Modified Combined Fascia Sheath and Levator Muscle Complex Suspension With Muller Muscle Preservation on Treating Severe Congenital Ptosis
Modified Combined Fascia Sheath and Levator Muscle Complex Suspension With Muller Muscle Preservation on Treating Severe Congenital Ptosis
复制标题
保留Muller肌的改良组合筋膜鞘提上睑肌复合体悬吊术治疗重度先天性上睑下垂
DOI：
10.1097/sap.0000000000001657
复制
发表时间：
2019-01-01
影响因子：
1.5
通讯作者：
Fan, Xianqun
中科院分区：
文献类型：
--
作者：
Xing, Yue;Wang, Xi;Fan, Xianqun
背景：本研究旨在评估改良入路治疗重度先天性上睑下垂的效果。方法：经前路入路保留Muller肌，同时将上跗骨悬吊至联合筋膜鞘（CFS）和提肛肌（LM）复合体。主要观察指标包括边缘反射距离（MRD1）、睑裂高度（PFH）、MRD1消退、MRD1改善和患者自我满意度。结果：采用改良手术治疗重度先天性上睑下垂70例（90眼睑），其中双侧上睑下垂20例，单侧上睑下垂50例。平均LF为2.53±1.06 mm。术前MRD1和PFH分别为-0.06 +/- 0.76 mm和4.25 +/- 0.85 mm。随访至少6个月，平均12.67±4.92个月。术后即刻MRD1和PFH平均值分别为4.52 +/- 0.39 mm和9.24 +/- 0.26 mm。末次随访MRD1和PFH平均值分别为2.43 +/- 0.57 mm和7.16 +/- 0.69 mm，明显改善（P < 0.01）。术后1个月MRD1消退程度不同，末次随访MRD1消退为2.09 +/- 0.67 mm。术后即刻眼球lagophthalmos明显，6个月后正常释放。客观疗效评价：满意78眼（86.7%），改善4眼（4.4%），无效8眼（8.9%）。2只无效眼需再次行额叶悬吊手术。自我满意度为93.3%。参数分析显示，LF与末次随访MRD1呈正相关，与MRD1改善程度呈负相关（P < 0.01）。5眼有提上睑肌缩短史，与CFS + lmfs疗效显著相关（P < 0.01）。平均肿胀时间为0.53±0.41个月，至最后一次访视无并发症发生。结论：该改良方法矫正力度大，眼睑轮廓鲜明，手术步骤简单，并发症少，效果满意，值得推广应用。
Background: This study aims to evaluate the effect of a modified approach on severe congenital ptosis treatment.Methods: Through anterior approach, Muller muscle was preserved, meanwhile the upper tarsus was suspended to combined fascia sheath (CFS) and levator muscle (LM) complex. The main outcome measures included marginal reflex distance1 (MRD1), palpebral fissure height (PFH), MRD1 regression, MRD1 improvement, and patient self-satisfaction.Results: There were 70 patients (90 eyelids) with severe congenital ptosis received treatment of modified operation, including 20 bilateral and 50 unilateral ptosis. The average LF was 2.53 +/- 1.06 mm. The preoperative MRD1 and PFH was -0.06 +/- 0.76 mm and 4.25 +/- 0.85 mm, respectively. The follow-up was at least 6 months with average of 12.67 +/- 4.92 months. The immediate postoperative MRD1 and PFH average was 4.52 +/- 0.39 mm and 9.24 +/- 0.26, respectively. The last follow-up MRD1 and PFH average was 2.43 +/- 0.57 mm and 7.16 +/- 0.69 mm, respectively, which was improved significantly (P < 0.01). Therewere variety degrees ofMRD1 regression especially in the firstmonth after operation, and the last follow-up MRD1 regression was 2.09 +/- 0.67 mm. The lagophthalmos was obvious immediately after operation and regularly released after 6 months. Objective curative effect assessment showed 78 (86.7%) satisfactory eyes, 4 (4.4%) improved eyes, and 8 (8.9%) noneffective eyes. Two noneffective eyes required reoperation of frontalis suspension. Self-satisfaction rate was 93.3%. Parameters analysis showed that LF had positive correlation with last follow-up MRD1 and negative correlation with MRD1 improvement (P < 0.01). Five eyes had levator shorten history, which was associated remarkably with CFS + LMcurative effect (P < 0.01). Mean swelling timewas 0.53 +/- 0.41months, and no complications were observed until the last visit.Conclusions: This modified method gives powerful correction and vivid eyelid contour, featured with simple surgical procedures, few complications, and satisfactory effect, which is worth to wide application.