动眼神经麻痹性上睑下垂手术疗效观察

Clinical effect of surgical correction of paralytic ptosis

目的探讨动眼神经麻痹性上睑下垂的手术治疗效果。方法回顾性病例分析。临床收治动眼神经麻痹性上睑下垂患者17例,均为单眼重度上睑下垂,行改良额肌筋膜瓣悬吊术,观察手术疗效及并发症的处理。结果本研究入组病例共17例17眼,术前检查所有患者提上睑肌肌力均小于1 mm,平均0.6 mm,额肌肌力8~12 mm,平均9.1 mm,睑缘角膜映光距离(MRD)值-4^-6 mm,平均-5.2 mm,Bell现象均为阴性或者可疑阳性。术后随访期末,手术效果优秀者1例(5.9%),MRD值2.4 mm;良好者12例(70.6%),MRD值平均1.6 mm;较差者4例(23.5%),MRD值平均0.9 mm。所有患者术后均存在不同程度的睑裂闭合不全,其中1例(5.9%)发生暴露性角膜炎,经及时给予绷带型角膜接触镜,同时联合使用人工泪液和角膜上皮修复药物后逐步恢复正常。结论动眼神经麻痹性上睑下垂行改良额肌筋膜瓣悬吊术,尽量避免过矫,术后重视暴露性角膜炎的预防和及时处理,多数病例均可取得良好的手术效果。

Objective To investigate the clinical effect of surgical correction of paralytic ptosis.Methods This retrospective study included 17 patients with unilateral several ptosis secondary to oculomotor nerve palsy who underwent modified frontalis muscle suspension.The clinical effect of surgical treatment and the management of complications were observed and analyzed.Results In this study,there were 17 enrolled cases(17 eyes).Preoperative examination in all patients showed that the levator muscle strength was less than 1mm,with an average of 0.6mm;the frontal muscle strength was 8-12mm,with an average of 9.1mm;the margin reflex distances(MRD)value was-4--6mm,with an average of-5.2mm;the Bell sign was negative or suspiciously positive.At the end of postoperative follow-up,the surgical effect was excellent in 1 case(5.9%)with the MRD value of 2.4mm,good in 12 cases(70.6%)with the MRD values averaged 1.6mm,poor in 4 cases(23.5%)with the MRD values averaged 0.9mm.All patients had different degrees of eyelid fissure closure after surgery,one of them(5.9%)had exposed keratitis.The cornea gradually returned to normal after giving use the bandage contact lenses,artificial tears and eye drops for promoting the repair of corneal epithelium.Conclusion Paralytic ptosis was treated with modified frontalis muscle suspension,avoiding overcorrection as far as possible,and paying attention to the prevention and management of exposed keratitis after operation,could achieve satisfactory surgical curative effect.