重睑生物力学在轻度上睑下垂矫正术的应用

Biomechanics of double eyelid and clinical application in mild blepharoptosis

目的探讨重睑生物力学在轻度上睑下垂患者行重睑成形术的临床应用。方法2016年1月至2018年2月,南京医科大学附属友谊整形外科医院整形美容外科收集179例双侧轻度上睑下垂、单睑、内眦赘皮患者,其中合并上睑凹陷者23例。在轻度上睑下垂矫正联合重睑成形术中,通过合理平衡力的作用点、力的方向以及力的大小,将提上睑的主要力量分配给提上睑板用于睁眼。对存在上睑凹陷者,同时行眶隔脂肪转位和(或)自体脂肪填充。存在内眦赘皮者,同时行内眦赘皮矫正术。结果术后随访6个月至2年,15例患者效果欠佳,行二次手术修复:其中7例为术后重睑宽度不对称,3例因轻度上睑下垂矫正不足,2例因重睑宽度变浅、变窄,3例上睑凹陷矫正不足者行二次上睑凹陷自体脂肪脂肪填充。其余164例患者轻度上睑下垂均得到较好矫正,且重睑形态稳定、自然,效果满意。结论轻度上睑下垂矫正联合重睑成形术中,合理处理生物力学平衡,对避免术后并发症及改进重睑的手术效果有一定的临床意义。

Objective To investigate biomechanical properties of double eyelid surgery and its clinical application in upper blepharoplasty. Methods In the mild ptosis correction combined with double eyelid surgery, the main force from levator was assigned to upper tarsus to open eyes. At the same time, not only it could ensure the enough height of palpebral fissure, but also had relatively stable and persistent double eyelid. For those who had sunken upper eyelid, were given fat transposition and/or autologous fat grafting. For those who had medial epicanthal fold, to achieve a pleasing eye appearance, we performed epicanthoplasty. Results After 6 months to 2 years of follow-up, 15 cases had unsatisfactory results and underwent secondary surgery. The revision reason was as follows: 7 patients had asymmetry double eyelid width, 3 patients had insufficient correction for ptosis, 2 patients had shallower and narrower double eyelid line. In 3 cases, the correction of the upper sunken was insufficient. The remaining 164 patients with mild ptosis were well corrected, and the double eyelid was stable and natural, and the results were satisfactory. There were no major complications. Conclusions During mild blepharoptosis correction combined with double eyelid surgery, reasonable treatment of the biomechanical balance has certain clinical significance for avoiding postoperative complications and improving the effect of double eyelid surgery.