两种术式矫治不同程度先天性上睑下垂99例临床效果观察

目的观察提上睑肌缩短术和额肌瓣悬吊术矫治不同程度先天性上睑下垂的临床效果。方法选取我院2001年5月至2012年5月就诊的先天性上睑下垂患者99例131眼,随机分为提上睑肌缩短术组(51例61眼)和额肌瓣悬吊术组(48例70眼),术后随访3~12个月,评价手术效果。结果提上睑肌缩短术组患者术后并发症例数明显高于额肌瓣悬吊术组,差异具有统计学意义(P<0.05);重度患者中提上睑肌缩短术组术后并发症为14例,明显高于额肌瓣悬吊术组,差异具有统计学意义(P<0.05),但两组术后上睑遮盖上角膜平均数差异无统计学意义(P>0.05);额肌瓣悬吊术治疗重度的该症患者较前者疗效更为显著,患者满意率高达92.59%。经统计学分析,差异具有统计学意义(P<0.05)。结论提上睑肌缩短术不影响美观,对轻度先天性上睑下垂患者有显著疗效。而额肌瓣悬吊术则更适用于中度和重度先天性上睑下垂,尤其是肌力极差的患者。

Clinical effects of shortening operation of musculus levator palpebrae superioris and frontalis muscle flap suspension operation on correction of different degrees of congenital ptosis.

Objective To compare and analyze the clinical effects of shortening operation of musculus leva- tor palpebrae superioris and frontalis muscle flap suspension operation on correction of different degrees of congenital ptosis. Methods Ninety-nine patients with congenital ptosis （altogether 131 eyes） treated in our hospital from May 2001 to May 2012 were selected as the research subjects, and they were divided into two groups randomly, which were treated with shortening operation of musculus levator palpebrae superioris （51 cases, 61 eyes, group A） and fron- talis muscle flap suspension operation （48 cases, 70 eyes, group B）. Follow-up survey was carried out in three to twelve months to evaluate the operation effects. Results The occurrence rate of postoperative complications in group A was significantly higher that in group B, and the difference was statistically significant （P〈0.05）. Among patients with a more serious degree of congenital ptosis, 14 cases of postoperative complications were found in group, signifi- cantly more than those in group B （P〈0.05）. There was no significant difference in the average cases of undercorrec- tion and exposure keratitis （P〉0.05）. For severe patients, the curative effects of frontalis muscle flap suspension opera- tion were significantly better （P〈0.05）, with the satisfaction rate of patients reaching 92.59%. Conclusion Shorten- ing operation of musculus levator palpebrae superioris has a more obvious effect on the light degree of congenital pto- sis, without an aesthetic influence, while frontalis muscle flap suspension operation is more suitable for patients with middle degree and serious degree of congenital ptosis, especially for those patients with bad muscle force.