金属弹簧丝植入治疗面神经麻痹性眼睑闭合不全

摘要

背景 瞬目和眼睑闭合功能障碍是面神经麻痹患者所共有的症状,其治疗方法包括上睑植入机械性装置,帮助眼睑闭合.一种新型的植入装置为金属弹簧,国内尚无关于金属弹簧植入治疗面神经麻痹性眼睑闭合不全的报道. 目的 评价眼睑金属弹簧植入术治疗面神经麻痹性眼睑闭合不全和暴露性角膜病变的临床疗效.方法 采用回顾性系列病例观察设计,收集2010年8月至2012年11月在河南省眼科研究所&河南省立眼科医院因面神经麻痹性眼睑闭合不全行眼睑金属弹簧植入术的患者11例11眼,所有患者均由同一名手术医师完成.金属弹簧由直径0.3 mm的镍合金丝制成,术中将弹簧下臂末端用涤纶布包裹并缝合于上睑睑板表面.手术前后均进行详细的外眼检查,对手术前后眼睑闭合不全的程度、上睑缘到瞳孔中心的距离(ULMD)、眼睑运动的幅度等进行比较.术后随访8～38个月,观察术后的不良反应和并发症.结果 术眼术后眼部酸痛不适症状逐渐消失,术眼睁眼、闭眼自然.术眼术前及术后ULMD值分别为(3.51±0.73)mm和(3.20±0.86)mm,差异无统计学意义(t=1.36,P=0.10);术眼手术前后眼睑闭合不全程度分别为(5.94±1.57) mm和(1.06±0.98) mm,差异有统计学意义(t=9.42,P=0.00);术后患眼眼睑运动幅度为(5.89±0.70)mm,较术前的(0.11±0.33)mm明显改善,差异有统计学意义(t=22.97,P=0.00).术后患眼的暴露性角膜病变均得到明显改善.本组术眼中除1例患者术眼因受外伤需要进行金属弹簧调整,其他术眼未发生金属弹簧暴露、金属疲劳、术区感染等并发症. 结论 眼睑内金属弹簧植入术治疗面神经麻痹性眼睑闭合不全的手术安全有效,术后上睑的提睑和闭合功能明显改善.%Background The dysfunction of the blink reflex the eyelid-closure ability appears in the patients with facial paralysis,and its management is the implantation of mechanical-assisted eye-closure device in the upper eyelid.A novel device is palpebral spring implant.However,there is no similar study in China.Objective This study was to evaluate the clinical efficacy of palpebral spring placement for lagophthalmos caused by facial nerve palsy.Methods This clinical research complied with Helsinki declaration and the protocol was approved by Ethic Committee of Henan Eye Institute & Henan Eye Hospital.Written informed consent was obtained from each patient prior to the surgery.A retrospective serial case-observational study was performed.The medical records of 11 patients who underwent palpebral spring placement for hypophasis due to facial nerve palsy were reviewed at Henan Eye Hospital from August 2010 to November 2012.Palpebral spring placement was performed by the same surgeon to ensure a more even outcomes.Palpebral spring was made by nickel wire,with the diameter of 0.3 mm and implanted on tarsal plate in 11 eyes of 11 patients with symptomatic facial nerve palsy.The lower tip of Levine spring was encased into a small terylene bag and sutured to the anterior tarsal surface during the surgery.Preoperative and postoperative symptoms,upper eyelid margin to mid pupil distance (ULMD),degree of lagophthalmos and eyelid moving scope were examined and compared between before and after operation.The operating complication was followed-up for 8-38 months.Results The discomforted symptoms disappeared in all the operated eyes.The ULMD was (3.51±0.73) mm in preoperation and (3.20±0.86) mm in posteration,without significant difference between them (t=1.36,P=0.10).The degree of lagophthalmos was (5.94±1.57) mm and (1.06±0.98) mm in preoperation and postoperation respectively,showing a significant difference between them (t =9.42,P =0.00).The eyelid moving scope was (5.89±0.70) mm in postoperation,which was significantly increased in comparison with (0.11 ±0.33) mm of preoperation (t =22.97,P =0.00).The palpebral spring implant was regulated in 1 patient during the follow-up duration due to the trauma.No complication in other 10 patients appeared during the follow-up duration,such as implant exposure,metal fatigue or infection.Conclusions Palpebral spring placement is safe and effective for lagophthalmos in patients with facial nerve palsy.