以额肌为动力治疗上睑下垂方法的改进

Improvement of frontal muscle-fascia suspension for blepharoptosis treatment

目的 探索一种简便、实用的以额肌为动力治疗上睑下垂的方法的改进。方法 对22例不同程度的上睑下垂患者仍利用额肌作为动力，将分离的额肌筋膜直接固定于睑板上缘进行治疗。术中经重睑成形术切口将额肌筋膜与皮下组织充分游离，在眶上缘下横行切开额肌筋膜长约1．5cm，在骨膜表面向上分离额肌筋膜，至眶上1．5cm左右，不制作额肌筋膜瓣，然后将分离的额肌筋膜直接向下牵拉与睑板上缘睑上提肌腱膜缝合固定3～4针，并调整固定至张力适度为止，术中无需分离眼轮匝肌后隧道。结果 22例伤口均I期愈合，睁眼时无抬眉、皱额表现，重睑外形佳，双眼对称，手术效果良好，患者满意。经3～6个月随访，无1例复发。结论 借用额肌作为动力，将额肌筋膜直接与睑板上缘缝合悬吊治疗上睑下垂，方法简便，疗效稳定，损伤小，并发症少。此方法可应用于额肌功能正常的各型上睑下垂患者。

Objective To introduce a new and practical method of treating blepharoptosis with di- rect suspension of the frontal muscle-fascia improvement. Methods 22 cases of blepharoptosis were corrected by direct suspension of the frontal muscle-fascia in which the dynamia still came from frontal muscle. Through double-fold eyelid incision, the frontal muscle-fascia was dissected from the subcutaneous tissue and a I. 5 cm length incision of the frontal muscle-fascia was cut under the supraorbital margin. And through the incision, the frontal muscle-fascia on the superficies of periosteum was dissected 1.5 cm to the upper margin of orbital, and then the frontal muscle-fascia was pulled down and fixed to the levator muscle aponeurosis directly by mattress sutures, with the tension being adjusted to a moderate degree. Results 22 cases of blepharoptosis were cured by primary healing with this method. The patients were followed up for 3 to 6 months with satisfactory results and no recurrence. Conclusion Compared with the traditional methods, this one may decrease the damage to the upper lid and frontalis area, leaving no risk of damaging the vessels or nerves. The technique is simple and the curative effect is affirmed. It can be used to treat any blepharoptosis patient with normal frontal muscle function.