额肌动力上睑SMAS提紧治疗上睑下垂方法研究

The frontalis muscle and upper eyelid SMAS suspension for the surgical treatment of blepharoptosis

目的 研究重度上睑下垂的动力选择、上睑提升传动结构再造、传动方向设置和再造动力的起止点。方法 根据多年临床实践及尸体解剖研究 ,以治疗 2例家族性先天肌原性上睑下垂的过程 ,确定额肌作为上睑动力的解剖结构的命名 ;动力源滑车设计 ,动力传动组织结构 ;动力传布的方向 ;动力源额肌瓣的起点和止点设计 ,以及动力源额肌瓣的长宽设计等。结果 以额肌作为动力 ,额骨眶上缘作为滑车 ,上睑SMAS瓣为动力传动组织结构 ,取宽 12～ 15mm ,长 15～ 2 0mm的长方形额肌上睑SMAS瓣 ,置于眼轮匝肌后方。眶缘上 1cm额肌和SMAS结合处 ,作为上睑动力源的起点 ,上睑睑板上 1/ 3,为再造上睑动力的止点。修复后静态时 ,使矫正的上睑缘高于健侧 1～2mm ,即位于角膜上缘 ,或角膜上缘 1mm。 2例患者手术治疗后功能和外形得到改善。结论 额肌上睑SMAS提紧是治疗先天性重度上睑下垂和复发性上睑下垂的良好方法 ,手术操作简便 。

Objective To study the surgical treatment of severely congential blepharoptosis.including: the design of levator of upper eyelid; the reconstruction of suspension tissue for upper eyelid; and the location of suspension structure. Methods According to the experience of clinical practice and cadaver study and the treatment of two cases of congential myogenic blepharoptosis, to confirm the name of recontructive levator of upper eyelid; pulley of levator design; the reconstruction of suspension tissue for upper eyelid; and the location of suspension structure; and the design of flap of frontalis muscle and upper eyelid SMAS and so on. Results The levator reconstruction of upper eyelid by frontal muscle; the pulley of levator was set up at the edge of obital; the suspension tissue for upper eyelid by a flap of SMAS of upper eyelid, the suspension tissue passed through under the muscle of orbiculais orbitalis. The flap of SMAS were measured 12～15?mm in width and 15～20?mm in length. Two cases in one family with congenital myogenic blepharoptosis have treated and got good result. Conclusion The frontal muscle and upper eyelid SMAS lift that is good indication for the surgical treatment of severity congenital myogenic blepharoptosis and the recurred congential blepharoptosis. It is simple and good technique.