颞筋膜复合组织片法额肌悬吊术治疗重度上睑下垂的效果评价

Efficacy evaluation of frontalis muscle suspension through temporal-fasciae-complex sheet in the treatment of severe blepharoptosis

目的探讨利用颞筋膜复合组织片行额肌悬吊术在治疗重度上睑下垂中的应用效果。方法自2010年3月至2019年6月,中国医学科学院北京协和医学院整形外科医院整形九科收治了28例(36只眼)重度上睑下垂患者。在颞部切取带有双侧疏松结缔组织的颞深筋膜,即颞筋膜复合组织片。通过眼轮匝肌下隧道,利用颞筋膜复合组织片将睑板悬吊在额肌上。术后应用光点上睑距、最大光点上睑距、上睑动度与闭眼功能对术后效果进行系统评价。结果本组28例患者获随访12~36个月,患者平视时上睑缘均位于瞳孔上缘以上,外观流畅自然。术前与术后光点上睑距、最大光点上睑距、上睑动度差异均有统计学意义(P<0.05)。随访期间无复发和明显并发症发生。结论颞筋膜复合组织片法额肌悬吊术是治疗重度上睑下垂的有效方法;不仅能克服术后粘连的不良效果,而且能提供更均匀的仿生上提力;术后上睑外观良好,复发率较低。

Objective To explore the efficacy of frontalis muscle suspension through temporal-fasciae-complex sheet in the treatment of severe blepharoptosis. Methods From March 2010 to June 2019, 28 patients(36 eyelids) with severe blepharoptosis were collected. An incision in the temporal region was made to harvest deep temporal fascia with the loose connective tissue attached on both sides. Through the tunnel below orbicularis oculi muscle, the tarsal plate was suspended to the frontalis muscle by temporal-fasciae-complex sheet. The postoperative efficacy was evaluated by marginal reflex distance 1(MRD1), marginal reflex distance 1 as lifting eyebrow forcefully(MRD1 F), eyelid excursion and closable eyelid function. Results All 28 patients were followed-up for 12 to 36 months. The upper eyelid margins were located above the pupil upper margins when patients were under horizontal vision. The appearance was natural.There was a statistically significant difference among the preoperative and postoperative MRD1, MRD1 F and eyelid excursion(P<0.05). No recurrence and severe complications were found during the follow-up period. Conclusion The frontalis muscle suspension through temporal-fasciae-complex sheet is an effective method to correct severe blepharoptosis. This method can overcome the postoperative adhesion and provide even bionic lifting force. The appearance of upper eyelid is good after operation and the recurrence is low.