额肌瓣悬吊术矫正重度先天性上睑下垂

目的:探讨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28例35眼重度先天性上睑下垂患者,施行额肌瓣悬吊术,观察分析术中、术后并发症,随访观察术后效果。结果:本组病例均矫正理想,无严重术中术后并发症发生。结论:额肌瓣悬吊术矫正重度先天性上睑下垂的手术可靠,效果满意,是治疗重度上睑下垂较可靠的手术方法。     

重度先天性上睑下垂术式的评估

目的分析异体阔筋膜悬吊术和额肌筋膜瓣悬吊术矫正重度先天性上睑下垂的效果。方法对56例78眼重度先天性上睑下垂住院病例行手术治疗,其中额肌瓣悬吊术20例36眼,阔筋膜悬吊术36例42眼。结果阔筋膜悬吊术的复发率高于额肌瓣悬吊术,且眼险弧度不易掌握,术后兔眼征明显。额肌瓣悬吊术双重睑形成稍差,术中出血较多。结论综合评估额肌瓣悬吊术,矫正重度先天性上睑下垂较为优势。     

额肌瓣悬吊术治疗重度先天性上睑下垂临床观察

目的:探讨额肌瓣悬吊术治疗重度先天性上睑下垂的临床效果。方法:采用额肌瓣悬吊术治疗重度先天性上睑下垂患者22例27眼。并对术后效果进行随访观察。结果:本组22例27眼,随访3～36mo,除1眼矫正不足外,余均取得良好效果。结论:额肌瓣悬吊术适用于治疗重度先天性上睑下垂,效果确切。     

重度先天性上睑下垂的手术治疗

目的分析额肌筋膜瓣悬吊术和异体阔筋膜悬吊术矫正重度先天性上睑下垂的优缺点。方法对重度先天性上睑下垂66例87眼进行手术治疗,其中额肌筋膜瓣悬吊术30例45眼,异体阔筋膜悬吊术36例42眼,分析术后上睑下垂矫正效果、上睑弧度、双重睑成形及暴露性角膜炎发生情况。结果额肌筋膜瓣悬吊术取材方便、复发率较低、上睑弧度匀称;阔筋膜悬吊手术简单、重睑形成良好,但取材困难、复发率稍较高。结论额肌筋膜瓣悬吊术和阔筋膜悬吊术均能有效治疗重度先天性上睑下垂,前者无需特殊材料,术后效果较稳定。     

重度先天性上睑下垂两种悬吊方法的评估

目的分析异体阔筋膜悬吊术和额肌筋膜瓣悬吊术矫正重度先天性上睑下垂的优缺点.方法对56例78眼重度先天性上睑下垂住院病例行手术治疗,其中额肌瓣悬吊术20例(36眼),阔筋膜悬吊术36例(42眼).结果阔筋膜悬吊术的复发率高于额肌瓣术;术后兔眼明显.额肌瓣悬吊术双重睑形成稍差,术中出血较多.结论综合评估矫正重度先天性上睑下垂额肌筋膜瓣悬吊术较优于异体阔筋膜悬吊术.     

超常量提上睑肌缩短及额肌瓣悬吊治疗重度先天性上睑下垂效果比较

目的：比较提上睑肌缩短术与额肌瓣悬吊术治疗重度先天性上睑下垂的疗效与并发症。

方法：对40例58眼重度先天性上睑下垂患者进行手术治疗,其中,20例28眼行额肌腱膜瓣悬吊术,20例30眼行改良的提上睑肌缩短术,术后随访6mo,观察两种手术方式治疗重度先天性上睑下垂的治疗效果及术后并发症的发生情况。

结果：术后随访6mo,提上睑肌缩短术组及额肌瓣悬吊术组治疗重度先天性上睑下垂的正矫率分别为：83%、82%,差异无统计学意义(P>0.05),但术后并发症的发生,如倒睫、闭合不全、暴露性角膜炎、结膜脱垂等,提上睑肌缩短术组少于额肌瓣悬吊术组,且有更好的外观。提上睑肌缩短术后6mo复诊时,眼睑闭合不全15眼,暴露性角膜炎共1眼,结膜脱垂2眼; 额肌瓣悬吊术后6mo随诊,眼睑闭合不全23眼,暴露性角膜炎2眼,上睑倒睫3眼。

结论：提上睑肌缩短术及额肌瓣悬吊术均能有效矫正重度先天性上睑下垂,但前者并发症少,术后外观好。     

改良额肌悬吊术治疗儿童先天性上睑下垂

目的：探讨改良额肌悬吊术治疗儿童先天性上睑下垂的手术效果。方法：采用改良额肌悬吊术治疗先天性上睑下垂患儿36例44眼,对术后疗效进行随访观察。结果：本研究36例44眼患儿均随访12mo以上,上睑下垂全部矫正,除1例术后出现倒睫外,其余均获得良好远期效果。结论：改良额肌悬吊术是治疗提上睑肌肌力先天性上睑下垂的有效方法,不仅操作简便,而且可以有效防止并发症。     

改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂

目的:探讨改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂的有效性。方法:20例(25眼)学龄前儿童先天性重度上睑下垂,采用改良式额肌瓣悬吊术,利用额肌力量提起上睑。结果:术后1～4a上睑缘位于角膜上缘下1mm20眼,2mm5眼,无复发。结论:改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂效果肯定。     

额肌瓣悬吊术治疗重度先天性上睑下垂远期疗效观察

目的评价额肌瓣悬吊术治疗儿童重度先天性上睑下垂的远期疗效。探讨影响手术远期效果的相关因素。方法对48例(48眼)实施额肌瓣悬吊术的重度先天单纯性上睑下垂患儿进行回顾性分析,记录其睑裂高度及弧度,眼睑开闭情况,视力及屈光不正矫正状况,平均随访7年。结果48例患者中,成功35例(72.9%), 复发13例(27.1%),复发病例均有屈光不正且未坚持戴镜治疗。结论额肌瓣悬吊术治疗重度先天性上睑下垂远期疗效肯定,未矫正的屈光不正是影响额肌瓣悬吊术远期疗效的主要因素。     

儿童先天性上睑下垂手术方法探讨

目的观察不同的手术方式矫治儿童先天性上睑下垂的治疗效果。方法对56例（100眼）儿童先天性上睑下垂采用上睑皮肤单切口,分3组：第1组利用额骨膜缝线式吊术,治疗年龄在3月～1．5岁的患儿。第2组利用上睑提肌缩短术治疗上睑提肌肌力为4—8mm的患儿。第3组利用额肌瓣悬吊术治疗上睑提肌肌力为0～6mm的患儿。结果随访6月～2a,额肌瓣组病例全达满意效果,而上睑提肌组12眼,矫正不足,额骨膜缝线悬吊组4眼上睑垂睑线消失。结论额肌瓣悬吊术为矫治儿童先天性上睑下垂的最佳手术方式。     

Long-term results of frontalis suspension using autogenous fascia lata for congenital ptosis in children under 3 years of age

PURPOSE: To evaluate the outcome of frontalis suspension surgery for congenital ptosis using autogenous fascia lata for children under 3 years of age. DESIGN: Retrospective nonrandomized interventional case series. METHODS: This study included nine children (14 eyelids) with severe congenital ptosis aged less than 3 years. All patients underwent frontalis suspension surgery using autogenous fascia lata. Postoperative lid level results, ptosis recurrence, and cosmetic appearance of leg scars were evaluated after the operation. RESULTS: The mean age of the patients was 15.3 months (range, 6 months to 2.5 years) with a mean follow-up period of 41.6 months (range, 18 to 96 months). All children achieved satisfactory cosmetic and functional results, with no postoperative complications such as wound infection, corneal exposure, eyelid contour abnormalities, or ptosis overcorrection. No recurrence of ptosis was encountered. Harvesting was not difficult, and a sufficient amount of material was achieved. There was one patient (11.1%) with a hypertrophied leg scar. CONCLUSIONS: Frontalis suspension using autogenous fascia is proposed as a possible procedure for correcting congenital ptosis in children younger than 3 years of age. It appears to be an effective and feasible treatment for children with poor levator muscle function in this age group.     

上横韧带悬吊术矫治中重度先天性上睑下垂

目的:探讨矫治中重度先天性上睑下垂简便有效的手术方法。方法:198例(225眼)中重度先天性上睑下垂的患者,实行上横韧带悬吊190例216眼,睑板切除加上横韧带悬吊8例9眼。结果:经5mo~5a随访,198例225眼中,治愈219眼,欠矫6眼,术后早期所有患者有轻度闭合不全,通过代偿,3mo内闭合不全逐渐好转,无暴露性角膜炎。结论:上横韧带悬吊术是矫治中重度先天性上睑下垂简便而有效的方法。     

额肌腱膜瓣悬吊术治疗儿童重度先天性上睑下垂的临床体会

目的:探讨额肌腱膜瓣悬吊术治疗重度先天性上睑下垂的疗效。方法:对40例上睑下垂患者行额肌腱膜悬吊术。术后随访3~15mo,观察其术后效果。结果:患者39例术后效果满意,1例术后出现倒睫行二次手术,无1例出现暴露性角膜炎。结论:额肌腱膜悬吊术是治疗儿童重度先天性上睑下垂的理想的手术方式。     

额肌瓣悬吊术矫治重度上睑下垂临床观察

目的 探讨额肌瓣悬吊术矫治重度上睑下垂的临床效果.方法 局麻后于上睑重睑皱褶处切开皮肤,剪除切口下唇的一条眼轮匝肌以暴露睑板.然后于眶上缘眉弓处作一长约15～20 mm的辅助切口,于两切口之间的眼轮匝肌下作隧道.在辅助切口处直视下夹持额肌,沿额肌止端横形剪断宽约15mm,分别在皮下与额肌间及骨膜与额肌间钝性分离以游离额肌,于其两侧向上作扇形剪开制成额肌瓣,向下牵引此瓣缝合于睑板上1/3处.间断缝合重睑切口及辅助切口.术后观察5月～6年.结果 76例（92眼）全部矫正满意,外观良好,未见复发病例.结论 额肌瓣悬币术矫治重度上睑下垂方法简单,符合生理功能,手术成功率高,效果良好.     

Analysis of treatment results 389 patients with congenital blepharoptosis

PURPOSE: Retrospective analysis of the results in the treatment of congenital blepharoptosis. MATERIAL AND METHODS: We retrospectively reviewed the records of 389 patients with blepharoptosis who underwent surgical treatment in the Hospital of Plastic Surgery in Polanica-Zdrój, from January 1976 to January 2005. The age of patients, degree of malformation and unilateral or bilateral occurrence of ptosis, was analyzed. Moreover, we studied treatment results of patients with blepharoptosis treated in our hospital and patients treated elsewhere, before admission to our hospital. RESULTS: 218 patients from 327 operated in our hospital had levator muscle resections. After 6 months of observation 39 patients were qualified for surgical re-correction. 12 months after surgery 4 patients had recurrence of ptosis. Frontalis suspension technique with using the temporal fascia, was performed in 109 patients. After 6 months observation, 8 patients were qualified for surgical re-correction. CONCLUSIONS: For patients with maintained function of the levator muscle the most effective and physiological procedure, is the muscle shortening. Frontalis suspension technique with use of the temporal fascia should be limited to treat failure cases and patients with poor or absent function of the levator muscle.     

Evaluation of polytetrafluoroethylene suture for frontalis suspension as compared to polybutylate-coated braided polyester

PURPOSE: To evaluate the efficacy of polytetrafluoroethylene (Gore-Tex) suture as compared to polybutylate-coated braided polyester (Ethibond) suture as sling materials for frontalis suspension in bilateral congenital ptosis. METHODS: Frontalis sling surgery by modified Crawford's double triangle technique was performed on 30 patients (60 eyes) with bilateral ptosis. The patients were randomized into two groups depending on the type of suture material used: polytetrafluoroethylene or braided polyester. RESULTS: Polytetrafluoroethylene suture achieved a statistically significant better and more stable ptosis correction, with slightly more lagophthalmos, than braided polyester suture over a mean (+/- SD) follow-up period of 16 +/- 3.24 months. There were more postoperative complications with braided polyester suture, but the difference was not statistically significant. CONCLUSION: This is the first clinical study in which polytetrafluoroethylene in the form of suture has been studied. Polytetrafluoroethylene suture was found to be a safe and effective sling material for frontalis suspension and it can be recommended for clinical use.     

改良额肌腱膜瓣悬吊术在儿童先天性上睑下垂治疗中的应用

目的探讨改良额肌腱膜瓣悬吊术治疗儿童先天性上睑下垂的疗效和手术时机的选择。方法回顾总结我院2007年4月至2010年5月采用改良额肌腱膜瓣悬吊术治疗的218例（259眼）先天性上睑下垂患儿,其中男113例;女105例,双眼41例,单眼177例,年龄16月-15岁,重度上睑下垂59例,中度上睑下垂136例,轻度23例。术后经3月-3年的随访观察。结果矫正满意者197例,欠矫21例,1例过矫,术后早期多有闭合不全,3月后逐渐消失,无一例倒睫,无一例出现暴露性角膜炎。结论改良额肌腱膜瓣悬吊术治疗儿童先天性上睑下垂疗效肯定,手术操作简单,不损伤额部血管神经,术中出血少,术后反应轻,恢复快,是治疗儿童先天性上睑下垂的首先方法,为避免术后欠矫,手术年龄选择在3岁后为宜。     

改良额肌瓣悬吊术治疗先天性上睑下垂

目的观察改良额肌瓣悬吊术治疗先天性上睑下垂的疗效。方法对59例（73眼）先天性上睑下垂行改良额肌瓣悬吊术。男35例（44眼）,女24例（29眼）。单眼45例,双眼14例。轻度6例（6眼）,中度18例（20眼）,重度35例（47眼）。结果73眼中66眼效果良好（90．41％）,7眼好转（9．59％）。术后早期多有睑裂闭合不全,1—3个月后逐渐消失,随访6个月-3年,59例未见严重并发症,无复发者。结论额肌瓣有丰富的血供及神经支配,并且有足够的肌力提起上睑,具有符合生理和解剖的优点。改良额肌瓣悬吊术能矫正畸形及改善外观,是治疗先天性上睑下垂安全有效方法。     

额肌瓣悬吊治疗外伤性上睑下垂

目的:评价额肌瓣悬吊术对外伤性上睑下垂的疗效。方法:对43例伤后6个月以上的外伤性上睑下垂病人行上睑额肌瓣悬吊术,平均随访时间18个月,观察其睑裂高度、上睑弧度、闭眼状态和角膜情况。结果:28例获得理想效果,13例获得显著效果,总有效率95.4％。结论:额肌瓣悬吊术是治疗外伤性上睑下垂的效果确切而安全的方法。眼科学报1997;13:107～108。     

Early Frontalis Flap Surgery as First Option to Correct Congenital Ptosis with Poor Levator Function

Abstract

In congenital blepharoptosis the upper eyelid cannot be lifted normally because of congenital impairment in the levator function. The descended eyelid margin partially or completely obstructs of the visual axis with the consequent risk of amblyopia. Frontalis suspension is the surgery of choice for ptosis with poor levator function creating a linkage between the frontalis muscle and the tarsus; the frontalis muscle is used to elevate the eyelid. Direct transplantation of frontalis muscle to the upper eyelid has been widely described. We report our experience using frontalis flap in congenital ptosis with poor levator function in children.

Methods: Retrospective study of 30 eyes with severe congenital ptosis and poor levator function treated by means of direct frontalis flap. Mean age 2 years. Eyelid measurements were taken at baseline, 1, 3, 12 months postoperatively and last visit. Mean ptosis degree was 5?mm (3--8?mm) and levator function 2?mm (1--5?mm). The presence of complications, flap function and palpebral contour were evaluated. Mean follow up time was 27 months. At last visit, ptosis degree ranged from 0 to 3?mm.

Discussion: Direct advancement of the frontalis muscle to treat severe eyelid ptosis is effective and stable in the long term avoiding the use of a linking structure, therefore the risk of foreign-body reaction, absorption, granuloma and late exposure, as well as the need for a second visible incision in the forehead. Patients learn how to control the lid height by means of the frontalis muscle achieving more symmetry.