不同额肌腱膜瓣悬吊术治疗重度先天性上睑下垂的临床分析

摘要

OBJECTIVE To explore the clinical efficacy between without cutting frontal muscular slap and cutting frontal muscular slap during frontalis aponeurosis flap suspension in treating severe congenital ptosis. METHODS In our hospital from October 2012 to August 2014, ninety patients with severe congenital ptosis divided into two groups were treated by frontalis aponeurosis flap suspension. Group A (45 cases, 58 eyes) was treated with-out cutting frontal muscular slap during suspension, while Group B (45 cases, 58 eyes) was cut both sides of the frontal muscle flap. The efficacy of two groups was compared. RESULTS After 6 months, Group A achieved as fol-lowings:good cosmetic correction in 48 eyes (82.75%), undercorrection in 4 eyes (6.89%), overcorrection in 6 eyes (10.34%), upper eyelid activity for (4.70±0.69) mm and lagophthalmos in 14 eyes, palpebral fissure exposed height for (2.02±0.524) mm, while Group B achieved:good cosmetic correction in 50 eyes (86.21%), undercorrection in 5 eyes (8.6%), overcorrection in 3 eyes (5.17%), upper eyelid activity for (5.08±0.75) mm, and lagophthalmos in 8 eyes, palpebral fissure exposed height for (1.32±0.432) mm. The correction rates were closed between Group A and B (P>0.05), however, Group B were superrior to Group A in upper eyelid motion, lagophthalmos and palpebral fis-sure exposed height (P<0.05). CONCLUSION Though the overall clinical efficacy of two kinds of frontalis aponeurosis flap suspensions were closed in treating severe congenital ptosis, yet it was highlighted that cutting on both sides of the frontal muscle flap was superrior to that of wihtout cutting frontal muscular slap in improving post-operative eyelid closure and increaseing upper eyelid activity.%目的：比较额肌腱膜瓣悬吊术中不剪开或剪开额肌瓣治疗重症上睑下垂的临床效果。方法2012年10月至2014年8月笔者所在医院收治的重症上睑下垂患者90例，将其分成2组，均施行额肌腱膜瓣悬吊术。A组45例（58只眼），术中额肌瓣两侧不剪开，B组45例（58只眼），术中行额肌瓣两侧剪开。比较2组患者的术后治疗效果。结果术后6个月时，A组正矫48只眼（82.75%），欠矫4只眼（6.89%），过矫6只眼（10.34%），上睑活动度（4.70±0.69） mm；眼睑闭合不全14只眼，睑裂暴露高度（2.02±0.524） mm。 B组正矫50只眼（86.21%），欠矫5只眼（8.6%），过矫3只眼（5.17%），上睑活动度（5.08±0.75） mm；眼睑闭合不全8只眼，睑裂暴露高度（1.32±0.432） mm。2组的眼睑下垂矫正率接近（P＞0.05），B组在上睑活动度、眼睑闭合不全睑裂暴露高度方面均好于A组（P＜0.05）。结论两种额肌腱膜瓣悬吊术治疗重症上睑下垂的总体疗效接近；额肌瓣两侧剪开在改善术后眼睑闭合、增加上睑活动度方面优于额肌瓣不剪开的方法。