额肌悬吊术治疗重度先天性上睑下垂的效果分析

Analysis of Clinical Effects on Severe Congenital Blepharoptosis by Frontalis Aponeurosis Flap Suspension

目的探讨在额肌筋膜瓣悬吊术中，行否睑轮匝肌桥瓣对手术效果的影响。方法分析2003～2006年接受手术治疗的重度先天性上睑下垂患者，随机分为A组（术中做睑轮匝肌桥瓣）与B组（术中未做睑轮匝肌桥瓣），比较两组术后远期效果。结果术后6个月比较，A组矫正满意42只眼，矫正良好7只眼，矫正不良2只眼；B组矫正满意51只眼，矫正良好6只眼，矫正不良0只眼，经Ridit检验两组差异有统计学意义（P〈0．01）。结论在额肌筋膜瓣悬吊术中，睑轮匝肌桥瓣对手术效果并无至关重要的作用，相反因其术后较多的产生局部粘连，可能使额肌筋膜瓣的活动性受到一定程度的限制。因此，不主张在该手术中采用睑轮匝肌桥瓣的做法。

Objeetive To evaluate whether orbicularis muscle bridge can affect the clinical results for treating severe congenital blepharoptosis by frontalis aponeurosis flap suspension surgery. Methods The subjects were selected from the in-hospital severe blepharoptosis patients of Fuzhou Southeast Eye Hospital from 2003 to 2006. All patients were randomly allocated into two groups： Group A （with orbicularis muscle bridge ） and Group B （without orbicularis muscle bridge ）. There were 44 patients （ 51 eyes ） in Group A and 49 patients （57 eyes） in Group B. All patients of these two groups were followed up and the near and long-term therapeutic effects were compared. Results In group A, 42 eyes were completely corrected, 6 eyes corrected, 2 cases poorly corrected. In group B, 51 eyes completely corrected, 6 eyes corrected, and none poorly corrected. There is statistical difference between the two groups using Ridit method （P 〈0.01 ）. Conclusions Making an orbicularis muscle bridge during frontalis aponeurosis flap suspension surgery can not contribute to the clinical results for treating severe congenital blepharoptosis. Orbicularis muscle bridge may limit the activity of frontalis aponeurosis flap because of local adhesion. Therefcre we do not advocate orbicularis muscle bridge during frontalis aponeurosis flap suspension surgery for treating severe congenital blepharoptosis.