上睑提肌缩短术与联合筋膜鞘悬吊术治疗中重度上睑下垂的效果比较  

Comparison of the efficacy of levator muscle resection and combination of conjoint fascia sheath suspension in the treatment of moderate and severe ptosis

作　　者：曹晶晶 魏星[2] 张秀杰 Cao Jingjing;Wei Xing;Zhang Xiujie(Zhoukou Ophthalmic Hospital,Zhoukou Seventh People′s Hospital,Zhoukou 466002,China;Department of Ophthalmology,Zhengzhou University Second Affiliated Hospital,Zhengzhou 450014,China)

机构地区：[1]周口市眼科医院周口市第七人民医院,周口466002 [2]郑州大学第二附属医院眼科,郑州450014

出　　处：《中华眼外伤职业眼病杂志》2024年第2期149-155,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的比较上睑提肌缩短术(LMR)与联合筋膜鞘悬吊术(CFSS)治疗中重度上睑下垂的效果。方法前瞻性随机对照研究。纳入2020年1月至2022年9月至周口市眼科医院进行中重度上睑下垂治疗的患者66例(97眼),按随机数字表法分为两组,观察组34例(50眼)采用CFSS进行治疗,对照组32例(47眼)采用LMR进行治疗。比较术后两组矫正效果、泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、额肌和提上睑肌肌力水平、并发症。结果两组矫正总有效率分别为观察组92.00%(46/50)、对照组78.72%(37/47),观察组更高(Z=2.28,P=0.023);术后4周BUT[观察组(15.27±3.81)s;对照组(15.66±3.84)s]、SⅠt[观察组(11.63±1.71)mm;对照组(11.69±1.73)mm]水平无明显变化(t=0.51,P=0.617;t=0.17,P=0.864),角膜荧光染色(FL)[观察组(1.20±0.38)分;对照组:(1.77±0.47)分]水平均有明显提升,且对照组的FL水平明显高于观察组(t=6.59,P<0.001);两组患者术后1周、4周的额肌肌力为[观察组(13.14±0.56)、(13.89±0.62)mm;对照组(12.97±0.54)、(13.52±0.55)mm]和提上睑肌肌力[观察组:(8.18±0.59)、(9.39±0.48)mm;对照组(7.56±0.61)、(9.02±0.42)mm],较术前均呈逐渐增加趋势(均P<0.001),且观察组额肌肌力、提上睑肌肌力均高于对照组(均P<0.001);两组患者的并发症发生率分别为16.00%(8/50)和36.17%(17/48),差异有统计学意义(χ^(2)=5.15,P=0.023)。结论CFSS治疗中重度上睑下垂的效果优于LMR,可有效减少角膜损害,提升额肌和提上睑肌肌力。Objective To evaluate the efficacy of levator muscle resection(LMR)and combination of conjoint fascia sheath suspension(CFSS)in the treatment of moderate and severe ptosis.Methods This was a prospective randomized controlled study.Sixty-six patients(97 eyes)who received moderate to severe ptosis treatment in Zhoukou Eye Hospital from Jan.2020 to Sep.2022 were included.All cases were divided into two groups based on random number table method.A total of 34 patients(50 eyes)in the observation group were treated with CFSS,and 32 patients(47 eyes)in the control group were treated with LMR.Postoperative correction effect,tear film break up time(BUT),SchirmerⅠtest(SIt),muscle strength of frontal muscle and levator eyelid muscle,and complications were compared between the two groups.Results The total effective rate of the two groups was 92.00%(46/50)in the observation group and 78.72%(37/47)in the control group,which was significantly higher in the observation group(Z=2.28,P=0.023).At 4 weeks after surgery,there was no significant difference in BUT[observation group(15.27±3.81)s;control group(15.66±3.84)s]or SIT[observation group(11.63±1.71)mm;control group(11.69±1.73)mm]levels(t=0.51,P=0.617;t=0.17,P=0.864),but corneal fluorescence staining(FL)[observation group(1.20±0.38)points;control group(1.77±0.47)points]levels improved significantly,and the FL level in the control group was significantly higher than that in the observation group(t=6.59,P<0.001).The frontal muscle strength of the two groups of patients at 1 and 4 weeks after surgery was[observation group(13.14±0.56),(13.89±0.62)mm;control group(12.97±0.54),(13.52±0.55)mm]and levator palpebrae muscle strength was[observation group(8.18±0.59),(9.39±0.48)mm;control group(7.56±0.61),(9.02±0.42)mm],which showed a gradually increasing trend compared to those before operation(all P<0.001).The strength of the levator palpebrae muscle and the frontal muscle were higher those of the control group(all P<0.001).The incidence of complications in the two groups

关 键 词：缩短术 提肌 上睑 悬吊术 筋膜鞘 下垂 上睑 中重度 

分 类 号：R779.6[医药卫生—眼科]