颞肌束移位术在下睑退缩患者治疗中的应用  

Clinical study of temporal muscle transfer for treatment of lower eyelid retraction

作　　者：林启 孙铁 刘康成 黎彪 徐晓玮 朱佩文[1] 闵幼兰 石文卿 袁晴[1] 邵毅[1] LIN Qi;SUN Tie;LIU Kangcheng;LI Biao;XU Xiaowei;ZHU Peiwen;MIN Youlan;SHI Wenqing;YUAN Qing;SHAO Yi(Department of Ophthalmology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China)

机构地区：[1]南昌大学第一附属医院眼科,江西省南昌市330006

出　　处：《眼科新进展》2020年第3期239-242,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号81660158);江西省自然科学基金重大项目(编号2016ACB21017);江西省青年科学基金(编号20151BAB215016,20161BAB215198);江西省重点研发项目(编号20151BBG70223,20181BBG70004);江西省杰出青年人才计划(编号S2019RCQNB0259);江西省学位与研究生教育教学改革研究项目(编号JXYJG-2018-013);江西省基层卫生适宜技术“星火推广计划”项目(编号20188003);江西省卫计委科技计划面上项目(编号20175116);江西省卫计委中医药科技计划项目(编号2018A060)。

摘　　要：目的对比观察颞肌束移位术在下睑退缩患者中的治疗效果。方法选取2016年8月至2018年8月在南昌大学第一附属医院眼科确诊为下睑退缩的患者32例(32眼),随机分为两组,各16例(16眼),A组行颞肌束移位术,B组行内眦开大术。分别于术前、术后1周、术后1个月对患者行最佳矫正视力、浅点状上皮糜烂、突眼数、眼表症状评分、睑板腺相关指标和OSDI评分、泪液分泌试验、角膜荧光素染色评分的测定。结果术后1周与术前相比,A、B两组疼痛、眼红和流泪症状均明显改善,症状评分差异均有统计学意义(均为P<0.05)。术后1个月,除B组干涩症状未见明显好转外,A、B两组其余眼部症状评分均较术前明显降低(均为P<0.05)。与B组相比,A组术后1个月时眼部干涩、疼痛、异物感、烧灼感和流泪症状缓解更为明显,各症状评分差异均有统计学意义(均为P<0.05)。术后1个月,两组眼部OSDI评分、泪液分泌试验、角膜荧光素染色评分均较术前明显改善(均为P<0.05)。术后1个月,A组角膜荧光素染色评分为(0.9±0.4)分,较B组的(1.6±0.6)分降低更明显,差异有统计学意义(P<0.05)。结论对于下睑退缩患者,颞肌束移位术疗效显著优于内眦开大术,是更为理想的方法。Objective To investigate the curative efficacy of temporal muscle transfer for patients with lower eyelid retraction.Methods Thirty-two patients(32 eyes)with lower eyelid retraction diagnosed in Ophthalmology Department of the First Affiliated Hospital of Nanchang University from August 2016 to August 2018 were selected,and randomly divided into two groups,16 cases(16 eyes)in each group.Patients in group A underwent temporal muscle transfer,and those in group B underwent medial canthoplasty.The best corrected visual acuity,superficial punctate epithelial erosions,number of exophthalmia eyes,ocular surface symptom score,tarsal gland related index,ocular related index,OSDI score,Schirmer test and corneal fluorescein staining(CFS)score were measured before operation,1 week and 1 month after operation.Results One week after operation,the symptoms of ocular pain,redness and tears in group A and B were significantly improved compared with those before operation(both P<0.05).One month after operation,except for dry eye symptoms in group B,the other ocular symptoms in group A and B improved significantly compared with those before operation(all P<0.05).Compared with group B,the symptoms of dry eye,ocular pain,foreign body sensation,burning and tearing symptoms obviously relieved in group A at 1 month after operation(all P<0.05).One month after operation,OSDI score,Schirmer test score and CSF score in both two groups obviously improved compared with those before operation(all P<0.05).One month after operation,CSF score was 0.9±0.4 in group A,obviously lower than 1.6±0.6 in group B,and the difference was statistically significant(P<0.05).Conclusion For the patients with lower eyelid retraction,temporal muscle transfer is a better and safer method than medial canthoplasty.

关 键 词：下睑退缩 颞肌束移位术 内眦开大术 

分 类 号：R777.1[医药卫生—眼科]