泪小管断裂后解剖结构的量化分析

目的:对泪小管断裂后的解剖结构进行量化分析,为术中寻找泪小管鼻侧断端提供依据,评价以泪阜为解剖标志寻找下泪小管鼻侧断端的可行性。方法:前瞻性病例对照研究。选择外伤性下泪小管断裂患者100例(男72例,女28例)。完全随机分组:实验组(50例),以泪阜为解剖标志寻找下泪小管鼻侧断端;对照组(50例),直视法寻找下泪小管鼻侧断端。测量泪小点与颞侧断端距离、泪小管鼻侧断端与泪阜的垂直距离及象限位置,记录两组寻找下泪小管鼻侧断端的成功率。数据的比较采用χ2检验。结果:下泪小管鼻侧断端位于泪阜下半象限者94%,下泪小管鼻侧断端距离泪阜的垂直距离为2.34±0.68mm,其中泪小点距颞侧断端<4mm者鼻侧断端与泪阜的垂直距离为2.01±0.77mm,泪小点距颞侧断端4～7mm者为0.57±0.19mm,泪小点距颞侧断端>7mm者为3.05±0.97mm。手术寻找下泪小管鼻侧断端成功率:实验组:49/50(98%),对照组:40/50(80%),两组差异有统计学意义(P<0.05)。结论:下泪小管鼻侧断端多位于泪阜水平延长线下方,泪小管鼻侧横断面多位于泪阜深面2～3mm范围内,术中可以泪小点与颞侧断端的长度来确定鼻侧断端在泪阜周围的寻找范围。寻找鼻侧断端成功率实验组优于对照组,以泪阜为解剖标志寻找下泪小管鼻侧断端是可行的,尤其适合下泪小管颞侧断端距下泪小点4～7mm患者。

Clinical study of quantitative analysis of the anatomical structure after canalicular laceration

AIM ： To quantitatively analyse the anatomical structure after canalicular laceration, to provide a basis for finding nasal ends of the canalicular and to evaluate the feasibility of taking the lacrimal caruncle as anatomic landmarks for finding the nasal ends of the inferior canalicular. METHODS： In this prospective case-control study, 100 cases （72 males and 28 females） of traumatic inferior canalicular laceration were chosen. They were completely random divided into the experimental group （n=50）, finding the nasal ends of the inferior canalicular by applying the method of lacrimal caruncle anatomic landmarks; the control group （n=50）, finding the nasal ends of the inferior canalicular by applying the direct vision method. The distance of the lacrimal puncture and the temporal side of the stump, the vertical distance and quadrant between nasal ends of the canalicular and lacrimal caruncle were measured. The success rate of the two groups to find the nasa lends of the canalicular were recorded. The data were compared using χ2 test. RESULTS： The nasal ends of the inferior canalicular in the semi-quadrant of the lacrimal caruncle was 94%. The canalicular nasal ends from the lacrimal caruncle of the vertical distance was 2.34±0.68 mm, in which lacrimal punctums pitch temporal side of the stump〈 4mm by nasal ends vertical distance of the lacrimal caruncle was2.01±0.77mm. Lacrimal punctures pitch temporal side of the stump between 4-7ram was 0. 57±0.19ram, lacrimal punctums pitch temporal side of the stump 〉 7mm was 3.05±0.97ram. The success rate of surgery looking the inferior lacrimal duct nasal stump： experimental group： 49/50 （98%） , control group： 40/50 （80%）, the difference was statistically significant （P〈0.05）, CONCLUSION： Nasal ends of the inferior canalicular locates below the parallel lines of the lacrimal caruncle. The canalicular nasal ends locates in the deep side of the lacrimal caruncle within 2-3ram. The lacrimal puncture and the length of the temporal side can be used to clear the radius around the lacrimal caruncle. The success rate of finding the nasal ends of the experimental group is faster than the control group. The lacrimal caruncle as anatomic landmarks to find the nasal ends of the inferior canalicular is feasible, especially for patients whose inferior canalicular bitamporal side of the stump from inferior lacrimal puncture was 4-7mm.