改良式宽大额肌瓣恳吊治疗上睑下垂的临床观察

目的:观察应用保留眶上神经血管束的宽大额肌瓣悬吊治疗重度上睑下垂的治疗效果.方法:设计额肌瓣时,将传统额肌筋膜瓣的内侧纵切口由眶上神经血管束的外侧改为内侧,并且内侧纵切口长于外侧,使瓣的宽度与睑板水平宽度相等.结果:应用该方法治疗18例21侧重度上睑下垂,其中12例术后随访3-12月,除1例双侧上睑下垂术后左右重睑弧度不对称外,余11例术后效果满意,睑缘外形匀称,无复发和并发症.结论:宽大额肌瓣,血供非富,悬吊睑板力点分布均匀、牢固,符合生理和解剖结构的要求;术后提睑活动可靠,上睑闭合良好,睑缘和重睑线弧度及外观满意.适用于中重度上睑下垂的治疗.     

改良式宽大额肌瓣悬吊治疗上睑下垂的临床观察

目的：观察应用保留眶上神经血管束的宽大额肌瓣悬吊治疗重度上睑下垂的治疗效果。方法：设计额肌瓣时,将传统额肌筋膜瓣的内侧纵切口由眶上神经血管束的外侧改为内侧,并且内侧纵切口长于外侧,使瓣的宽度与睑板水平宽度相等。结果：应用该方法治疗18例21侧重度上睑下垂,其中12例术后随访3～12月,除1例双侧上睑下垂术后左右重睑弧度不对称外,余11例术后效果满意,睑缘外形匀称,无复发和并发症。结论：宽大额肌瓣,血供非富,悬吊睑板力点分布均匀、牢固,符合生理和解剖结构的要求;术后提睑活动可靠,上睑闭合良好,睑缘和重睑线弧度及外观满意。适用于中重度上睑下垂的治疗。     

额肌瓣悬吊治疗重度先天性上睑下垂

目的:观察额肌瓣悬吊治疗重度上睑下垂的临床效果。方法:观察额肌瓣悬吊法矫正先天性中重度上睑下垂的手术效果及并发症,评价手术方式的合理性。结果:本组患者共56例(65眼),随访观察2~24个月,有3例低矫,2例重睑形态不佳,其余患者均眼裂恢复正常大小,重睑弧线流畅,形态自然,无上睑结膜脱垂,倒睫等并发症。结论:额肌瓣悬吊术治疗先天性上睑下垂效果满意,安全可靠。     

上睑提肌腱膜瓣联合宽大额肌瓣融合术治疗重度上睑下垂

目的：探讨上睑提肌腱膜瓣联合宽大额肌瓣融合术治疗重度上睑下垂的效果。方法：对27例（36眼）重度先天性上睑下垂患者进行上睑提肌腱膜联合宽大额肌瓣融合手术治疗,术后随访3个月～2年。结果：矫治良好25例,基本矫正2例,无过矫及欠矫者。结论：上睑提肌腱膜瓣联合宽大额肌瓣融合矫治手术,符合生理解剖的特点,可充分利用无功能提上睑肌腱膜,具备功能矫正效果,手术后外形满意,功能良好。     

两种不同术式矫正不同程度先天性上睑下垂的效果探讨

目的:探讨提上睑肌缩短术和额肌瓣悬吊术这两种术式对于不同程度先天性上睑下垂的矫正效果。方法:回顾性分析2000年-2008年在笔者医院接受提上睑肌缩短术或额肌瓣悬吊术的先天性上睑下垂患者37例53眼的临床资料,根据手术方式的不同,将其分为提上睑肌缩短术组(n=17)和额肌瓣悬吊术组(n=20),比较两组不同程度先天性上睑下垂的矫正效果及术后并发症发生率。结果:提上睑肌缩短术对于轻度上睑下垂的正矫率为87.5%高于额肌瓣悬吊术组的55.6%,差异有统计学意义(P0.05)。提上睑肌缩短术对于中、重度上睑下垂的正矫率分别为30.0%、50.0%,低于额肌瓣悬吊术组的90.0%、90.0%,差异有统计学意义(P0.05)。提上睑肌缩短术组的并发症发生率为17.7%低于额肌瓣悬吊术组的20.0%,但两组间比较差异无统计学意义(P0.05)。结论:提上睑肌缩短术适用于轻度先天性上睑下垂;额肌瓣悬吊术适用于中、重度先天性上睑下垂。     

单纯额肌瓣悬吊术治疗重度先天性上睑下垂的临床观察

目的:探讨额肌瓣悬吊术治疗先天性上睑下垂的可行性.方法:对23例30只眼的重度先天性上睑下垂采用额肌瓣悬吊,利用额肌的力量提起上睑.结果:23例30只眼矫正满意27只眼,矫正良好3只眼,矫正不良0只眼.结论:额肌肌瓣悬吊术是治疗重度先天性上睑下垂有效的主要的手术方式.     

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。     

改良额肌瓣悬吊术治疗重度上睑下垂的疗效分析

目的:评估改良额肌瓣悬吊术矫治重度上睑下垂的临床疗效。方法:对笔者所在医院2008年1月-2013年10月采用改良额肌瓣悬吊术治疗的39例(43眼)重度上睑下垂患者进行回顾性疗效分析,该组患者包括先天性上睑下垂34例(38眼),外伤性上睑下垂5例(5眼),评估手术效果及手术的安全性。结果:术后2年随访结果,本组矫正良好者37例(41眼),占95.3%,基本矫正2例(2眼),占4.7%,无过矫和矫正不足,无严重并发症发生。结论:改良额肌瓣悬吊术治疗重度上睑下垂疗效满意、安全可靠。     

额肌瓣悬吊术治疗重度外伤性上睑下垂疗效观察

目的:观察额肌瓣悬吊术对重度外伤性上睑下垂的疗效.方法:对28例重度外伤性上睑下垂患者行额肌瓣悬吊术,平均随访12个月,观察睑裂高度、上睑弧度、闭眼状态和角膜情况.结果:21例治愈,6例好转,治愈率75.0%.有效率96.4%.结论:额肌瓣悬吊术治疗重度外伤性上睑下垂是一种安全有效的方法.     

额肌瓣悬吊治疗重度上睑下垂的远期临床疗效观察

目的:探讨额肌瓣悬吊术治疗重度上睑下垂的治疗效果。方法:对2011年3月~2016年1月于我院整形外科就诊的重度上睑下垂患者共54例(86只眼)进行回顾性研究,成年患者均给予额肌瓣悬吊术进行矫正,未成年患者给予改良额肌筋膜瓣悬吊术进行矫正,观察并分析其临床效果。结果:49例获得随访,随访观察时间4~57个月,平均26.9月。46例获得满意疗效,3例出现复发。无一例出现睑裂闭合不全、穹窿部结膜脱垂、睑内翻、睑外翻、倒睫、感染、血肿等并发症。结论:额肌瓣悬吊术治疗成人重度上睑下垂疗效满意,作用持久,是治疗重度上睑下垂安全可靠比较理想的可行术式。对于年幼患者,可将额肌筋膜复合瓣悬吊术作为首选术式。     

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.     

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。     

L形额肌瓣悬吊治疗重度上睑下垂的临床研究

目的：探讨治疗重度上睑下垂的手术方法。方法：制作宽蒂、深面分离多浅面分离少的L形额肌瓣,治疗重度上睑下垂81例114只眼。结果：临床治疗81例115只眼,随访0.5～3年,矫正良好,外形自然,无复发及并发症发生,均获满意疗效。结论：L形额肌瓣悬吊术是治疗重度上睑下垂可靠而有效的方法。     

改良额肌瓣法矫正重度上睑下垂效果观察

目的:探讨改良额肌瓣法矫正重度上睑下垂的临床效果。方法:18例(31眼)重度上睑下垂患者行改良额肌瓣悬吊手术治疗。结果:随访6~18个月,术后过矫2例(3只眼),其余患者效果满意,无并发症。结论:改良额肌瓣法矫正重度上睑下垂效果持久满意。     

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.     

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.     

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.     

Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous levator muscle resection

Based on the detailed anatomy, the orbicularis oculi muscle and the orbital septum are the continuation of the frontalis muscle and its fascia. Therefore, the shortened orbicularis oculi muscle and orbital septum would transmit the frontalis muscle action more effectively. The superior-based orbicularis oculi muscle and orbital septum flap, as a single flap, were advanced and attached to the tarsal plate for the correction of blepharoptosis. Six patients with undercorrected blepharoptosis were included in this study. Each patient had undergone more than two levator resection procedures by ophthalmologists or plastic surgeons. Conventionally, the frontalis suspension procedure was the next choice in these cases. The shortened orbicularis oculi muscle and orbital septum flap was used in these cases. Postoperative results were satisfactory after 3-year follow-up.     

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。