改良扇形额肌瓣悬吊术矫正重度上睑下垂的临床研究

摘要：目的　评价改良扇形额肌瓣悬吊手术治疗重度上睑下垂的临床疗效。方法　采用单臂临床设计，对214例（285眼）重度上睑下垂患者行改良额肌瓣悬吊术。手术采用重睑切口，眶上切迹颞侧做额肌瓣鼻侧垂直切口，颞侧不做垂直切口，其皮下分离范围为眉毛下缘向上到眉上约5 mm，腹面分离止于眶上缘下。比较术前及术后上睑缘至角膜中央反光的距离（MRD1）、双眼对称性、上睑弧度变化及术后并发症发生情况。结果　术后随诊平均（10.2±3.1）个月，患者MRD1大于术前［（3.2±0.7）mm vs. （-0.5±0.8）mm，t=58.760，P＜0.01］，上睑活动度明显增大［（11.2±1.4）mm vs.（3.5±0.8）mm，t=80.617，P＜0.01］。190例患者（253眼）术后达到了理想眼睑高度及弧度，最终成功率88.8%。术后未出现上睑内翻、暴露性角膜炎、额肌麻痹、额部感觉丧失及严重血肿等并发症。结论　改良的额肌瓣悬吊术成功率高，术中出血少、损伤小、术后并发症少，是治疗重度上睑下垂的合理选择。

Clinical research about correction of severe ptosis using a modified frontalis muscle suspension

Abstract: Objective　To evaluate the clinical effect of a modified frontalis muscle flap suspension for severe ptosis. Methods　Two hundred and fourteen patients (285 eyes) with severe ptosis underwent a modified frontalis muscle flap suspension approach. The surgical approach was a crease incision, and a nasal vertical incision of frontal muscle flap was made on temporal side of supraorbital notch without temporal vertical incision. The subcutaneous separation of frontal muscle began at the lower edge of the eyebrow and ended at 5 mm above the eyebrow and the ventral separation ended under the upper edge of the orbit. The marginal reflex distance (MRD1), symmetry of height, contour and complications before and after surgery were compared. Results　The average follow-up period was (10.2 ± 3.1) months. The postoperative MRD1 was higher than that before operation [(3.2±0.7) mm vs. (-0.5±0.8) mm，t=58.760, P＜0.01], and the upper eyelid activity increased significantly [(11.2±1.4) mm vs. (3.5±0.8) mm，t=80.617, P＜0.01]. One hundred and ninety patients (253 eyes) achieved their desired lid height and contour, with a final success rate of 88.8%. Complications such as entropion, exposure keratitis，frontal paralysis, frontal hypoesthesia, severe hematoma were not seen in our series. Conclusion　The modified frontalis muscle suspension technique shows a high success rate with less bleeding, mild damage and fewer complications. It is a reasonable alternative treatment in severe ptosis.