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.     

额肌筋膜瓣矫正上睑下垂并发症的统计

目的探讨额肌筋膜瓣悬吊术在矫正上睑下垂术后并发症发生的原因及防治措施,提高手术效果。方法对５１３例在住院期间及门诊复查中发现的术后并发症进行病因和防治研究。结果发现术后并发症共１４种并以相应措施防治。结论绝大部分并发症可以防治,额肌筋膜瓣悬吊术矫治完全性上睑下垂的效果可靠。     

额肌筋膜复合体弓状悬吊治疗重度上睑下垂

目的 寻求更佳的治疗重度上睑下垂的手术方法。方法 在手术治疗上睑下垂时，通过制作出完整的额肌、皱眉肌、眼轮匝肌及SMAS复合体，弓形下移悬吊纠正上睑下垂，治疗47例患者，观察近、远期效果。结果 应用额肌筋膜复合体悬吊治疗上睑下垂47例54只眼，术后3个月内有不同程度闭合不全，后逐步好转，6个月闭合自然，外形美观，无复发现象。结论 该方法是一种可靠的治疗上睑下垂的方法，较传统方法更具优越性。     

额肌筋膜瓣矫正上睑下垂并发症的统计

目的 探讨 额肌筋膜瓣悬吊术在矫正上睑下垂术后并发症发生的原因及预防措施，提高手术效果。方法 对５１３例在住院期间及门诊复查中发现的术后并发症进行病因和防治研究。结果 发现术后并发症共１４种并以相应的措施防治。结论 绝大部分并发症可以防治，额肌筋膜瓣悬吊术矫治疗完全性上睑下垂的效果可靠。     

Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous frontalis suspension.

The frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the level of the eyebrow. Therefore, the superiorly based orbicularis oculi muscle flap, when advanced and attached to the tarsal plate, can dynamically elevate the upper lid and correct blepharoptosis with previous frontalis sling. Six patients with undercorrected blepharoptosis after frontalis sling suspension were included in this study. The superiorly based orbicularis oculi muscle flap was advanced to the tarsal plate in these patients and the redundant portion of the distal flap was resected. Postoperative results were satisfactory after 1-year follow-up.     

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。     

额肌瓣悬吊术治疗重度上睑下垂临床探索

目的:探索重度上睑下垂的治疗方法.方法:制作宽窄和长度适宜的额肌瓣,经眼轮匝肌与眶隔膜间隧道,下移固定于睑板上缘,治疗重度上睑下垂97例.结果:临床治疗126只眼(97例),随访0.5～9年,外形自然,闭合自如,无复发现象,均获满意效果.结论:额肌瓣悬吊术是活疗重度上睑下垂可靠而有效的方法.     

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。     

梯形额肌瓣转移治疗上睑下垂

目的 提高上睑下垂的治疗效果，防止复发。方法 弧形切断额肌形成梯形额肌，经修剪成上窄下宽的梯形额肌瓣，经上睑眼轮匝肌下转移，使梯形额肌瓣下缘与睑板广泛接触并缝合。结果 16例24只眼，术后上睑下垂矫正满意，睑缘外形匀称，上睑闭合良好，无复发和并发症。结论 梯形额肌瓣转移，与睑板缝合牢固，有利于额肌瓣收缩上提眼睑，尤适用于中重度上睑下垂的治疗。     

改良的额肌瓣辅以缝线悬吊减张治疗上睑下垂

目的　为了减少额肌损伤 ,保证额肌瓣转移 ,治疗中、重度上睑下垂 ,术后吻合口无张力愈合 ,加快血运建立的效果。方法　用 3 - 0可吸收缝线横向贯穿睑板上缘提上睑肌腱膜组织 2针 ,经额肌瓣隧道缝至眶上缘骨膜上 ,转移不等边额肌瓣使之无张力缝合。结果　减张手术组 2 5例 ,总优良率 92 % ,常规手术组 34例 ,总优良率 61 .1 8%。结论　本手术方法减少了额肌瓣外侧血管神经损伤 ,增强了额肌的收缩力 ,利用缝线悬吊减张辅助吻合口愈合 ,是治疗中、重度上睑下垂的有效辅助方法     

改良的额肌瓣辅以缝线悬吊减张治疗上睑下垂

目的为了减少额肌损伤,保证额肌瓣转移,治疗中、重度上睑下垂,术后吻合口无张力愈合,加快血运建立的效果.方法用3-0可吸收缝线横向贯穿睑板上缘提上睑肌腱膜组织2针,经额肌瓣隧道缝至眶上缘骨膜上,转移不等边额肌瓣使之无张力缝合.结果减张手术组25例,总优良率92%,常规手术组34例,总优良率61.18% .结论本手术方法减少了额肌瓣外侧血管神经损伤,增强了额肌的收缩力,利用缝线悬吊减张辅助吻合口愈合,是治疗中、重度上睑下垂的有效辅助方法.     

减张法在额肌瓣转移治疗重度上睑下垂中的应用

目的　为防止因额肌瓣转移治疗重度上睑下垂术后复发,我们采用眉上减张法，以避免吻合口因张力大影响愈合的弊端。方法　术中用1号线横行贯穿额肌瓣与上睑提肌腱膜缝合缘下方的腱膜组织，缝线两端通过额肌瓣隧道至眉上穿出皮肤，垫纱布卷打结。结果　术后远期临床效果明显提高，行减张手术的35例中优良率高出常规手术组32.81％，未见1例失败。结论　认为此方法是额肌瓣转移治疗重度上睑下垂的有效辅助方法。     

Comparison of levator resection and frontalis muscle transfer in the treatment of severe blepharoptosis

BACKGROUND: The optimal surgical approach for blepharoptosis is dependent upon many factors, the most important being levator function. However, the preferred approach in severe blepharoptosis remains a matter of contention. METHODS: We investigated 130 patients with levator function between 2 and 4 mm who underwent corrective surgery for blepharoptosis between January 1990 and December 2004. There were 65 eyelids of levator resection performed in 50 patients and 105 eyelids of frontalis transfer performed in 80 patients. Postoperative results were evaluated, with an average follow-up period of 27 months. RESULTS: The average preoperative degree of ptosis was approximately 2.7 mm in cases treated with levator resection and 4.0 mm in cases treated with frontalis muscle transfer. The average postoperative level of ptosis was approximately 1.7 mm in levator resection and 2.1 mm in frontalis muscle transfer. The average degree of postoperative ptosis improvement was approximately 1.0 mm in levator resection and approximately 1.86 mm in frontalis muscle transfer. The most frequent complication of levator resection was undercorrection. Eyelid deformity due to excessive traction was more frequent in the frontalis muscle flap technique. CONCLUSION: Levator resection and frontalis transfer can effectively treat blepharoptosis patients with poor levator function. Frontalis muscle transfer should be performed more carefully in operation to avoid complications which too excessive contraction could cause for blepharoptosis patients with 2 approximately 4 mm of levator function. Also, some accessorial methods were regarded as necessary to prevent undercorrection in performing levator resection.     

额肌动力上睑SMAS提紧治疗上睑下垂方法研究

目的:研究重度上睑下垂的动力选择、上睑提升传动结构再造、传动方向设置和再造动力的起止点。方法:根据多年临床实践及尸体解剖研究，以治疗2例家族性先天肌原性上睑下垂的过程，确定额肌作为上睑动力的解剖结构的命名；动力源滑车设计，动力传动组织结构；动力传布的方向；动力源额肌瓣的起点和止点设计，以及动力源额肌瓣的长宽设计等。结果:以额肌作为动力，额骨眶上缘作为滑车，上睑SMAS瓣为动力传动组织结构，取宽12～15mm，长15～20mm的长方形额肌上睑SMAS瓣，置于眼轮匝肌后方。眶缘上1cm额肌和SMAS结合处，作为上睑动力源的起点，上睑睑板上1／3，为再造上睑动力的止点。修复后静态时，使矫正的上睑缘高于健侧1～2mm，即位于角膜上缘，或角膜上缘1mm。2例患者手术治疗后功能和外形得到改善。结论:额肌上睑SMAS提紧是治疗先天性重度上睑下垂和复发性上睑下垂的良好方法，手术操作简便。再造动力功能良好。     

Dense deposit disease: long term follow-up of three cases of recurrence after transplantation.

The incidence and early recurrence after transplantation prove the specificity of the appearance of an electron dense alteration of kidney basement membrane often called dense intra-membranous deposit disease. Three new cases with dense deposit disease affecting the original kidneys have been followed-up after transplantation for periods ranging from 4 to 8 years and illustrate the natural history of the recurrence. Serial kidney biopsies showed the predominance of dense deposits near the mesangial area and the vascular pole. These deposits were also seen in some tubular basement membranes. Absence of cell proliferation was noted in all biopsies performed. Immunofluorescence studies revealed fixation of C3 alone. Histological signs of recurrence are compatible with the absence of clinical and biological signs. Transient or permanent proteinuria and microhematuria were common findings. Serum complement levels, measured after transplantation, were low in all three cases. Despite recurrence of the original glomerulonephritis, long-term survival of the graft was commonly observed, two cases being followed-up for 7 and 8 years. Patients with dense intra-membranous deposits glomerulonephritis should not be excluded from a transplantation program. One of the three cases reported here illustrates the exceptional association of recurrence of dense intramembranous deposits, de novo membranous glomerulonephritis and chronic rejection.     

额肌动力上睑SMAS提紧治疗上睑下垂方法研究

目的研究重度上睑下垂的动力选择、上睑提升传动结构再造、传动方向设置和再造动力的起止点.方法根据多年临床实践及尸体解剖研究,以治疗2例家族性先天肌原性上睑下垂的过程,确定额肌作为上睑动力的解剖结构的命名;动力源滑车设计,动力传动组织结构;动力传布的方向;动力源额肌瓣的起点和止点设计,以及动力源额肌瓣的长宽设计等.结果以额肌作为动力,额骨眶上缘作为滑车,上睑SMAS瓣为动力传动组织结构,取宽12～15mm ,长15～20mm的长方形额肌上睑SMAS瓣,置于眼轮匝肌后方.眶缘上1cm额肌和SMAS结合处,作为上睑动力源的起点,上睑睑板上1/3,为再造上睑动力的止点.修复后静态时,使矫正的上睑缘高于健侧1～2mm,即位于角膜上缘,或角膜上缘1mm.2例患者手术治疗后功能和外形得到改善.结论额肌上睑SMAS提紧是治疗先天性重度上睑下垂和复发性上睑下垂的良好方法,手术操作简便,再造动力功能良好.     

223例Colles骨折患者的长期随访结果

目的 总结不同类型Ｃｏｌｌｅｓ骨折非手术治疗的疗效。方法 ２２３例Ｃｏｌｌｅｓ骨折按Ｏｌｄｅｒ方法分类,随访１－１０年,用Ｇａｒｔｌａｎｄ和Ｗｅｒｌｅｙ评估系统进行功能评定。结果 ２２３例患者中,功能恢复优良者１７４例,占７８％。腕关节畸形与疼痛等并发症的发生率为３５．４％。结论骨折类型,早期治疗与功能锻炼对Ｃｏｌｌｅｓ骨折的功能恢复有明显的影响。