下直肌后退联合下睑筋膜头分离复位在甲状腺相关眼病患者斜视矫正术的应用  

A surgical technique to prevent lower eyelid retraction after inferior rectus recession in patients with thyroid-associated ophthalmopathy

作　　者：颜建华[1] 杨敏[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中华眼视光学与视觉科学杂志》2013年第9期522-525,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的探讨甲状腺相关眼病患者下直肌后退术中下睑退缩的防治措施。方法回顾性病例研究。广州中山大学中山眼科中心2007年1月至2011年12月行下直肌后退术的甲状腺相关眼病患者24例，其中男18例，女6例；平均年龄（47．8±10．7）岁。甲状腺相关眼病患者下直肌后退术中除充分分离下直肌与下睑的联系外，同时将与下直肌相联的下睑筋膜头分离并标记，下直肌后退后将下睑筋膜头缝回到下直肌原肌止点处。结果下直肌后退量2．5～8．0mm，平均为（5131±1．16）mm，仅5例在术后出现轻度的下睑退缩，术后下睑位置总量改变为0。2例患者显示下方巩膜暴露，但睑裂大小无改变。所有患者术后无下睑其他外观改变。结论下直肌后退术中充分分离下睑与下直肌的联系，同时分离下睑筋膜头并缝回到下直肌原肌止点处可有效防治甲状腺相关眼病患者下直肌后退术后的下睑退缩。Objective To introduce a surgical technique to prevent lower eyelid retraction after inferior rectus recession in patients with thyroid-associated ophthalmopathy. Methods Twenty-four strabismic patients with thyroid-associated ophthalmopathy, who had undergone inferior rectus recession, were retrospectively analyzed. Eighteen patients were males and 6 were females, with ages ranging from 28 to 66 years （mean 47.8 ±10.7 years）. After inferior rectus recession with dissection along the muscle as far as or more than 20 mm from its insertion, the fibers of the capsulopalpebral head （CPH） were isolated and reattached to the insertion point of the inferior rectus. Results The inferior rectus muscle recession ranged from 2.5 mm to 8.0 mm （mean 5.31±1.16 mm）. Five patients showed a slight lower eyelid retraction after surgery. Two patients had a little inferior scleral visible with no change in the size of the eyelid. No patients demonstrated other lower eyelid changes. The surgical management did not affect the results of the strabismus correction. Conclusion When the inferior rectus muscle is sufficiently dissected from the lower eyelid with CPH isolation and reattached to the insertion point of the inferior rectus, it can effectively prevent lower eyelid retraction after inferior rectus muscle recession in patients with thyroid-associated ophthalmopathy.

关 键 词：眼睑退缩 下直肌后退 GRAVES眼病 斜视 手术 

分 类 号：R779.6[医药卫生—眼科]