额肌瓣悬吊与扇形额肌瓣悬吊两种手术方式治疗重度上睑下垂的临床效果观察

Effect of two kinds of frontal muscle flap in the treatment of severe congenital upper eyelid prolapse

目的探讨额肌瓣悬吊与扇形额肌瓣悬吊两种手术方式治疗重度上睑下垂的临床效果。方法收集广东省佛山市禅城区中心医院眼科31例（41只跟）重度上睑下垂的患者进行研究。按照自由表法将全部患者随机分为两组。I组，16例（22只眼），行额肌瓣悬吊术：Ⅱ组，15例（19只眼），行扇形额肌瓣悬吊术。手术后随访1年。全部患者术后1个月及1年时患跟的矫正情况，采用眼数和百分比的方式进行描述；其中，I组与Ⅱ组的组间比较采用Ⅳ。检验。全部患者术后各时间点的上睑回退量，采用均数±标准差（x±s）进行描述；其中，I组与Ⅱ组的组间比较采用独立样本t检验。全部患者术后1个月及1年时患眼并发症和眼睑高度对称度的情况，采用眼数和百分比进行描述；其中，I组与Ⅱ组的组间比较采用χ2检验。以P〈0．05表示差异具有统计学意义。结果I组患者采用额肌瓣悬吊术、Ⅱ组患者采用扇形额肌瓣悬吊术治疗后1个月时，I组16例（22只眼）患者中，矫正者14例（20只眼），占90．91％：欠矫者1例（1只眼），占4．55％；过矫者1例（1只眼），占4．55％。1／组17例（19眼）患者中，矫正者15例（16只眼），占84．21％；欠矫者0例（0只眼），占0．00％；过矫者2例（3只眼），占15．79％。两组数据经过χ2检验，差异无统计学意义（χ2=2．21，P〉0．05）。I组患者采用额肌瓣悬吊术、Ⅱ组患者采用扇形额肌瓣悬吊术治疗后1年时，I组16例（22只眼）患者中，完全矫正者13例（18只眼），占81．82％；基本矫正者2例（3只眼），占13．64％；部分矫正者1例（1只眼），占4．55％；未矫正者0例（0只眼），占0．00％。II组17例（19眼）患者中，完全矫正者15例（17只眼），占89．47％；基本矫正者2例（2只眼），占10．53％；部分矫正者0例（0只眼），占0．00％；未矫正者0例（0只眼），占0．00％。两组数据经过，检验，差异无统计学意义（χ2=1．05，P〉0．05）。I组患者采用额肌瓣悬吊术、Ⅱ组患者采用扇形额肌瓣悬吊术治疗后上睑回退量，I组16例（22眼）中，术后1周、3个月、6个月及1年回退量分别为（0．47±0．65）mm、（0．35±0．68）mm、（0．31±0．52）mm及（0．27±0．41）mrll；Ⅱ组17例（19眼）中，术后1周、3个月、6个月及1年回退量分别为（0．98±0．79）mm、（0．87±0．41）mm、（0．76±0．41）mm和（0．71±0．39）mm。两组各时间点比较差异有统计学意义（t=-2．31，-2．39，-2．68，-2．92；P〈0．05）。I组患者采用额肌瓣悬吊术、Ⅱ组患者采用扇形额肌瓣悬吊术治疗后1个月内，I组16例（22眼）患者中，发生并发症3例（3只眼），占13．64％。其中，暴露性角膜炎1例（只1眼）、睑缘切迹1例（1只眼）及睑裂不对称1例（1只眼）。Ⅱ组17例（19只眼）患者中，发生并发症6例（8只眼），占42．11％。其中，暴露性角膜炎2例（3只眼）、睑缘切迹2例（2只眼）、睑缘成角畸形1例（1只跟）及睑裂不对称1例（2只眼）。两组患者发生并发症差异有统计学意义（χ2=4．22，P〈0．05）。此外，两组患者重睑皱襞均明显，且均存在眼睑闭合不全及上睑迟落现象。I组患者采用额肌瓣悬吊术、Ⅱ组患者采用扇形额肌瓣悬吊术治疗1年后，I组16例（22只眼）患者中，发生并发症2例（2只眼），占9．09％。其中，睑缘切迹1例（1只眼），眼睑闭合不全1例（1只眼）。Ⅱ组17例（19只眼）患者中，发生并发症4例（4只眼），占21．05％。其中，睑缘切迹1例（1只眼）、睑缘成角畸形1例（1只眼）及眼睑闭合不全2例（2只眼）。两组患者发生并发症差异有统计学意义（13．42，P〈0．05）。I组患者采用额肌瓣悬吊术、Ⅱ组患者采用扇形额肌瓣悬吊术治疗后，对患者进行上睑睑高对称度的检查。结果在患者平视状态下，I组16例（22眼）患者中，满意者16例（19只眼）；Ⅱ组17例（19眼）患者中，满意者14例（15只眼）；两组差异无统计学意义（χ2=0．40，P〉0．05）。在患者上视状态下，I组16例（22只眼）患者中，满意者8例（10只眼）。Ⅱ组17例（19只眼）患者中，满意者9例（10只眼）。两组差异无统计学意义（χ2=2．34，P〉0．05）。结论额肌瓣悬吊术与扇形额肌瓣悬吊术两种手术方法均有良好的临床治疗效果，且效果相当。前者比后者并发症少，但在眉部会遗留少许瘢痕。后者更适合于外伤性上睑下垂。

Objective To investigate the clinical effect of two kinds of surgical treatment of the simple frontalis muscle flap suspension and the fan-shaped frontalis muscle flap suspension in the treatment of severe congenital ptosis. Methods 3l patients （41 eyes） with severe congenital ptosis were collected from department of Ophthalmology, Central Hospital of Foshan Chancheng District, Guangdong province. All patients were randomly divided into two groups according to the free table method. The group Ⅰhas16 cases （22 eyes） which received simple frontalis muscle flap suspension surgery and the group Ⅱ has 15 cases （19 eyes） which received fan-shaped frontalis muscle flap suspension surgery. The number of eyes and percentage were used to describe the correction of eyes of all the patients after 1 month and 1 year; among them, χ2 test was used in the group comparison of group I and group H. The upper eyelid backspace quantity of all patients at each time point was described by mean ± standard deviation （x±s） ; among them, independent samples t test was used in the group comparison of group l and group II. The difference was statistically significant with P〈0.05. Results One month after the surgery , among the 16 cases （22 eyes） who accepted the simple frontalis muscle flap suspension in group I , the correction of severe congenital ptosis is 14 cases （20 eyes）, accounting for 90.91%; the under-correction is 1 case （1 eye）, accounting for 4.55% ; the over-correction is 1 case （ 1 eye） about 4.55%. The difference of the two sets of data was not statistically significant though X2test （P〉0.05, χ2 = 2.21 ）. One year after the surgery, among the 16 cases （22 eyes） who accepted the simple frontalis muscle flap suspension in group I , the complete correction of severe congenital ptosis is 13 cases （ 18 eyes）, accounting for 81. 82% ; the correction is 2 cases （3 eyes）, 13.64% ; the partial correction is 1 case （1 eye）, 4.55% ; the uncorrected in 20 cases （20 eyes） is 0 case, and the percentage is 0.00%. While among the 17 cases （19 eyes） in group II who accepted fan-shaped frontalis muscle flap suspension, 15 cases （17 eyes） were complete correction, 89.47% ; 2 cases （2 eyes） were correction, 10.53% ; the partial correction and the uncorrected in 20 cases （20 eyes） was 0 case , and the percentage is 0.00%. The difference of the two sets of data was not statistically significant though χ2 test （P 〉 0. 05, χ2 = 1. 05 ）. However, the quantity of the 17 cases （19 eyes） in group II who accepted fan-shaped frontalis muscle flap suspension is （0.98±0.79） ram, （0.87±0.41） mm, （0.76±0.41） mm and （0.71±0.39） mm respectively, after 1 week, 3 months, 6 months and 1 year of the treatment. The difference of the two sets of data was statistically significant at each time point（t=-2.31 ,-2.39,-2.68,-2.92;P〈0.05）. During the one month of the treat I ment, among the 16 cases （22 eyes） who accepted the simple frontalis muscle flap suspension in group [ , there were 3 complications （3 eyes）, accounting for 13.64%. The difference of the two groups of patients who cased complications had statistical significance （χ2 = 4.22, P〈0.05）. In addition, the double eyelid plicas of the two groups of patients were all significantly, and they all had hypophasis and upper eyelid lag phenomenon. After the one year of the treatment, among the 16 cases （22 eyes） who accepted the simple frontalis muscle flap suspension in group I , there were 2 complications （2 eyes） , accounting for 9.09%. The difference of the two groups of patients who cased complications had statistical significance （χ2 = 13.42, P〈0.05 ）. To test the degree of symmetry＂ of eyelid height of the patients in group I who were treated with simple frontalis muscle flap suspension and group II patients with fan- shaped frontalis muscle flap suspension. When the patients looked straightly, there were 16 cases （19 eyes） satisfied with the results among thel6 cases （22 eyes） patients in group I. However, there were 14 cases （15 eyes） satisfied with the results among the 17 cases （ 19 eyes） patients in group II ; the difference between the two groups had no statistical significance （χ2 =0.40,P〉0.05）. However, there were 9 patients （ 10 eyes） satisfied with the results among the 17 cases （19 eyes） patients in group II. The difference between the two groups had no statistical significance （χ2 = 2.34,P〉0.05）. Conclusion Both of the two surgical methods of the frontalis muscle flap suspension and the fan-shaped frontalis muscle flap suspension have a good clinical effect, and the effect is equal. The former has fewer complications than the latter, but it will leave patients a little scar in the brow. And the latter is more suitable for traumatic ptosis.