提上睑肌切除联合自体阔筋膜额肌悬吊术治疗Marcus-Gunn综合征
发布时间：2019-02-26 09:10
【摘要】：目的 分析Marcus-Gunn患者的临床特点,评估提上睑肌切除联合自体阔筋膜额肌悬吊手术治疗Marcus-Gunn综合征的临床效果。 设计 回顾性病例研究 方法 对浙江大学医学院附属第二医院眼科中心2009年7月至2012年12月间收治的12例(12眼)Marcus-Gunn综合征患者的病例资料进行临床特点分析,进行术前评估,对患者行患侧提上睑肌切除联合同侧自体阔筋膜额肌悬吊手术(术前已对患有弱视及垂直性斜视患者进行评估及矫正治疗),术后进行随访,评价其手术治疗效果。 结果 12例患者性别无统计学差异(男性4例,女性8例,p=0.248),眼别无统计学差异(右眼7例,左眼5例,p=0.564)。无家族史。手术时患者年龄4-39岁,平均年龄14.4岁。儿童患者7例,年龄4-12岁,平均年龄7.4岁。成人患者5例,年龄16～39岁,平均年龄24.2岁。12例患者术前患眼裸眼视力为0.04～1.0。弱视1例(8.3%),屈光参差2例(16.7%),斜视1例(8.3%)。12例患者术前健眼平均睑裂高度为8.75±0.45mm(8.0～9.0mm),患眼平均睑裂高度为4.42±1.08mm (3.0～7.0mm).患侧上睑下垂为4.33±1.07mm(2.0～6.0mm)。上睑联动幅度为2.0-7.0mm,平均4.67±1.44mm。患眼平均提上睑肌肌力为3.33±1.50mm(2.0-7.0mm)。 术后随访5月～45月,平均随访期为23.3个月。所有患者双侧睑裂高度对称,弧度自然,患眼平均睑裂高度为8.58±0.79mm(7.0～10.0mm),外观较术前明显改善。术后10/12例(83.3%)患者张口及咀嚼时上睑下颌联动现象完全解除,2/12例(16.7%)患者残余1.Omm联动。1/12例(8.3%)患者欠矫。4/12例(33.3%)患者术眼有轻度闭合不全,其中2例在术后半年内恢复。1例(8.3%)患者因上睑迟滞明显要求行二次手术治疗,行阔筋膜松解术后上睑迟滞明显改善。无暴露性角膜炎、睑内翻、结膜脱垂、上睑下垂复发等并发症出现。随访期末,9/12例(75%)患者表示对手术效果满意,3/12例(25%)患者较满意。 结论 有求治欲望的Marcus-Gunn综合征患者大多需要手术治疗。单侧提上睑肌切除联合同侧自体阔筋膜额肌悬吊手术具有操作简单、组织损伤小、疗效确切、术后外观美观、并发症少等优点,是治疗Marcus-Gunn综合征的理想手术方式。
[Abstract]:Objective to analyze the clinical features of patients with Marcus-Gunn and evaluate the clinical effect of levator palpebral muscle resection combined with self-suspension of frontal fascia lata in the treatment of Marcus-Gunn syndrome. Design retrospective case study methods the clinical data of 12 patients (12 eyes) with Marcus-Gunn syndrome admitted to the Ophthalmology Center of the second affiliated Hospital of Medical College of Zhejiang University from July 2009 to December 2012 were designed. To analyze the clinical features, The patients were evaluated pre-operatively and underwent levator muscle resection combined with ipsilateral levator fascia frontalis suspension operation (the patients with amblyopia and vertical strabismus were evaluated and corrected before the operation) and followed up after the operation. To evaluate the effect of surgical treatment. Results there was no significant difference in sex among 12 patients (M 4, F 8, p = 0.248). There was no significant difference between eyes (right eye 7 cases, left eye 5 cases, p = 0.564). No family history. The patients were 4 years old and 39 years old, with an average age of 14.4 years. There were 7 children with an average age of 7.4 years (4-12 years old). There were 5 adult patients aged 16 to 39 years with an average age of 24. 2 years. The preoperative naked visual acuity of 12 patients was 0. 04. 0. 0. 0. 0. 0. 0. 0. 0. 4%. Amblyopia was found in 1 case (8.3%), anisometropia in 2 cases (16.7%) and strabismus in 1 case (8.3%). The mean height of palpebral fissure in 12 cases was 8.75 卤0.45mm (8.0~9.0mm). The average height of palpebral fissure was 4.42 卤1.08mm (3.0~7.0mm). The ptosis of the affected side was 4.33 卤1.07 mm (2.0~6.0mm). The range of upper eyelid linkage was 2.0 卤7.0mm, with an average of 4.67 卤1.44mm. The average muscle strength of levator palpebrae was 3.33 卤1.50 mm (2.0-7.0mm). The follow-up period ranged from 5 months to 45 months, with an average follow-up period of 23.3 months. The average palpebral fissure height was 8.58 卤0.79mm (7.0~10.0mm). The appearance of bilateral palpebral fissure was significantly improved compared with that before operation. In 12 patients (83. 3%), the movement of upper eyelid and mandible was completely relieved during opening and mastication 10 months after operation. (2) residual 1.Omm linkage was found in 12 cases (16.7%), under correction in 12 cases (8.3%) and mild insufficiency in 12 cases (33.3%). Among them, 2 cases recovered within half a year after operation, and 1 case (8.3%) was treated with secondary operation because of upper eyelid hysteresis, and the upper eyelid hysteresis was obviously improved after fascia latissima release. No exposure keratitis, ectropion, conjunctival prolapse, recurrence of blepharoptosis and other complications occurred. At the end of follow-up, 12 patients (75%) were satisfied with the operation, and 12 patients (25%) were satisfied with the operation. Conclusion most of the patients with Marcus-Gunn syndrome need surgical treatment. Unilateral levator palpebral muscle resection combined with ipsilateral autogenous frontalis latissima muscle suspension operation has the advantages of simple operation, small tissue injury, definite curative effect, beautiful appearance and few complications after operation. It is an ideal surgical method for treatment of Marcus-Gunn syndrome.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R779.6
[Abstract]:Objective to analyze the clinical features of patients with Marcus-Gunn and evaluate the clinical effect of levator palpebral muscle resection combined with self-suspension of frontal fascia lata in the treatment of Marcus-Gunn syndrome. Design retrospective case study methods the clinical data of 12 patients (12 eyes) with Marcus-Gunn syndrome admitted to the Ophthalmology Center of the second affiliated Hospital of Medical College of Zhejiang University from July 2009 to December 2012 were designed. To analyze the clinical features, The patients were evaluated pre-operatively and underwent levator muscle resection combined with ipsilateral levator fascia frontalis suspension operation (the patients with amblyopia and vertical strabismus were evaluated and corrected before the operation) and followed up after the operation. To evaluate the effect of surgical treatment. Results there was no significant difference in sex among 12 patients (M 4, F 8, p = 0.248). There was no significant difference between eyes (right eye 7 cases, left eye 5 cases, p = 0.564). No family history. The patients were 4 years old and 39 years old, with an average age of 14.4 years. There were 7 children with an average age of 7.4 years (4-12 years old). There were 5 adult patients aged 16 to 39 years with an average age of 24. 2 years. The preoperative naked visual acuity of 12 patients was 0. 04. 0. 0. 0. 0. 0. 0. 0. 0. 4%. Amblyopia was found in 1 case (8.3%), anisometropia in 2 cases (16.7%) and strabismus in 1 case (8.3%). The mean height of palpebral fissure in 12 cases was 8.75 卤0.45mm (8.0~9.0mm). The average height of palpebral fissure was 4.42 卤1.08mm (3.0~7.0mm). The ptosis of the affected side was 4.33 卤1.07 mm (2.0~6.0mm). The range of upper eyelid linkage was 2.0 卤7.0mm, with an average of 4.67 卤1.44mm. The average muscle strength of levator palpebrae was 3.33 卤1.50 mm (2.0-7.0mm). The follow-up period ranged from 5 months to 45 months, with an average follow-up period of 23.3 months. The average palpebral fissure height was 8.58 卤0.79mm (7.0~10.0mm). The appearance of bilateral palpebral fissure was significantly improved compared with that before operation. In 12 patients (83. 3%), the movement of upper eyelid and mandible was completely relieved during opening and mastication 10 months after operation. (2) residual 1.Omm linkage was found in 12 cases (16.7%), under correction in 12 cases (8.3%) and mild insufficiency in 12 cases (33.3%). Among them, 2 cases recovered within half a year after operation, and 1 case (8.3%) was treated with secondary operation because of upper eyelid hysteresis, and the upper eyelid hysteresis was obviously improved after fascia latissima release. No exposure keratitis, ectropion, conjunctival prolapse, recurrence of blepharoptosis and other complications occurred. At the end of follow-up, 12 patients (75%) were satisfied with the operation, and 12 patients (25%) were satisfied with the operation. Conclusion most of the patients with Marcus-Gunn syndrome need surgical treatment. Unilateral levator palpebral muscle resection combined with ipsilateral autogenous frontalis latissima muscle suspension operation has the advantages of simple operation, small tissue injury, definite curative effect, beautiful appearance and few complications after operation. It is an ideal surgical method for treatment of Marcus-Gunn syndrome.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R779.6
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