重度先天性上睑下垂节制韧带悬吊新手术

A new technique of check ligament suspension for severe congenital blepharoptosis

目的探讨节制韧带悬吊术治疗重度先天性上睑下垂的临床效果。方法48例（64眼）重度先天性上睑下垂随机分为两组：试验组24例（34眼）采用节制韧带悬吊术；对照组24例（30眼）采用额肌悬吊术。通过评价术后睑缘高度、睑缘弧度、眼部肿胀程度、睑裂闭合情况和上睑迟滞情况，比较两种术式治疗重度先天性上睑下垂的临床效果。结果术后随访6—24个月，两种手术方式都能有效矫正上睑下垂，改善外观。试验组术后眼部肿胀较轻，睑缘弧度自然，上睑迟滞轻微；对照组中4眼欠矫，1眼睑缘弧度欠佳，1眼发生上睑内翻，术后早期眼部肿胀较重，上睑迟滞较明显，2眼睑裂裂闭合相对延迟，半年后仍有闭合不全者6眼。结论用上直肌节制韧带代替上睑提肌治疗重度先天性上睑下垂疗效可靠，上睑运动与生理运动方向一致，术后眼睑外形动态与静态均较自然。

Objective To invastigate the clinical efficacy of check ligament suspension for severe congenital blepharoptosis. Methods Sixty-four eyes of 48 patients of severe congenital blepharoptosis were divided randomly into trial group, suspension of the eyelid to the check ligament（ 34 eyes of 24 cases） ; and control group, frontal muscle suspension surgery （S0 eyes of 24 cases）. The clinical efficacy was compared according to the condition of the palpebral height, eyelid margin radian, edema, palpebral fissure closure and hd lag after surgery. Results After following up for 6 - 24 months, eyelids were all raised and appearance was improved in both groups. In trial group, the edema was less, the eyelid was more natural and lid lag was less. In control group, 4 of the 24 patients were undercorrection, 1 patient＇ s eyelid margin radian was not good and 1 patient got trichiasis. Patients in control group had more severe edema and obvious lid lag. Two patients＇ palpebral fissure closure was delayed. Lagophthalmos in 6 eyes still existed 6 months after surgery. Conclusion The suspension of the check ligament instead of musculi levator palpebrae superioris has reliable efficacy. The movement of upper eyelid is identical to the physical status, and the appearance of eyelids is more natural after surgery.