提上睑肌腱膜眶筋膜瓣与额肌瓣吻合矫正重度上睑下垂

Correction of severe ptosis by anastomosis of levator palpebrae superior lobe and frontal muscle flap

目的探讨提上睑肌腱膜眶筋膜瓣与额肌瓣吻合矫正重度上睑下垂的临床效果。方法术中切开眶隔，制做带蒂“舌形”眶隔筋膜瓣及提上睑肌腱膜瓣。在眼轮匝肌与眶隔间向眉区分离隧道，制作一宽15mm片状肌瓣，将眶隔膜瓣向上，额肌瓣向下，提上睑肌腱膜瓣向上牵引，三者重叠缝合，上睑缘重度以位于上角膜缘1～2mm为度。结果对23例27只眼采用此法治疗，随访2周-5年。其中24只眼良好，3只眼满意，重睑弧度自然美观，无一例复发及并发症出现。结论该手术结合了提上睑肌缩短及额肌瓣悬吊两者功能并加以优化，上睑悬吊固定牢固，不易复发，同时保留并加强提上睑肌的部分功能及运动方向，保持了提上睑肌原有附着结构和完整性，使得上睑弧度自然，外观美观满意，畸形矫正效果良好。

Objective To investigate the clinical effect of anastomosis of levator palpebrae superior lobe and frontal muscle flap on correction of severe ptosis. Methods Intraoperative incision and orbital septum, making pedicled ＇ tongue＇ orbital sep- tum aponeurosis flap and levator palpebrae superior lobe. Separation of tunnel to the eyebrow region in the orbicularis oculi mus- cle and the orbital compartment, making a 15 mm wide sheet muscle flap, the orbital septum flap of frontal muscle flap upward, downward, the levator palpebrae flap upward traction, three overlapping suture, upper eyelid severe to located on limbal 1 - 2 mm degree. Results For 23 cases （27 eyes）, the above treatment was given, the followed-up time was 2 weeks to 5 years. A- mong them, 24 eyes were exccelent, 3 eyes were good, with double eyelid radian, natural beauty, no recurrence or complications occurred. Conclusion The operation adopts function of the shortening of levator palpebrae superioris and frontal muscle flap suspension and optimizing, has firm fixation of upper eyelid suspension and less recurrence, at the same time, it can maintain and strengthen the function of the levator muscle and movement direction, keep the levator muscle of upper eyelid original attach- ment structure and integrity, has natural upper eyelid radian, beautiful appearance and good deformity correction.