先天性重度上睑下垂筋膜鞘悬吊联合上睑提肌缩短术的治疗效果  

Clinical efficacy of conjoint fascial sheath suspension combined with levator muscle shortening for congenital severe blepharoptosis

作　　者：喻静文 张丹娜 耿闫 赵文嘉 胡卫群 Yu Jingwen;Zhang Danna;Geng Yan;Zhao Wenjia;Hu Weiqun(Department of Postgraduate Training Base,Xiaogan Central Hospital of Jinzhou Medical University,Xiaogan 432100,China;Department of Ophthalmology,Xiaogan Central Hospital,Wuhan University of Science and Technology,Xiaogan 432100,China)

机构地区：[1]锦州医科大学孝感市中心医院研究生培养基地,孝感432100 [2]武汉科技大学附属孝感市中心医院眼科,孝感432100

出　　处：《中华眼外伤职业眼病杂志》2023年第3期168-173,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：孝感市自然科学计划项目(XGKJ2021010033)。

摘　　要：目的探讨筋膜鞘悬吊联合上睑提肌缩短术治疗先天性重度上睑下垂的效果。方法随机对照研究。收集孝感市中心医院2020年2月至2022年4月先天性重度上睑下垂46例(74只眼)随机分为两组:研究组24例(39只眼)行筋膜鞘悬吊联合上睑提肌缩短术;对照组22例(35只眼)行额肌瓣悬吊术。术后随访3个月,观察两组术后上睑缘角膜映光距离(MRD1)、眼睑闭合不全程度、上睑回退量及矫正情况。结果两组患者随访各时间点MRD1、眼睑闭合不全程度、上睑回退量相比差异均有统计学意义(均P<0.05)。研究组术后1和3个月MRD1[(4.32±0.16)mm、(4.28±0.17)mm]高于对照组[(4.21±0.14)mm、(4.07±0.18)mm](t=3.29、5.27,P=0.001,<0.001)。研究组术后7 d、1和3个月眼睑闭合不全程度[(1.40±0.27)mm、(0.81±0.23)mm、(0.30±0.15)mm]均低于对照组[(2.32±0.33)mm、(1.27±0.33)mm、(0.49±0.14)mm](t=-13.07、-8.00、-5.79,均P<0.001)。研究组术后7 d、1和3个月上睑回退量[(0.24±0.16)mm、(0.39±0.15)mm、(0.23±0.14)mm]均低于对照组[(0.34±0.13)mm、(0.51±0.23)mm、(0.39±0.13)mm](t=-2.83、-2.69、-5.03,均P<0.001)。研究组术后矫正率为97.43%(38/39)高于对照组80.00%(28/35),差异有统计学意义(P<0.05)。结论筋膜鞘悬吊联合上睑提肌缩短术和额肌瓣悬吊术对先天性重度上睑下垂均有良好的矫正效果,但筋膜鞘悬吊联合上睑提肌缩短术能更好地改善上睑下垂程度,提高术后矫正率。Objective To investigate the efficacy of fascial sheath suspension combined with levator muscle shortening in the treatment of congenital severe blepharoptosis.Methods This was a prospective random control study.A total of 74 eyes of 46 cases with congenital severe blepharoptosis from Feb.2020 to Apr.2022 in Xiaogan Central Hospital were included and all cases were randomly divided into two groups.In the study group 39 eyes of 24 cases received fascial sheath suspension combined with levator muscle shortening and in the control group 35 eyes of 22 cases received frontal muscle flap suspension.Postoperative follow-up was 3 months to observe the Margin-reflex distance 1(MRD1),degree of eyelid closure opacification,amount of upper lid regression,and correction situation in both groups.Results There were statistically significant differences in MRD1,degree of eyelid closure opacification,and amount of upper lid regression between the two groups at every follow-up time points(all P<0.05).At 1 and 3 months after surgery,the MRD1 in the study group[(4.32±0.16)mm,(4.28±0.17)mm]was higher than that in the control group[(4.21±0.14)mm,(4.07±0.18)mm](t=3.29,5.27;P=0.001,<0.001).At 7 days,1 and 3 months after surgery,the degree of eyelid closure opacification in the study group[(1.40±0.27)mm,(0.81±0.23)mm,(0.30±0.15)mm]was lower than that in the control group[(2.32±0.33)mm,(1.27±0.33)mm,(0.49±0.14)mm](t=-13.07,-8.00,-5.79;all P<0.001).At 7 days,1 and 3 months after surgery,the amount of upper lid regression in the study group[(0.24±0.16)mm,(0.39±0.15)mm,(0.23±0.14)mm]was lower than that in the control group[(0.34±0.13)mm,(0.51±0.23)mm,(0.39±0.13)mm](t=-2.83,-2.69,-5.03;all P<0.001).The postoperative correction rates of the study group(97.43%,38/39)was higher than that of the control group(80.00%,28/35)(P<0.05).Conclusion Fascial sheath suspension combined with levator muscle shortening and frontal muscle flap suspension have good correction effects on congenital severe ptosis,but fascial sheath suspension comb

关 键 词：眼睑下垂 动眼肌 腱膜 

分 类 号：R779.6[医药卫生—眼科]