改良的联合筋膜鞘悬吊术治疗复发性上睑下垂的效果

Efficacy of modified fascial sheath suspension in the clinical treatment of recurrent ptosis

目的评估改良的联合筋膜鞘悬吊术治疗复发性上睑下垂的效果。方法前瞻性随机对照研究。纳入开封市中心医院2020年8月至2021年9月收治的复发性上睑下垂64例(64只眼),按数字表法随机分为两组,每组32例。对照组行常规额肌瓣悬吊术;观察组行改良的联合筋膜鞘悬吊术。术后随访12个月,比较两组临床疗效,术前和术后上睑缘角膜映光距离(MRD1)值,术后上睑提肌上提量和眼睑闭合不全程度,并发症发生率。结果观察组有效率(97.36%,37/38)较对照组(83.33%,30/36)高(χ^(2)=4.25,P=0.039);与术前相比较,两组术后3、6及12个月的上睑缘角膜映光距离均有所提升,观察组术后3、6、12个月上睑提肌缘高度值分别为(4.35±0.65)mm、(4.22±0.63)mm及(4.63±0.69)mm,均高与对照组的(4.05±0.60)mm、(3.83±0.57)mm及(4.21±0.62)mm(F_(组间)=20.19,P=0.001;F_(时间)=820.90,P=0.001;F_(交互)=1.96,P=0.002);观察组术后3、6及12个月上睑上提量分别为(4.32±0.64)mm、(5.41±0.81)mm及(5.38±0.80)mm,高与对照组的(4.01±0.58)mm、(4.96±0.74)mm及(5.01±0.75)mm,眼睑闭合不全程度分别为(2.25±0.33)mm、(1.23±0.18)mm及(0.24±0.03)mm,低与对照组的(3.68±0.55)mm、(2.74±0.41)mm及(1.55±0.23)mm(术后上睑提肌上提量:F_(组间)=14.94,P组间<0.05;F_(时间)=49.18,P时间<0.05;F_(交互)=0.17,P_(交互)=0.840;眼睑闭合不全程度:F_(组间)=1019.00,P组间<0.05;F_(时间)=726.20,P时间<0.05;F_(交互)=1.72,P_(交互)=0.180);术后并发症观察组(7.89%,3/38)发生率较对照组(25.00%,9/36)低(χ^(2)=3.98,P=0.046)。结论改良的联合筋膜鞘悬吊术治疗复发性上睑下垂效果显著,并发症发生率低。

Objective To evaluate the efficacy of modified combined fascial sheath suspension in the treatment of recurrent ptosis.Methods This was a prospective randomized controlled study.A total of 64 cases of recurrent ptosis from Aug.2020 to Sep.2021 in Kaifeng Central Hospital were divided into two groups based on the random number table method with 32 cases in each group.The control group received frontal muscle flap suspension and the observation group received modified combined fascial sheath suspension.Clinical efficacy,preoperative and postoperative margin reflex distance 1(MRD1)values,eyelid lift and degree of upper eyelid insufficiency after surgery,and the incidence of complications were compared between the two groups.Results The effective rate of the observation group(97.36%,37/38)was higher than that of the control group(83.33%,30/36)(χ^(2)=4.25,P=0.039).Compared with the preoperative results,the upper palpebral margin height values of both groups improved at 3,6 and 12 months after surgery.The upper palpebral margin height values of the observation group were(4.35±0.65)mm,(4.22±0.63)mm and(4.63±0.69)mm at 3,6 and 12 months after operation,respectively,which were higher than those of the control group[(4.05±0.60)mm,(3.83±0.57)mm and(4.21±0.62)mm](F_(group)=20.19,Pgroup=0.001;F_(time)=820.90,Ptime=0.001;F_(interaction)=1.96,Pinteraction=0.002).The upper eyelid lift values of the observation group were(4.32±0.64)mm,(5.41±0.81)mm and(5.38±0.80)mm at 3,6 and 12 months after operation,respectively,which were higher than those of the control group[(4.01±0.58)mm,(4.96±0.74)mm and(5.01±0.75)mm].The degrees of upper eyelid insufficiency were(2.25±0.33)mm,(1.23±0.18)mm and(0.24±0.03)mm,which were lower than those of the control group[(3.68±0.55)mm,(2.74±0.41)mm and(1.55±0.23)mm](postoperative upper eyelid lift:F_(group)=14.94,Pgroup<0.05,F_(time)=49.18,P_(time)<0.05,F_(interaction)=0.17,Pinteraction=0.84;degree of upper eyelid insufficiency:F_(group)=1019.00,Pgroup<0.05;F_(time)=726.20,P_(time)<0.05;F_(interaction)=1.72,Pinteraction=0.18).The incidence of postoperative complications in the observation group(7.89%,3/38)was lower than that in the control group(25.00%,9/36)(χ^(2)=3.98,P=0.046).Conclusion Modified fascial sheath suspension in the treatment for patients with recurrent ptosis has significant clinical effect,which is beneficial to improve the MRD1 and upper eyelid lift of patients,reducing the degree of upper eyelid insufficiency,and effectively reducing the incidence of postoperative complications.