超声生物显微镜在老年性上睑下垂术前评估中的应用

摘要

Objective To explore the application of ultrasound biomicroscopy in measuring the thickness of levator aponeurosis,and to provide more accurate clinical guidance for surgical treatment of senile ptosis.Methods One hundred and two upper eyelids in patients with senile ptosis and normal elderly persons were randomly selected from this department.The strength of muscle and length of ptosis in each eye with levator aponeurosis were measured,and all eyelids were categorized into normal,mild,moderate and severe groups.Ultrasound biomicroscopy had been applied for measuring the thickness of levator in each eyelid and their resules were statistically analyzed for finding the significant difference among these groups and to analyze the relationship between strength and thickness of levator muscles.Results The average measurement by ultrasound biomicroscopy in normal,mild,moderate and severe groups were 0.719±0.027 mm,0.655±0.027 mm,0.599±0.028 mm and 0.353±0.003 mm respectively.The statistical analysis showed that there was significant difference among these groups (P＜0.001) ,and there was also significant difference between any two groups (P＜0.001).There was no significant difference between age and gender in these groups (P＞0.05).The thickness of levator was gradually increased with the increase in strength of levator muscle,thus it showed positive correlation (r=0.796,P＜0.001).Conclusion The thickness of levator in aponeurosis measured by ultrasound biomicroscopy can make up the defects of lacking quantitative standard for assessment of perioperative thickness of levator,thus it can provide more accurate clinical guidance for surgical treatment.%目的 研究超声生物显微镜(UBM)在提上睑肌厚度测量中的应用,从而对老年性上睑下垂手术治疗方法给予更为准确的指导.方法 采用随机临床对照研究.随机选择单侧或双侧不同程度老年性上睑下垂患者及正常人群共102只眼,测量每只眼的提上睑肌肌力以及上睑的下垂量,排除各种并发症,按提上睑肌肌力将所有受测眼分为正常、轻度、中度、重度四组,通过超声生物显微镜对各组的提上睑肌厚度进行测量,比较四组提上睑肌厚度的差异性,分析年龄和性别对提上睑肌厚度是否存在影响,并对提上睑肌肌力与其厚度的相关性进行评估.结果 经测量四组平均值分别为(0.719±0.027)mm;(0.655±0.027)mm;(0.599±0.028)mm;(0.353±0.003)mm.统计学处理用单因素方差分析法和Pearson直线相关分析法,结果显示各组间有显著差异(P＜0.001),且四组间两两比较提上睑肌厚度差异也有统计学意义(P＜0.001).而不同年龄组别和性别的提上睑肌厚度差异无统计学意义(P＞0.05).肌力与提上睑肌厚度呈正相关(r=0.796,P＜0.001).结论 通过UBM测量所得的提上睑肌厚度值可以弥补上睑下垂手术围手术期评估缺少量化标准的缺陷,从而为手术医生提供更为直观的理论依据,使手术术式更为合理和精确.