and the former appeared earlier than the latter. The prevalences of all signs were increased gradually with age.Objective: To study the anatomic mechanism of tear trough and palabromalar groove.Methods: 6 old cadavers (3 male,3 female, an average age of 67.2 years) with obvious tear trough deformity and palpbromalar groove deformity and 6 young cadavers (3 male, 3 female, an average age of 23.5years) without tear trough deformity and palpbromalar groove deformity were slected,dissection and histological observation were performed on lower eyelid and periorbital region.Results:1 Layered dissection :Tear trough and palabromalar groove locate at the junction of thin eyelid skin and thick cheek skin. Skin is closely attached to the orbicularis oculi muscle. The superior border of the malar fat pad covers the junction of the palpebral and orbital portions of the orbicularis muscle, and does not desend with malar fat pad, which is also corresponded to the location of tear trough and palpbromalar groove. The gap between the orbicularis oculi muscle and the levator labii superioris alaeque nasi muscle is not correspond to tear trough. The orbicularis retaining ligament arises from the orbital rim and ends at the junction of the palpebral and orbital portions of the orbicularis muscle, and the ligament connects with the deep part of the orbicularis muscle which directly attachs to the infraorbital rim. Suborbicular oculi fat pads locate at the inferolateral of the orbital region, thin and flabby. Orbital septal arises from the infraorbital rim, and the orbital fat extrudes anteriorly and inferiorly.2sagital dissection: Compared to young specimens,the skin and orbicularis oculi muscle of old specimens are atrophy and relaxation.Tear trough deformity and palabromalar groove deformity overlay the junction of thiner eyelid skin and thicker cheek skin. The superior border of the malar fat pad covered the junction of the palpebral and orbital portions of the orbicularis muscle,and correlated with the tear trough and palpbromalar groove,but the superior border of the malar fat pad in young cadavers was found above the tear trough and palpbromalar groove line.The orbicularis retaining ligament arose from the orbital rim and caudal to the junction of the palpebral and orbital portions of the orbicularis muscle,and it’s relax in old group than in young group.No obvious difference about suborbicularis oculi fat was found between these two groups.Conclusions: Tear trough deformity and palabromalar groove deformity result from combination of age-related relaxation, atrophy and descent of layers of tissues .The orbital septal and the orbicularis retaining ligament prevent tissues from descending, which make tear trough and palabromalar groove more visible.更多还原