额肌瓣与提上睑肌腱膜瓣吻合矫正重度上睑下垂

目的：探讨额肌瓣和提上睑肌腱膜瓣吻合术矫正重度上睑下垂的疗效。方法：对36例（43眼）重度先天性上睑下垂患者行额肌瓣和提上睑肌腱膜瓣吻合矫正术,术后随防3个月～2年,平均13个月。结果：矫正良好31例,矫正尚可5例,无矫正不良者。结论：额肌瓣与提上睑肌腱膜瓣吻合术矫正重症上睑下垂较传统单纯额肌瓣悬吊术操作简单,损伤小,并发症少,手术成功率高,更符合生理解剖特点,矫正重症上睑下垂安全可靠。     

眶隔筋膜瓣及提上睑肌与额肌瓣吻合悬吊矫正重度上睑下垂

目的：研究利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣悬吊矫正重度上睑下垂的临床效果。方法：术中切开眶隔,形成蒂在睑板上缘的眶隔筋膜瓣,在眉部分离形成额肌瓣,将这两瓣与提上睑肌腱膜重叠缝合固定,建立与额肌的连接,悬吊上睑并矫正下垂畸形。结果：采用此方法对27例35侧重度上睑下垂的眼睑进行了治疗,随访3～6个月,其中31侧眼睑取得了满意的效果,额肌收缩时患睑睁大两侧眼裂大小对称,睑缘位置正常,外形自然,睑缘弧度及重睑外形满意。矫正不足4侧,后行二次手术而修复。结论：利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣重叠吻合悬吊矫正重度上睑下垂,上睑悬吊牢固,不易复发,保持了眼睑的原有结构,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的上睑提肌腱膜瓣悬吊和单纯额肌悬吊的方法。     

提上睑肌腱膜瓣联合额肌瓣悬吊治疗先天性上睑下垂畸形

目的：研究改良的提上睑肌腱膜瓣联合额肌悬吊治疗重度先天性上睑下垂的，临床治疗效果。方法：自2005年8月～2008年3月，笔者采用该方法矫治重度先天性上睑下垂患者20例，年龄6～27岁，单侧8例，双侧12例。手术形成蒂在睑板上缘的的提上睑肌腱膜瓣，并与额肌建立连接，模拟提上睑肌上提眼睑的功能。结果：本组患者20名，术后随访6个月，15例矫正效果良好，4例好转，1例无效，部分患者出现不同程度的眼睑闭合不全，术后2-3月恢复。无明显并发症发生，效果良好。结论：与单纯的额肌悬吊不同，该术式形成的上提眼睑系统更符合生理结构，并且具备动态矫正效果，手术后外形满意、功能良好。     

上睑提肌腱膜瓣与额肌瓣悬吊缝合矫正重度上睑下垂

目的：为克服单纯额肌瓣悬吊治疗重度上睑下垂存在的缺点，更好地保持眼睑的原有结构，使矫治后的眼睑符合其生理和生物力学特点。方法：在患侧分别形成额肌瓣和上睑提肌腱膜瓣，将两瓣相互重叠缝合固定，起到悬吊上睑、矫正下垂畸形的作用。结果：利用该方法对46例52侧重度上睑下垂的眼睑进行了治疗，随访患者24例，28侧眼睑，其中23侧眼睑取得了较满意的治疗效果，患睑睁大时额肌收缩两侧眼裂大小基本对称，可达到正常睑缘的位置。睑缘弧度及重睑线外形满意。5侧眼睑矫正不完全，仍有一定程度的下垂。结论：术者认为利用无功能的上睑提肌形成腱膜瓣与传统的额肌瓣重叠悬吊缝合，保持了眼睑的原有结构，具有上睑悬吊牢固、不易复发、睑缘和重睑线弧度及外观满意的优点，对畸形矫正效果良好，优于传统的单纯额肌悬吊术。     

宽大额肌瓣悬吊治疗重度先天性上睑下垂

探讨宽大额肌瓣悬吊术矫正重度先天性上睑下垂的临床效果.方法:对34例(52眼)重度先天性上睑下垂患者进行宽大额肌瓣悬吊术治疗,观察分析术中、术后并发症,随访观察术后效果.结果:术后随访3个月～2年效果满意,睑缘外形自然,闭合自如,无复发和并发症.结论:宽大额肌瓣血供非富,悬吊牢靠,适用于重度上睑下垂的治疗.     

提上睑肌腱膜眶隔膜复合瓣额肌吻合术治疗重度上睑下垂

对于重度上睑下垂需要手术矫治者，临床一般首选借助额肌力量的矫正术式，其方法颇多，各有优点和不足。我们采用提上睑肌腱膜眶隔膜复合瓣和额肌吻合术方法，矫正30例重度上睑下垂患者收到了满意效果。现总结讨论如下。     

改良额肌瓣矫治重度上睑下垂

目的 探讨改良额肌筋膜瓣悬吊矫治重度上睑下垂的术式.方法 针对其操作较复杂损伤额肌瓣生理功能而影响手术效果的特点,改良形成了额肌眼轮匝肌瓣直接缝合于睑板上缘的提上睑肌腱上联合手术.结果 本组36例,51只眼,术后随访了25例1～2年,33只眼矫治满意,平视时上睑缘在瞳孔上缘,重睑弧线自然流畅,睑裂闭合良好.2只眼矫治略显不足,无并发症出现.结论 额肌眼轮匝肌瓣,提上睑肌联合手术,操作简易,创伤小,保证了肌瓣的收缩功能,维持了上睑原有的生理结构状态,使上睑缘整齐自然,无成角畸形、内外翻等并发症出现.     

提上睑肌腱膜瓣与额肌腱膜瓣悬吊在重度上睑下垂中的应用

目的：为了保持了提上睑肌的原位附着，使矫治后的上眼睑弧度自然、更接近生理要求.方法：在患侧上睑分离制作提上睑肌腱膜瓣和额肌腱膜瓣，将二瓣重叠缝合.结果：对34例（48只）重度上睑下垂进行矫治.其中，对26例患者，30只眼随访，除4例矫治不足，其余均可达到睁眼时双眼基本对称，睑缘弧度正常.结论：本方法保持了提上睑肌在睑板上的原有附着结构和生理功能，悬吊牢固，睑缘和重睑弧度满意.省去眉上切口，简化步骤，美容效果明显。     

协同开睑术矫治上睑下垂的临床研究

克服以往手术单肌负荷过大,提肌力＜５ｍｍ者提肌手术出现矫正不足和额肌手术后有明显兔眼及上睑迟滞等现象,并使术后开睑功能更接近生理。改变以往治疗中单一利用额肌或提上睑肌矫治的方法,采用提上睑肌折叠瓣—额肌协同开睑矫正重度上睑下垂。本组３８例５３只眼重度上睑下垂,经提上睑肌折叠瓣额肌吻合术矫治,疗效满意。协同开睑术矫治重度上睑下垂比单一提上睑肌或额肌手术更为合理。     

提上睑肌腱膜瓣──额肌吻合术治疗重度上睑下垂（附30例报告）

本文报告了作者采用提上睑肌腱膜瓣──额肌吻合术治疗重度上睑下垂３０例（３６只眼），手术后上睑下垂矫正和美容效果均非常满意。介绍了该手术主要方法和步骤。讨论了手术的机理、优点和注意事项等。     

眶隔筋膜瓣与额肌瓣重叠吻合悬吊矫正重度上睑下垂

目的:为更好地保持眼睑的原有结构,符合其生理和生物力学特点,探索一种治疗重度上睑下垂的新方法。方法:术中于眼轮匝肌下分离并显露眶隔筋膜至近眶上缘处,在眶隔表面设计一蒂位于睑板上缘的梯形瓣,按设计线全层切开眶隔,形成眶隔筋膜瓣。在患侧眉上形成一额肌瓣,将两瓣相互重叠缝合固定,上提睑缘至角膜上缘处,起到悬吊上睑、矫正下垂畸形的作用。结果:作者利用该方法对22例26侧重度上睑下垂的眼睑进行了治疗,随访病人17例,19侧眼睑,其中16侧眼睑取得了满意的效果,额肌收缩时患睑睁大两侧眼裂大小对称,可达到正常睑缘的位置。睑缘弧度及重睑外形满意。3侧眼睑矫正不完全,经二次手术修复得以矫正。讨论:作者认为利用眶隔筋膜形成的组织瓣与额肌瓣重叠吻合悬吊缝合,保持了眼睑的原有结构,具有手术损伤轻,上睑悬吊牢固,不易复发,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的单纯额肌悬吊术和上睑提肌腱膜瓣悬吊的方法。     

Strategies for Simultaneous Double Eyelid Blepharoplasty in Asian Patients With Congenital Blepharoptosis

Background Most patients with blepharoptosis prefer to undergo a double eyelid operation and a ptosis repair simultaneously to achieve the optimal cosmetic and functional result. However, it is difficult to achieve symmetry in patients with blepharoptosis. Methods Surgery was performed on the levator aponeurosis or frontalis muscle to correct blepharoptosis while double eyelid surgery was simultaneously performed to correct blephroptosis in 264 patients over the past 15 years. This report describes 39 representative cases of unilateral congenital blepharoptosis and 30 representative cases of bilateral congenital blepharoptosis. In cases of unilateral ptosis with good or fair levator function, a levator resection or plication was performed, and the position of the lid margin was adjusted to 1 to 2 mm below the upper limbus. Cases of severe unilateral blepharoptosis were corrected by frontalis muscle flap, orbicularis oculi muscle flap, or frontalis myofacial flap, and the height of the double eyelid was created to be 1 to 2 mm less than the height on the normal side. The position of the lid margin was adjusted to the level of the superior limbus, and the height of the lid crease of the ptotic eye was determined to be according to that on the nonptotic side. For bilateral ptosis patients with equal levator function, the height of the double eyelid was designed symmetrically. Bilateral blepharoptosis patients with unequal levator muscle function should have the double eyelids on both sides created the same as in normal cases, and they must be grafted in proportion to the severity of the blepharoptosis. If the results are unpredictable, the two-stage operation should be performed. Results Only 30% of the eyelids in this study were perfectly symmetric after the blepharoptosis operation, with 70% asymmetric. These 70% showed good symmetry immediately after surgery, but asymmetry occurred 6 months after the operation. Conclusion In blepharoptosis surgery, different techniques for double eyelids must be applied according to the method of ptosis correction used. Usually, the height of the double eyelid on the ptotic side should be a little less than the normal double eyelid height on the nonptotic side. However, it is difficult to achieve symmetric double eyelids in blepharoptosis patients.     

应用改良的额肌瓣转移矫正重度上睑下垂

目的:探讨应用改良的额肌瓣转移治疗重度上睑下垂的手术方法及临床价值。方法:沿重睑线切开皮肤,剪除部分眼轮匝肌,显露睑板;作皮下和额肌及额肌与骨膜间分离,于额肌与眼轮匝肌交界处提起并横行切断额肌,与其内侧斜向内上方弧形切开肌瓣达眉上1.5cm,外侧向外上方斜形剪开,注意不要超出眉毛平面0.5cm,形成不等边、扇形的额肌瓣,分别以内、中、外3点与睑板上缘作褥式缝合固定。结果:本组22例,切口均一期愈合,其中16例获得随访,上睑上提功能良好,重睑线自然、对称,“兔眼”征轻微,效果满意。结论:此法对额肌损伤小,不等边、呈扇形的额肌瓣使肌肉蒂部增宽,增加了额肌瓣的收缩力,适用于重度上睑下垂。     

眶隔筋膜瓣与额肌瓦合固定矫正重度上睑下垂

目的：研究利用眶隔筋膜瓣与额肌瓦合固定矫正重度上睑下垂的临床效果。方法：术中于眼轮匝肌下分离并显露眶隔至近眶上缘处,在眶隔表面设计一蒂位于睑板前面的梯形瓣。在眉上缘切开皮肤,于眼轮匝肌表面锐性游离至近眶上缘区、横形剪开肌层1cm宽,形成隧道,将眶隔筋膜组织瓣经隧道上提眉区额肌表面、与额肌瓦合固定。结果：作者利用该术式对15例19只眼、其中5只眼为复发性病例进行治疗,临床效果满意,两眼外形对称,睑缘弧线好、重睑自然,无睑内外翻、睑球分离、闭眼不全现象。6个月随访12只眼,1只眼好转,11只眼矫正效果保持良好状态。结论：作者利用眶隔筋膜组织瓣与活动度较大的眉部额肌瓦合固定,具有固定牢固、眉部额肌无损伤、肌力长久、活动范围大、不易复发等优点,而且睑缘弧度好、重睑自然、并发症少,优于传统的额肌悬吊术。     

提上睑肌-额筋膜瓣吻合治疗重度上睑下垂

目的：为重度上睑下垂的治疗提供一个效果理想、外观满意的方法。方法：自2000年1月至2002年12月采用提上睑肌-额筋膜瓣吻合术治疗重度上睑下垂16例(20眼)，并对术后效果进行了随访观察。结果：本组病例术后效果良好，创伤小，医患双方均感满意。术后对其中的12例进行了半年至一年的随访，远期效果满意。结论：提上睑肌-额筋膜瓣吻合术适用于重度上睑下垂．上睑提肌肌力≤4mm的患者。     

额肌瓣悬吊术治疗儿童重度上睑下垂

目的：探讨额肌瓣悬吊术矫正1～5岁儿童重度上睑下垂的临床效果。方法：对我院1998年5月至2002年1O月收治的45例(60眼)先天性重度上睑下垂患儿的临床资料进行分析。按照重睑成形术原则设计重睑线，在眶上缘额肌附着处制作一宽约2．O～2．5cm的额肌瓣，固定在睑板上。结果：除2例(2眼)轻度欠矫外，其余58眼均获得了满意效果，双重睑形成自然美观，无畸形。结论：此方法操作简单，效果满意，对额肌损伤小，悬吊力量强，是矫正儿童先天性重度上睑下垂较理想的方法。     

Technique for blepharoptosis correction using double-breasted orbicularis oculi muscle flaps

BACKGROUND: The technique that uses the orbicularis oculi muscle flap to elevate the upper eyelid has become a popular surgical alternative for blepharoptosis. This method is especially effective in cases of severe blepharoptosis with poor levator muscle function. In this technique, the superiorly based orbicularis oculi muscle flap (which is connected to the frontalis muscle anatomically) is advanced and attached to the tarsal plate, thus enabling dynamic elevation of the upper eyelid. However, a temporary period of lagophthalmos occurs with the original method. Although the problem is temporary, it typically lasts 2 to 6 months and may lead to serious eye emergencies. METHODS: We describe a modification that eliminates lagophthalmos, which is the main drawback of the original technique. Two orbicularis oculi muscle flaps are created, one superiorly based and one inferiorly based. The inferiorly based flap corresponds to the strip of pretarsal orbicularis oculi that is considered "excess" and is discarded in other methods. Our aim with this modified technique is to preserve as much of the pretarsal part of the orbicularis oculi muscle as possible, and thus enable immediate tight eyelid closure postoperatively and achieve dynamic, powerful eyelid-opening action. RESULTS: We have used this technique in 7 patients (11 eyelids total) during the past 5 years and have achieved favorable results. All 11 operated eyelids showed immediate tight closure postoperatively, as well as dynamic, powerful eyelid-opening action. CONCLUSION: This operation is a good alternative for patients with severe ptosis who have insufficient levator function and for cases that have recurred after operations with other methods. Local native tissues are used and dynamic correction is achieved with a single incision. The need for intensive eye care is eliminated and there is less risk of corneal damage in the early postoperative period. Above all, this technique yields predictable eyelid-opening action.     

联合筋膜鞘+提上睑肌复合瓣悬吊矫治先天性重度上睑下垂

目的:探讨联合筋膜鞘+提上睑肌复合瓣悬吊治疗先天性重度上睑下垂的临床效果。方法:选取2017年9月至2019年3月于河北省眼科医院住院的先天性重度上睑下垂患者205例248眼,随机分为三组,分别应用联合筋膜鞘+提上睑肌复合瓣悬吊术(CFS+L复合瓣悬吊组)、联合筋膜鞘悬吊术(单纯CFS悬吊组)、额肌瓣悬吊术(额肌瓣悬吊组)加以矫正;随访6个月,比较三组患者正矫率、上睑回退率、上睑活动范围及眼睑闭合不全情况、并发症发生率和患者满意度。结果:CFS+L复合瓣悬吊组较其他两组有更高的正矫率,CFS+L复合瓣悬吊组及单纯CFS悬吊组术后较额肌瓣悬吊组有更好的上睑活动度、眼睑闭合不全状态较轻、并发症发生率较低,患者满意度较高;CFS+L复合瓣悬吊组较单纯CFS悬吊组术后上睑回退率低、具有更好的稳定性;差异均有统计学意义(P<0.05)。结论:联合筋膜鞘+提上睑肌复合瓣悬吊术矫正先天性重度上睑下垂具有治愈率高、效果更加稳定的特点,是一种符合眼睑活动生理学特点的动态术式。     

重睑切口额肌筋膜瓣拉下式悬吊矫治先天性重度上睑下垂

目的 探讨重睑切口额肌筋膜瓣拉下式悬吊术矫治先天性重度上睑下垂的临床效果.方法 2000年1月～2006年4月,采用重睑切口额肌筋膜瓣拉下式悬吊术式矫治先天性重度上睑下垂患者45例,男性24例,女性21例,年龄5岁～33岁,平均19.5岁.结果 本组45例患者,术后1周矫正良好37例,基本矫正8例,无矫正不足患者.所有患者术后早期均存在眼睑闭合不全,都于6个月内消失.无明显并发症发生.随访6个月～4年,效果良好.结论 重睑切口额肌筋膜瓣拉下式悬吊术矫治先天性重度上睑下垂,效果确切可靠.     

A Modified Technique Combining Excision of the Levator Muscle and Tarsus for Blepharoptosis in Asians: A 6-Year Experience with 116 Cases

Background  

In patients with blepharoptosis, the function of levator muscle is insufficient or completely absent, causing blepharoptosis in various degrees. For mild or moderate blepharoptosis, levator advancement or resection is commonly performed. However, in severe cases, undercorrection results and recurrence often occur even a great length of levator muscle is resected. Because the levator muscle makes the upper eyelid move in a physiologic direction, exerting the function of residual levator muscle is still a more preferred approach for correction of blepharoptosis. This study combined tarsus resection with levator resection. The resected tarsus can offset the amount of the levator excised, making this technique applicable for severe cases.