改良额肌瓣悬吊术治疗重度先天性上睑下垂的临床效果

目的 探究改良额肌瓣悬吊术治疗重度先天性上睑下垂的临床效果。方法 选取2019年 9月-2022年9月于我院进行治疗的65例（70眼）重度先天性上睑下垂患者作为研究对象，均给予改良额肌瓣 悬吊术治疗，观察临床疗效、术后并发症情况。结果 治疗3个月后，65例患者70眼中，效果良好60眼；效果 一般8眼；效果差2眼；70眼总体效果良好率为85.71%（60/70）；发生眼睑闭合不全4眼，暴露性角膜炎2 眼，6眼均逐渐自行恢复正常，无发生上睑内翻、外翻、感染、倒睫以及结膜脱垂的患眼；70眼术后并发 症发生率为8.57%（6/70）。结论 改良额肌瓣悬吊术治疗重度先天性上睑下垂能够获得满意的矫治效果， 手术后患者双眼睑裂对称，睑缘弧度自然美观，双眼重睑明显自然，且术后并发症发生几率低，值得临床 应用。     

额肌瓣悬吊术治疗重度上睑下垂的术式改进

目的：评价改进额肌筋膜瓣悬吊术治疗先天性重度上睑下垂术式的可行性及其效果。方法：20例先天性重度上睑下垂患者,采用美容的重睑切口入路,将额肌瓣向下拉至睑板上1／3部位,缝合固定于眼睑板前上方。结果：本组20例患者,术后随访3-36个月,上睑下垂均得到矫正,睁眼、闭眼功能恢复良好,眼睑、眉外形和位置均无异常,重睑弧度和形态自然,效果满意。结论：采用改进的重睑切口行额肌瓣悬吊治疗先天性重度上睑下垂,具有操作简单,疗效确切,术式隐蔽,无瘢痕等优点。     

通过上睑缘切口入路矫正上睑下垂的术式应用探讨

目的：探讨一种通过睑缘切口入路方式来矫正上睑下垂的手术方法。方法：2019年6月-2021年6月，笔者采用上睑缘切口矫正上睑下垂患者共28例（32只眼），其中提上睑肌前徙6例、提上睑肌缩短12例、CFS8例、上睑提肌缩短联合CFS2例。术前术后评估上睑缘角膜映光距离（MRD1）、睑裂大小、上睑提肌肌力、上眼睑外形满意度、睑缘切口瘢痕满意度、术后并发症（眼睑闭合不全、结膜脱垂、上睑下垂矫正不足、上睑下垂矫正过度）。结果：所有患者术后随访6～18个月，平均随访11.6月，术后满意率高（96.43%）；所有患者MRD1、睑裂大小、上睑提肌肌力均得到显著改善（P<0.05），眼睑外形满意度及睑缘切口瘢痕满意度高；未出现结膜脱垂、上睑下垂矫正不足、上睑下垂矫正过度等并发症。结论：通过睑缘切口矫正上睑下垂在临床应用中具有术后消肿快、瘢痕不明显恢复后上睑自然美观等优点，较传统切口入路方式有更高的满意率，更具有美容应用的实际意义，可作为上睑下垂矫正术的一种补充术式，值得临床推广。     

中重度上睑下垂应用CFS悬吊联合提上睑肌缩短术治疗的效果分析

分析对中重度上睑下垂患者应用CFS悬吊术联合提上睑肌缩短术进行治疗的效果。 方法 选取2019年3月-2023年5月黔南州人民医院收治的22例中重度上睑下垂患者为研究对象，以随机数 字表法分为对照组和观察组，每组11例。对照组行CFS悬吊术治疗，观察组行CFS悬吊术联合提上睑肌缩短 术治疗，比较两组治疗效果、上睑迟滞及眼睑闭合不足情况、并发症发生情况、术后睑裂高度（PFH）、 上睑缘至角膜映光点距离（MRD1）及手术矫正效果满意度。结果 观察组治疗总有效率为90.91%，高于对 照组的72.73%（P ＜0.05）；观察组上睑活动范围大于对照组，眼睑闭合不足量低于对照组（P＜0.05）；观 察组PFH及MRD1均大于对照组（P＜0.05）；观察组并发症发生率低于对照组（P ＜0.05）；观察组手术矫 正效果满意度高于对照组（P＜0.05）。结论 针对中重度上睑下垂患者，采取CFS悬吊术和联合提上睑肌缩 短术的效果良好，可改善上睑迟滞及眼睑闭合不足情况，降低并发症发生率，且患者对手术满意度较高。     

先天性上睑下垂治疗中的护理配合

额肌筋膜瓣悬吊术治疗先天性上睑下垂具有效果可靠、不易复发等优点而被广泛用于临床,该手术是利用额肌筋膜瓣的自然收缩,直接提起眼睑,增大睑裂,从而达到矫正上睑下垂的目的.     

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.     

额肌悬吊术在儿童先天性上睑下垂中的应用效果

分析为儿童先天性上睑下垂患者实施额肌悬吊术的临床效果。方法 选取苏州大学附属儿童 医院2017年1月-2022年12月收治的86例先天性上睑下垂患儿作为研究对象，按照上睑下垂程度分为对照 组（中度）和观察组（重度），每组43例。对照组采用提上睑肌缩短术，观察组采用额肌瓣悬吊术，比较 两组临床矫正效果、眼睑恢复情况及并发症发生情况。结果 观察组矫正有效率为97.67%，高于对照组的 86.05%，差异有统计学意义（P ＜0.05）；两组术后1、3、6个月眼睑恢复情况优于术前，且观察组优于对 照组，差异有统计学意义（P ＜0.05）；观察组并发症发生率为18.60%，低于对照组的39.53%，差异有统计 学意义（P ＜0.05）。结论 对先天性上睑下垂患儿实施额肌悬吊术，可提升患儿外貌美观度，改善眼睑情 况，在提升治疗效果的同时，降低并发症发生率，有效性和安全性较高。     

涤纶网织带额肌悬吊术治疗儿童上睑下垂

目的 探讨额肌悬吊术对儿童先天性上睑下垂手术的效果。方法 对164例（200只眼）儿童先天性上睑下垂进行涤纶网织带额肌悬吊要，采用自制隧道穿针，随访时间3个月至2年，平均5．24个月。结果 术后达正矫166只眼，占83％；低矫32只眼，占16％；过矫2只眼，占1％。眼睑外莆满意。结论 涤纶网织带额肌悬吊术治疗儿童先天性上睑下垂可取得良好效果，该手术适于各类上睑下垂儿童。     

两种方法矫正先天性上睑下垂的效果观察

目的:探讨额肌悬吊术与提上睑肌缩短术矫正先天性上睑下垂的临床疗效.方法:对15例(20只眼)上睑下垂患者采用额肌悬吊术.对20例(25只眼)上睑下垂患者采用提上睑肌缩短术矫正.结果:前一种方法术后早期眼睑高度、弧度及重睑形成尚可,但欠自然,闭睑不全明显,持久性欠佳.后一种方法术后眼睑高度、弧度及重睑形成良好,美观自然,持久性好.结论:提上睑肌缩短术是矫治先天性上睑下垂的理想选择.     

联合筋膜鞘悬吊术后上睑运动状态的观察与评价

目的:观察联合筋膜鞘悬吊术与额肌瓣悬吊术矫正重度先天性上睑下垂术后上睑的运动状态,评价联合筋膜鞘悬吊术后上睑运动功能的优势。方法:选取2015年3月至2016年3月在河北省眼科医院眼整形泪器科住院的重度上睑下垂患者46例6 0眼,随机分两组,分别接受联合筋膜鞘悬吊术与额肌瓣悬吊术,于术后1周、1个月、3个月、6个月时记录上睑的活动范围、泪膜分布状态、上睑迟滞及眼睑闭合不全四项指标,对这四项指标进行统计学处理。结果:接受联合筋膜鞘悬吊术患者术后上睑活动度、泪膜分布状态均明显优于额肌瓣悬吊组患者,两组对比具有统计学意义(P0.05);联合筋膜鞘悬吊术患者术后上睑迟滞及眼睑闭合不全现象较轻、恢复快;两组对比具有统计学意义(P0.05)。结论:联合筋膜鞘悬吊术与额肌瓣悬吊术相比,重度上睑下垂患者术后具有更好的上睑运动状态、泪膜分布状态好、上睑迟滞及眼睑闭合不全较轻,是局麻状态下治疗重度上睑下垂的更加优越的手术方式。     

应用提上睑肌缩短术与额肌瓣悬吊术治疗先天性上睑下垂

目的 应用提上睑肌缩短术与额肌瓣悬吊术治疗先天性上睑下垂,依据睑下垂程度寻求最佳手术选择.方法 对47例不同程度的先天性上睑下垂患者进行了手术治疗,其中28例上睑提肌肌力在2 mm以上者选择了提上睑肌缩短术,其中28例上睑提肌肌力之间者选择了额肌瓣悬吊术;19例上睑提肌肌力在0 mm～2 mm之间者选择了额肌瓣悬吊术.结果 采用上睑肌缩短术28例,术后双眼对称者20例,6例患眼较健侧低1 mm,2例相差2 cm;采用额肌瓣悬吊术19例,术后双眼对称者12例,5例相差1 mm,2例相差2 mm.两种手术方法比较,适用提上睑肌缩短术的患者上睑皱襞弧度自然,美容效果明显.结论 额肌瓣悬吊术适用于上睑提肌肌力为2 mm以下的重度患者;上睑提肌肌力在2 mm以上的患者宜采用提上睑肌缩短术矫正,能达到提上睑功能和美容效果最大程度的恢复与改善.     

An alternative frontalis suspension technique: triband suspension--a modified Garcia's procedure

Blepharoptosis surgery is one of the most common oculoplastic procedures, and the aim is to clear the visual axis. Many surgical techniques for the correction of ptosis have been described and performed, but the operative approach is based on the extent of eyelid excursion, the amount of levator function, and the degree of ptosis.In this study, the frontalis sling procedure with triband suspension was performed on 32 eyelids of 23 patients. All the patients had visual loss because of blepharoptosis with only 0 to 3 mm of measurable levator function. Postoperatively, the palpebral fissure was increased in all the patients. The purpose of this study was to report the use of a modified frontalis sling procedure for congenital ptosis patients with minimal to no levator function. In conclusion, this modified frontalis sling technique if used maximizes the frontalis muscle, creating sufficient eyelid elevation, with stable effect over time.     

Frontalis Suspension Technique with a Temporal-Fasciae-Complex Sheet for Repairing Blepharoptosis

Congenital blepharoptosis presents as a drooping upper eyelid with an unpleasant appearance. Severe blepharoptosis usually has to be treated with varying modifications of frontalis suspension techniques. Each, however, has certain drawbacks. In this paper, a refined frontalis suspension technique with temporal-fasciae-complex sheet is presented for repairing severe blepharoptosis. The technique suspends the eyelid from the frontalis muscle with a temporal-fasciae-complex sheet through the submuscular tunnel between the eyelid and the frontalis. Each of the 16 patients (22 eyelids) achieved good upper eyelid elevation and proper palpebral crease formation. We found that the technique is simple, effective, and predictable with minimal risk of complications. It could be optimal for correcting severe blepharoptosis, especially for Oriental patients who demand palpebral crease formation.     

Correction of recurrent blepharoptosis using an orbicularis oculi muscle flap and a frontalis musculofascial flap

Thirteen patients underwent reoperation for recurrent blepharoptosis using the orbicularis oculi muscle flap or the frontalis musculofascial flap. The orbicularis oculi muscle flap and the frontalis musculofascial flap are a modification of direct transplantation of the frontalis muscle to the tarsal plate. This is based on an anatomic study showing that the frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the eyebrow region. The patients' previous blepharoptosis operations were frontalis muscle suspension with autogenous or alloplastic material. Their follow-up period ranged from 6 months to 10 years. The average interval between the patient's first frontalis suspension to their reoperation was 8.09 years. The selection of the muscle flaps was based on the extent of levator function of the patient. When the eyelid excursion was moderate (>4 mm), the orbicularis oculi muscle flap was used. For patients with minimal or weak eyelid excursion (<3 mm), the frontalis musculofascial flap was used. Eleven patients (91.6%) gained levator excursion of more than 7 mm and reduced the height difference of both palpebral fissures by less than 2 mm after the reoperation. After an average follow-up of 20 months, 11 patients (14 eyelids) recorded satisfactory results. This is based on the criteria of Souther, and Jordan and Anderson. The overall results were more than satisfactory. Even though 2 patients reported poor results, there was no complete failure in this series. The authors' technique offers several advantages over conventional frontalis muscle suspension: it is a simple technique that has a good operative field, there is no donor morbidity and less complications, and asymmetrical supratarsal folding, eyelid notching, lagophthalmus, and abnormal eyebrow position that can occur after a frontalis muscle suspension can be avoided. In summary, the orbicularis oculi muscle flap or the frontalis musculofascial flap are considered for patients with recurrent blepharoptosis after frontalis muscle suspension.     

改良Park法重睑成形术治疗轻度上睑下垂的临床效果

探讨改良Park法重睑成形术治疗轻度上睑下垂的临床效果。方法 选取北京原力医疗美 容诊所2018年1月-2022年12月收治的52例轻度上睑下垂患者为研究对象，随机分为对照组与观察组， 每组26例。对照组接受传统上睑下垂矫正术治疗，观察组接受改良Park法重睑成形术治疗，比较两组睑 裂指标、重睑效果及并发症发生情况。结果 两组术后睑裂高度高于术前（P ＜0.05），观察组高于对 照组，但差异无统计学意义（P ＞0.05）；两组术后睑裂宽度低于术前（P ＜0.05），观察组低于对照 组，但差异无统计学意义（P ＞0.05）；两组术后重睑形态、双侧重睑对称、眼睑恢复情况评分及总评 分高于术前，且观察组高于对照组（P ＜0.05）；观察组并发症发生率为3.85%，低于对照组的30.77% （P＜0.05）。结论 采用改良Park法重睑成形术治疗轻度上睑下垂可有效改善睑裂情况，重睑效果较佳，同 时可减少并发症发生几率，安全性较高。     

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。     

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.