应用外翻严重度评分评价涤纶心脏补片联合睑板缩短术治疗麻痹性下睑外翻的手术疗效

Evaluation of surgical effect of heart dacron graft combined with tarsal plate shortening for paralytic ectropion by the ectropion severity score

目的应用外翻严重度评分(ESS)评价涤纶心脏补片联合睑板缩短术治疗麻痹性下睑外翻的手术疗效。设计回顾性病例系列。研究对象2017年5月至2019年6月北京同仁医院手术治疗的麻痹性下睑外翻患者7例(7眼),其中男性5例(5眼),平均年龄(70±9)岁。方法手术方法为将涤纶心脏补片修剪至合适尺寸后内侧固定于内眦韧带及内侧眶缘,外侧固定于外侧眶缘,同时联合行睑板缩短术。基于眼外观照相的ESS对下睑外翻的位置和程度,有无巩膜暴露、睑结膜暴露、泪膜过多、结膜充血、眦角圆顿、泪小点外翻的体征逐项评分,最高分为8分。应用ESS评分评价术前下睑外翻严重度及术后疗效。平均随访(19±10)个月。主要指标ESS评分及手术并发症。结果术前ESS评分4.5~8分,中位数为8分;术后随访终点ESS评分0~1分,中位数为0分;较术前显著好转(Z=-0.756,P=0.017)。无欠矫及复发,成功率100%。植入物无移位或脱位。结论涤纶心脏补片联合睑板缩短术应用于麻痹性下睑外翻的治疗安全有效,外翻严重度评分是一种直观并可量化的评价方法。

Objective To evaluate the surgical effect of heart dacron graft combined with tarsal plate shortening in the treatment of paralytic ectropion by the ectropion severity score(ESS).Design Retrospective case series.Participants Seven patients diagnosed with paralytic ectropion in Beijing Tongren Hospital between May 2017 and June 2019.Methods All of the participants received heart dacron graft combined with tarsal plate shortening for the correction of ectropion suspension.The heart dacron graft with suitable size was fixed medially to the inner canthus ligament and nasal orbital rim,and laterally to the temporal orbital rim.The preoperative and postoperative degree of ectropion was evaluated by the ESS based on photograph,depending on the range and degree of lower eyelid ectropion,the present of sclera show,conjunctival show,excess tear film,redness of the eye,round canthus and punctum lacrimale.The maximum score was 8 points.This photograph-based scoring was made by one researcher and reviewed by another superior physician.Main Outcome Measures ESS and postoperative complications.Results Among 7 patients(7 eyes) participated in this preliminary study,71% were male(5 eyes),with mean age of 70±9 years-old.The mean follow-up time was 19±10 months(range 6-36 months).The end point follow-up ESS score(median 0,range 0-1) was significantly improved compared to preoperative score(median 8,range 4.5-8,Z=-0.756,P=0.017).There was no under correction nor recurrence,and the success rate was 100%.No shift or dislocation of the implanted graft occurred.The patients were satisfied with the surgical appearance.Conclusion Heart dacron graft combined with tarsal plate shortening is an effective method for the correction of paralytic ectropion.ESS is a photograph-based and useful tool to evaluate the severity of paralytic ectropion.