用穹窿悬韧带前徙法矫正先天性上睑下垂临床研究

Preceding Operation of Suspensory Ligment of the Fornis for correction of Congenital Blepharoptosis

目的 探讨矫正先天性上睑下垂简单、无损伤、效果好的手术方式.方法 收集2014年9月至2015年3月在武汉爱尔眼科医院应用穹窿悬韧带前徙矫正先天性上睑下垂74例,其中男33例,女41例,年龄2～60（平均16.5岁）,单眼50例,双眼24例.全麻或局麻下,按标记的重睑线切开眼睑皮肤,打开眶膈,在提上睑肌复合体与结膜间向上穹窿分离,找到隙间筋膜鞘即穹窿悬韧带后,将其用缝线固定于睑板前表面,依眼睑位置,调整缝线高度,至满意为止,然后关闭创口.结果 74例的94只手术眼,术后上睑均矫正到满意位置,双侧对称,无暴露性角膜疾患发生.在术后观察期内,上睑位置稳定.结论 此法利用了提上睑肌复合体和上直肌共同的上转功能,较好地矫正各种程度的先天性上睑下垂,不截除肌肉,不添加组织或材料,且疗效稳定可靠.该法是目前矫正先天性上睑下垂较理想的一种手术方式.

Objective To investigate the simplest、harm minimazation and good effect surgical option for congenital blepharoptosis.Methods 17 patients affected by simple congenital bleapharoptosis were operated using the technique of suspending the eyelid to the check ligament from Sep.15th,2014 to March.15th,2015.Among the patients,33 were male,41 were female,the patients ranged from 2-60 years old with a mean age was 16.5,50 patients were unilateral and 24 were bilateral.Surgeries were under general anaesthesia or local anaesthesia,After incision of the skin and underlying orbicularis muscle,the orbit septurm was opened,Dissection was made between the levatoraponeurosis complex and conjuctival up to the fornix,when the check ligament of the superior conjunctival fornix was verified,it was sutured to the tarsus,adjusting the height of the suture until the height and contour of the eyelid was satisfied,closed the skin.Results 74 Patient（94 eyes） were operated,after the surgery,all patients got a satisfactory position of the eyelid,there were no occurrence of exposure keratitis and the position of the eyelid was stable during the followed up.Conclusions The new technique was proved to be quite successful in congenital blepharoptosis,its advantage over other technique was no involving neither resection of the muscle or additional of tissue or implant,and the efficacy of the treatment was stable.In conclusion we considered ita ideal surgical option for correcting congenital blepharoptosis.