上睑翼状韧带悬吊修复额肌瓣矫正重度上睑下垂术后复发

Repair of the recurrence of severe congenital ptosis after corrective surgery with conjoint fascia sheath suspension

目的探讨应用上睑翼状韧带悬吊修复额肌瓣矫正重度上睑下垂复发的临床疗效。方法自2013年1月至2016年5月,应用上睑翼状韧带悬吊修复矫正重度上睑下垂复发患者80例(80只眼);常规设计重睑切口线,松解游离各层次的瘢痕组织,离断额肌瓣于睑板的连接进行解剖复位;显露睑板上缘,在外侧位置进入提上睑肌下层,沿结膜面向穹窿方向分离,在上直肌前1/3和提上睑肌之间找到上睑翼状韧带,用6-0尼龙线将上睑翼状韧带及其对应的上睑提肌腱膜一同缝合于睑板上缘来矫正上睑下垂;将眶隔脂肪复位覆盖于睑板上缘,常规缝合形成重睑;设定术后睑裂高度较术前明显增大为满意。结果本组共80例(80只眼)患者。随访3~24个月,75只眼矫正良好,5只眼因与对侧差异较大而再次手术后效果满意。电话随访,患者均在15~90 d能完全闭眼,无其他并发症发生;重睑弧度、形态自然,外观满意。结论应用上睑翼状韧带悬吊修复额肌瓣矫正重度上睑下垂复发,能获得较满意的临床效果。

Objective To evaluate the clinical efficacy of conjoint fascia sheath（CFS） suspension in the repair of the recurrence of severe congenital ptosis. Methods From January 2013 to May 2016, conjoint fascia sheath suspension was performed in 80 patients（80 eyes） with recurrence after severe congenital ptosis correction. The double eyelid line was redesigned, the scar tissue at each layer was released and dissociated, the connection of frontal muscle flap to tarsal plate was amputated and anatomical reduction was performed. The eyelid board edge was exposed, and the lower layer of the levator palpebrae superioris muscle was penetrated at the lateral position. With separation toward the fornix along the conjunctiva, the CFS was located between the former 1/3 of the musculi rectus superior and the levator palpebrae superioris muscle. Ptosis was corrected by suturing the superior alar ligament and corresponding levator palpebrae superioris aponeurosis to the upper margin of the tarsal plate with 6-0 nylon thread. The orbital fat was restored and covered on the upper edge of the tarsal plate. Conventional suture was performed to shape the double eyelid. Success was assumed when the height of palpebral fissure measured significantly higher than before. Results All 80 cases were followed up from 3 to 24 months. Good correction was achieved in75 eyes. In 5 cases, satisfactory results were achieved after reoperation because of the large differences between bilateral eyes. All patients were able to completely close their eyes from 15 to 90 days. Double eyelid radian was natural and the appearance was satisfactory. No other complications occurred. Conclusion The application of conjoint fascia sheath suspension in the repair of recurrence after severe congenital ptosis correction can achieve satisfactory clinical results.