上睑提肌缩短术治疗上睑下垂的临床体会

上睑提肌缩短术是目前治疗上睑下垂的手术方法之一。根据多年临床观察,该手术方法比较理想可靠。作者自1999年5月至2000年10月25例30眼上睑下垂患者采用上睑提肌缩短术进行治疗,疗效确切,现报告如下。 一、资料与方法 1.临床资料:本组病例共25人、30只眼。其中男15例,女     

上睑解剖结构及其在上睑下垂矫正术中的意义

目的　熟悉上睑解剖结构,进一步提高上睑下垂的矫治疗效。 方法 近3年共治疗132例轻中度上睑下垂患者,大部分采用上睑提肌缩短或者折叠的手术方式,术中精细解剖上睑提肌肌瓣,注意勿损伤动脉弓、泪腺等结构,Whitnall韧带视情况予以切断。再按照上睑下垂的程度进行肌瓣缩短或者折叠。 结果　大部分病例术后矫正效果满意,3例患者矫正不足,1例患者矫正过高,2例患者重睑线不完全对称,经过进一步处理效果满意。 结论　按照解剖结构精细分离上睑提肌肌瓣,按照上睑下垂程度估测上睑提肌缩短的距离是成功进行上睑下垂矫正的关键。     

提上睑肌缩短与额肌瓣悬吊治疗中重度上睑下垂的临床治疗观察

目的探讨并比较提上睑肌缩短术与额肌瓣悬吊术治疗中重度上睑下垂的的临床疗效。方法选取我院在2002年1月~2014年1月收治的中重度上睑下垂患者50例,随机分为A组和B组,A组行提上睑肌缩短术,B组行额肌瓣悬吊术,并比较两组疗效。结果A组中度患者满意度明显大于重度患者(<0.05),B组重度患者满意度明显大于中度患者(<0.05)。结论提上睑肌缩短术较适应用于中度患者,额肌瓣悬吊术较适用于重度患者。     

先天性睑下垂三种术式的疗效比较

目的 对46例先天性上睑下垂分别采用了三种不同手术方法，对其进行了比较分析。方法 A组：单纯上睑提肌缩短术；B组：改良额肌GORE线悬吊术；C组：额肌瓣作上睑动力再造悬吊。观察术后上睑形态和功能的矫正效果及并发症的发生。结果 术后达Ⅰ级和Ⅱ级疗效者占全部病例数的89%,并发症的出现率为90％。结论 先天性上睑下垂矫正术应根据受术者的病情程度，选择合术式，提高疗效并发症。     

睑板部分切除的提上睑肌缩短术在中重度上睑下垂治疗中的应用

笔者采用睑板部分切除的提上睑肌缩短矫治上睑下垂12例，结果满意，报道如下。 1临床资料 1．1一般资料 本组12例，年龄18～38岁，其中男性7例，女性5例；单侧8例，双侧4例；中度6例，重度6例；患者都有提上睑肌肌力存在，约5—10mm，Bell氏征阳性。     

改良额肌腱膜与硬脑膜额肌悬吊术治疗重度先天性上睑下垂

目的：探讨改良额肌腱膜悬吊术和异体硬脑膜额肌悬吊术治疗儿童重度上睑下垂的疗效。方法：应用改良额肌腱膜悬吊术治疗上睑下垂23例（31眼），应用异体硬脑膜额肌悬吊组术治疗22例（30眼），所有病例上睑下垂均≥4mm，将两组结果进行对比分析。结果：改良额肌悬吊组：满意25眼，良好6眼，未矫正0眼。无复发。异体硬脑膜额肌悬吊组：满意23眼，良好7眼，未矫正0眼。复发2例。统计学处理两组疗效无明显差异。结论：改良额肌腱膜悬吊术治疗重度上睑下垂，手术操作简便，疗效可靠，可作为重度上睑下垂首选的治疗方法。     

应用眶隔筋膜瓣与额肌瓣治疗重度上睑下垂的美容学意义探讨

目的　探讨一种矫治重度上睑下垂的美容有效方法。 方法　术中制作一蒂在眶隔筋膜与提上睑肌结合部之上的眶隔筋膜瓣,在眉区分离额肌筋膜瓣,将额肌筋膜瓣插入眶隔筋膜与提上睑肌之间,三瓣重叠牢固缝合,悬吊上睑矫正上睑下垂。 结果　采用此法对12例12侧重度上睑下垂进行治疗,随访6~18个月,平均1年,其中, 10只眼睛满意,1只好转,1只眼睛上睑外侧偏低重新修复后正常。 结论　利用眶隔筋膜、额肌、提上睑肌腱膜三瓣吻合术矫正重度上睑下垂,上睑悬吊牢靠,眼部上提接近生理,睑缘弧度自然,达到美容治疗双重功效,是一种可以推广的美容方法。     

额肌瓣转位治疗重度上睑下垂

额肌由面神经的额支支配 ,利用额肌为动力的额肌瓣法是目前治疗重度上睑下垂较理想的一种方式。近年笔者采用单一重睑切口额肌瓣法矫正需二次修复的重度上睑下垂 9例 ,报道如下。1　应用解剖额肌起自帽状腱膜 ,向前下方止于眉部皮肤 ,部分肌纤维和眼轮匝肌相互交织 ,内侧有部分     

结膜皮样脂肪瘤术后上睑下垂的临床探讨

目的 探讨结膜皮样脂肪瘤术后上睑下垂发生的原因和治疗方法.方法 对2002年3月至2008年6月在我院行结膜皮样脂肪瘤行切除术的23例患者进行回顾性分析.结果 14例术后无上睑下垂发生;术后9例发生上睑下垂.其中,提上睑肌肌力为4～10 mm的轻中度下垂5例,应用提上睑肌修补及缩短术治疗;提上睑肌肌力为0～3mm的重度上睑下垂4例,采用额肌瓣悬吊术矫正.上睑下垂术后随访3～6个月,9例上睑下垂完全矫正,效果满意.结论 结膜皮样脂肪瘤术中提上睑肌腱膜的损伤是术后上睑下垂发生的主要原因,应用提上睑肌手术以及额肌瓣悬吊术治疗上睑下垂,可获得满意效果.     

超声生物显微镜在上睑下垂手术术式选择中的应用

目的 探讨一种比较精确的提上睑肌厚度的测量方法,从而对上睑下垂的手术治疗方法给与更为准确的指导.方法 随机选择先天性单侧或双侧上睑下垂患者,并将所有眼分为正常、轻度、中度、重度四组,通过超声生物显微镜对各种程度上睑下垂患者的提上睑肌厚度进行测量,再与传统的上睑下垂分级方法进行比较.结果 本组病例共42人,经测量四组平均值分别为0.478±0.037mm;0.383±0.038mm;0.381±0.042mm;0.339±0.035mm.统计学处理用单因素方差分析法,结果显示利用超声生物显微镜术前检查上睑提肌厚度各组间有明显差异(P相似文献   

眼轮匝肌缩短联合下睑缩肌修复在退行性下睑内翻的疗效观察

目的 观察眼轮匝肌缩短联合下睑缩肌修复在退行性下睑内翻的临床效果。方法 选取2014年7月~2017年1月就诊于我科的退行性下睑内翻患者120例（134眼）,随机分为A、B两组。A组48例（58眼）采用单纯眼轮匝肌切除术,B组72例（76眼）采用眼轮匝肌缩短联合下睑缩肌修复。观察两组患者术后1周、1个月、6个月、1年的术后效果及并发症情况。结果 两组患者术后1周、1个月内矫正情况比较,差异无统计学意义（P＞0.05）,但术后6个月、1年随访可见,B组患者矫正有效率分别为97.21%和100.00%,优于A组的86.21%和72.42%,差异具有统计学意义（P＜0.05）。两组患者均未发生严重并发症。结论 眼轮匝肌缩短联合下睑缩肌修复治疗退行性下睑内翻,解决了下睑水平和垂直方向松弛,并将眼轮匝肌固定于睑板下缘,避免眼轮匝肌产生骑跨,疗效可靠、稳定。     

260例眼袋术中观测及整复方法的探讨

目的：针对不同类型眼袋，探讨相应的手术方法。方法：回顾性分析1995年1月－2002年7月手术治疗的160例眼袋患临床资料，将国人眼袋分为3种类型。术中不仅去除部分眼轮匝肌、眶隔脂肪、皮肤，而且对眼轮匝肌、眶隔筋膜等作了实体观测。结果：I、Ⅲ型眼袋，眼轮匝肌较窄，厚度增加；Ⅱ型眼袋，眼轮匝肌较宽、薄。眶隔筋膜于中央区最薄弱，但未见“眶肌筋膜韧带”。260例眼袋整形均获得了满意的结果。结论：根据眼袋类型，辨析其解剖学成因。去除眼轮匝肌、眶膈脂肪、收紧眶区皮肤是眼袋整形的基础。     

Cloning of a DNA sequence unique to Clostridium botulinum group I by selective hybridization.

Nucleic acid sequences were isolated from a strain of Clostridium botulinum type A by a selective hybridization method known as deletion enrichment. Nontoxigenic C. sporogenes was used to produce a C. botulinum type A sequence-enriched library. A probe, pCBM44, which showed specific hybridization to a 4.0-kb HindIII fragment present in all of the C. botulinum type A strains tested was isolated, and there was no hybridization to any strains of C. sporogenes. Upon further investigation, pCBM44 was found to hybridize to all of the group I proteolytic C. botulinum strains tested (toxin types A, B, and F) but not to hybridize to groups II, III, and IV (toxin types B, C, D, or E). The probe did not cross-react with nine other Clostridium spp. Such a probe, which differentiates between nontoxigenic C. sporogenes and neurotoxigenic C. botulinum group I strains, should prove extremely useful.     

Types and time course of the alterations induced in monkey blink movements by botulinum toxin

The alterations induced in eyelid movement metrics subsequent to unilateral injections of botulinum toxin type A into the orbicularis oculi muscle were studied in chronic alert monkeys using the search coil technique. Botulinum toxin caused rapid paralysis of blinks in the treated eyelid. The amplitude and peak velocity of blinks generated by this eyelid remained at or below 20% of that of the fellow, untreated eyelid for 10–20 days. Blink amplitude gain increased linearly thereafter, attaining control values by 40–60 days after injection. Recovery of blink peak velocity was slower. The adaptive alterations in blink duration that were observed during the acute phase of toxin paralysis suggest that the mechanisms responsible for blink reflex plasticity may produce bilateral adjustments in eyelid function. Taken together, these data establish a quantitative data base that can be exploited in order to: (1) better understand the neural adaptive mechanisms that operate during eyelid movements and (2) allow quantitative comparisons between current treatment protocols that employ botulinum toxin and protocols that may lead to improvements in the treatment of chronic eyelid spasm (blepharospasm).     

Selective isolation and rapid identification of Clostridium botulinum types A and B by toxin detection.

A simple procedure for rapid identification of Clostridium botulinum type A and B colonies from cultures and stool samples from infants with botulism was devised. The stool samples were directly streaked on C. botulinum isolation medium containing selective inhibitory agents. Typical lipase-positive colonies that appeared within 24 to 48 h were examined for the presence of botulinal toxin by the enzyme-linked immunosorbent assay and conventional mouse toxicity test. The amount of toxin associated with 48-h colonies of stock strains was comparable to that of 96-h broth culture. The quantity of toxin present in a single colony or combination of two was shown to be sufficient for toxin detection by the enzyme-linked immunosorbent assay. Of 42 additional stock strains tested in this manner, 41 (97.5%) were identified as toxigenic C. botulinum type A or B. The remaining one strain also proved to be toxigenic when it was tested as a concentrated cell suspension. This procedure should prove useful for large-scale serological screening of food and clinical specimens.     

A preclinical evaluation of aminopyridines as putative therapeutic agents in the treatment of botulism.

4-Aminopyridine and 3,4-diaminopyridine were evaluated for their abilities to delay the onset of paralysis due to botulinum neurotoxin types A, B, and E. Experiments were done on phrenic nerve-hemidiaphragm preparations excised from mice. At a concentration that produced an enhancement in muscle twitch amplitude, 4-aminopyridine and 3,4-diaminopyridine delayed the onset of paralysis due to botulinum toxin type A. Under the same conditions, the drugs did little to protect tissues against botulinum toxin types B and E. 3,4-Diaminopyridine was also evaluated for its ability to reverse the paralysis due to botulinum toxin. Experiments were done on rat phrenic nerve-hemidiaphragm preparations that had previously been poisoned in vivo. The drug produced transient increases in neuromuscular transmission, with the effect being greater for botulinum neurotoxin type A than for botulinum neurotoxin types B and E. Equivalent types of experiments were done with tetanus toxin. The results with 3,4-diaminopyridine showed that tetanus toxin resembled botulinum toxin types B and E. The data help to clarify the role of aminopyridines as therapeutic agents in the treatment of botulism. They also provide insights into the mechanism of action of clostridial neurotoxins.     

Detection of type A, B, and E botulism neurotoxin genes in Clostridium botulinum and other Clostridium species by PCR: evidence of unexpressed type B toxin genes in type A toxigenic organisms.

We studied the effectiveness of the PCR in detecting the type A, B, and E botulism neurotoxin genes in 209 strains of Clostridium botulinum and 29 strains of other Clostridium spp. All 79 strains that produced type A toxin, 77 strains that produced type B toxin, and 51 organisms that produced type E toxin (46 C. botulinum and 5 C. butyricum) were PCR positive in reactions with primers targeting sequences specific for their respective toxin genes. The PCR for type A toxin was positive for one type B toxin-producing strain that produced a small amount of type A toxin in addition to a large amount of type B toxin. Surprisingly, the type B toxin gene was detected in addition to the type A toxin gene in 43 type A toxin-producing strains, only 1 of which could be shown by bioassay to produce biologically active type B toxin in culture. The type B gene was also detected in two strains of C. subterminale, which were determined to be nontoxigenic by bioassay. While the PCR was sensitive and specific in detecting the neurotoxin genes, the discovery of unexpressed toxin genes indicates that PCR results may not be adequate for establishing type B neurotoxigenicity.     

Detection of Clostridium botulinum type A toxin by enzyme-linked immunosorbent assay with antibodies produced in immunologically tolerant animals.

Immunological tolerance is a state of unresponsiveness to foreign substances (antigens) which can develop in human and animal species as the result of continued exposure to antigens early in life. We utilized this principle for the preparation of antibodies against Clostridium botulinum type A toxin. By selective suppression of the immunological response of rabbits to unwanted antigens and subsequent immunization with a toxoid, we were able to produce a specific type A antitoxin without the need to purify the toxin. Despite cross-reactivity with C. botulinum type B, our type A antitoxin was otherwise specific since it did not react with culture filtrates of nontoxigenic variants of type B, any other C. botulinum type (C, D, E, F, and G), nor with 18 other Clostridium species, including Clostridium sporogenes. Using this antitoxin, we developed a sensitive enzyme-linked immunosorbent assay for detection of C. botulinum type A toxin.