老年性上睑下垂退行性改变个性化治疗临床分析

Observation of individual therapeutic methods based on degenerative change of levator aponeurosis in patients with senile ptosis

目的依据老年性上睑下垂术中提上睑肌退行性改变实施个性化手术治疗，并对其效果进行评价。方法对2007年9月至2014年5月间在河北省眼科医院收治的40例（74只眼）老年性上睑下垂患者行手术治疗，术中根据提上睑肌腱膜改变将其分为3类：提上睑肌腱膜松弛无力为乏力型，行提上睑肌折叠术20只眼；提上睑肌腱膜部分断裂或裂孔为裂孔型，行裂孔修补术28只眼；提上睑肌增厚并呈现脂肪样改变为变性型，切除变性组织并行提上睑肌缩短术26只眼。结果上睑活动轻度受限、重睑欠对称3只眼（4％），上睑活动受限、重睑不对称2只眼（2％），其余患者重睑弧度自然，外形美观，随访2年，满意率达94％。结论根据老年上睑下垂提上睑肌解剖结构的改变行个性化合理选择手术方式，可取得最佳的治疗效果。

Objective According to the anatomy of levator aponeurosis in patients with senile ptosis, implete different operation and evaluate the effect. Methods 40 patients with senile ptosis were selected from our department between September 2007 and May 2014. According to the status of anatomy of levator aponeurosis each individual patient,they were divided into 3 types：the patients with levator aponeurosis weakness, were performed levator aponeurosis folding on 20 eyes, levator aponeurosis partial rupture were performed levator aponeurosis repair on 28 eyes,levator aponeurosis thickening and fat change,were performed superior levator muscle shortening on 26 eyes. Results Af- ter the surgery,3 eyes slightly restricted（4%）,2 eye was overeorreeted（2%）,The remaining patients were properly corrected that followed for more than 2 years with good effect, beauty, and without complications.Satisfaction rate was 94%. Conclusions In order to achieve the best correction in pa- tients with senile ptosis, it is important that selecting appropriate operation modes according to the anatomy of levator aponeurosis.