联合筋膜鞘悬吊术（CFSS）治疗重度上睑下垂的疗效研究

发布时间：2018-03-26 02:33

本文选题：重度上睑下垂　切入点：额肌瓣悬吊术　出处：《广西医科大学》2017年硕士论文

【摘要】：研究背景:额肌瓣悬吊术(Frontalis Muscle Suspension:FMS)是目前比较公认的适用于重度上睑下垂治疗的方法,但其缺点明显:(1)不符合提上睑生理(2)术后眼睑闭合不全时间较长(3个月—1年,甚至更长时间)。上睑提肌缩短术适用于轻中度上睑下垂病例此术式较额肌瓣更符合提上睑生理要求,但上睑提肌功能极差或全缺失者,勉强作大量肌肉切除或折叠前移,术后往往也会造成明显的睑裂闭合不全时间较长,且远期睑下垂复发程度及几率较大。联合筋膜鞘悬吊术(Conjoint Fascial Sheath Suspension:CFSS)是2002年由=Hans Holmstrom和Fabio Santanelli,文献报道的方法。文献作者认为此法可用于重度上睑下垂治疗优点:(1)符合提上睑生理(2)术后眼睑闭合时间较短。本研究用两种进行量化比较:(1)MRD1(Marginal Reflex Distance):MRD1是将患者角膜上的光反射到上盖边缘中心水平的距离(患者注视在主要位置)。MRD1是评估上眼睑下垂的指标。(2)上睑上提量:是评估术后眼睑闭合程度的指标。检测方法:检查者用拇指沿眉毛长轴方向按压住额肌,先嘱患者闭眼,再嘱患者平视,此时上睑移动的距离为上睑上提量。本研究中,额肌瓣悬吊术后睁眼仍需额肌参与,不能排除其干扰,因此所有病例统一采用不按压额肌的方法测量数码照片。目的:对联合筋膜鞘悬吊术(CFSS)治疗先天性重度上睑下垂的疗效进行观察、比较及分析方法:采用回顾性研究方法,调阅患者档案病历及术前术后标准化数码照片结合患者的在体测量获得研究指标数据,并统计比较并发症发生情况。研究样本病例为25名先天性重度上睑下垂患者(33眼),双眼8例,单眼17例,年龄11-40岁,平均年龄25岁。分为二组:A组:额肌瓣组(FMS),14例(17只眼)B组:联合筋膜鞘悬吊术(CFSS)组11例(16只眼)。测量术后1个月与6个月测量MRD1与上睑上提量。SPSS 17.0统计分析软件分别对术前、术后的观察指标进行统计分析。采用完全随机对照t检验;p0.05时,差异具有统计学意义。结果:测量数据的单位用mm,两组术后1个月MRD1比较:FMS组为2.82±0.907,CFSS组则为2.84±0.068,P0.05,差异无统计学意义。两组术后6个月MRD1比为,FMS组则为2.81±0.964,CFSS组则为4.13±0.071,P0.05,差异有统计学意义。两组术后1个月上睑上提量比较:FMS组则为3.69±0.068,CFS组则为4.13±0.071,P0.05,差异有统计学意义。两组术后6个月上睑上提量比为,FMS组术后则为5.13±0.081,CFSS组术后则为5.35±0.073,P0.05,差异没有统计学意义。结论:相对额肌瓣悬吊法,CFSS在矫正重度上睑下垂的时具有同等效力,但其术后眼睑闭合不全的持续时间明显缩短。
[Abstract]:Background: frontalis Muscle suspension of frontalis Muscle suspension: FMS is a generally accepted method for the treatment of severe blepharoptosis, but its shortcomings are obvious: 1) it is not in accordance with the upper eyelid physiology 2) after operation, the time of eyelid incompetence is longer (3 months to 1 year). Shortening of levator palpebrae muscle is suitable for patients with mild to moderate blepharoptosis. This procedure is more suitable to the physiological requirements of levator palpebrae than frontalis muscle flap, but those with extremely poor or total loss of levator palpebrae muscle are forced to be excised or folded forward. There is also a tendency to cause obvious blepharofissure incompetence after surgery for a longer period of time. In addition, the degree and probability of recurrence of ptosis in the long term were higher. Conjoint Fascial Sheath suspension: CFSS was reported by Hans Holmstrom and Fabio Santanelli in 2002. The authors believe that this method can be used in the treatment of severe blepharoptosis. The eyelid closure time was shorter after upper eyelid physiology. In this study, we compared the distance of light from the cornea to the center of the limbus of the upper lid by using two kinds of quantitative comparison. (the focus of the patient was at the main position. MRD1 was used to evaluate the upper eye.) in this study, we compared the distance between the light of the cornea of the patient and the center of the edge of the upper lid. Upper eyelid elevation: an index to assess the degree of eyelid closure after operation. Test method: the examiner uses the thumb to press the frontal muscle along the long axis of the eyebrow. The patients were told to close their eyes first, and then to look flat. The distance of upper eyelid movement was the amount of upper eyelid lift. In this study, the frontal muscle was still required to participate in the eye opening after suspension of frontalis flap, and its interference could not be ruled out. Objective: to observe the therapeutic effect of combined fascial sheath suspension (CFSS) in the treatment of congenital severe blepharoptosis. Access to patient records and standardized digital photographs before and after surgery combined with in-vivo measurements of patients to obtain research index data, There were 25 patients with congenital severe blepharoptosis with 33 eyes, 8 eyes with binocular and 17 cases with single eye, aged 11-40 years. The average age was 25 years. The patients were divided into two groups: group A: FMS flap group (n = 14), group B (n = 17): group B (n = 11) with combined fascial sheath suspension, group A (n = 11), and group A (n = 16): 1 month and 6 months after operation, the MRD1 and the upper-eyelid volume were measured and analyzed by statistical analysis software SPSS17.0 before operation, respectively. Statistical analysis was made on the observation indexes after operation. Results: the MRD1 of the two groups was 2.82 卤0.907 卤2.84 卤0.068 and 2.84 卤0.068, respectively. The MRD1 ratio of the two groups was 2.81 卤0.964CFSS (2.81 卤0.964CFSS, 4.13 卤0.071CFSS, 4.13 卤0.071a, P 0.05) at 6 months after operation. There was significant difference between the two groups at 1 month after operation, and the ratio of upper eyelid lift was 5.13 卤0.081 in the FMS group, 5.35 卤0.073 in the CFSS group, and 5.35 卤0.073 in the CFSS group, but there was no difference between the two groups in the postoperative value of the upper eyelid lift volume in the FMS group (3.69 卤0.068) and the upper eyelid lift volume ratio in the FMS group was 5.13 卤0.081CFSS group (5.35 卤0.073, P 0.05) at 6 months after operation, and there was no difference between the two groups. Conclusion: the relative frontal muscle flap suspension method has the same effect in correction of severe blepharoptosis. However, the duration of eyelid incompetence was significantly shortened after operation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6;R62

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