本文選題：重度上瞼下垂　切入點(diǎn)：額肌瓣懸吊術(shù)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:額肌瓣懸吊術(shù)(Frontalis Muscle Suspension:FMS)是目前比較公認(rèn)的適用于重度上瞼下垂治療的方法,但其缺點(diǎn)明顯:(1)不符合提上瞼生理(2)術(shù)后眼瞼閉合不全時(shí)間較長(3個(gè)月—1年,甚至更長時(shí)間)。上瞼提肌縮短術(shù)適用于輕中度上瞼下垂病例此術(shù)式較額肌瓣更符合提上瞼生理要求,但上瞼提肌功能極差或全缺失者,勉強(qiáng)作大量肌肉切除或折疊前移,術(shù)后往往也會造成明顯的瞼裂閉合不全時(shí)間較長,且遠(yuǎn)期瞼下垂復(fù)發(fā)程度及幾率較大。聯(lián)合筋膜鞘懸吊術(shù)(Conjoint Fascial Sheath Suspension:CFSS)是2002年由=Hans Holmstrom和Fabio Santanelli,文獻(xiàn)報(bào)道的方法。文獻(xiàn)作者認(rèn)為此法可用于重度上瞼下垂治療優(yōu)點(diǎn):(1)符合提上瞼生理(2)術(shù)后眼瞼閉合時(shí)間較短。本研究用兩種進(jìn)行量化比較:(1)MRD1(Marginal Reflex Distance):MRD1是將患者角膜上的光反射到上蓋邊緣中心水平的距離(患者注視在主要位置)。MRD1是評估上眼瞼下垂的指標(biāo)。(2)上瞼上提量:是評估術(shù)后眼瞼閉合程度的指標(biāo)。檢測方法:檢查者用拇指沿眉毛長軸方向按壓住額肌,先囑患者閉眼,再囑患者平視,此時(shí)上瞼移動的距離為上瞼上提量。本研究中,額肌瓣懸吊術(shù)后睜眼仍需額肌參與,不能排除其干擾,因此所有病例統(tǒng)一采用不按壓額肌的方法測量數(shù)碼照片。目的:對聯(lián)合筋膜鞘懸吊術(shù)(CFSS)治療先天性重度上瞼下垂的療效進(jìn)行觀察、比較及分析方法:采用回顧性研究方法,調(diào)閱患者檔案病歷及術(shù)前術(shù)后標(biāo)準(zhǔn)化數(shù)碼照片結(jié)合患者的在體測量獲得研究指標(biāo)數(shù)據(jù),并統(tǒng)計(jì)比較并發(fā)癥發(fā)生情況。研究樣本病例為25名先天性重度上瞼下垂患者(33眼),雙眼8例,單眼17例,年齡11-40歲,平均年齡25歲。分為二組:A組:額肌瓣組(FMS),14例(17只眼)B組:聯(lián)合筋膜鞘懸吊術(shù)(CFSS)組11例(16只眼)。測量術(shù)后1個(gè)月與6個(gè)月測量MRD1與上瞼上提量。SPSS 17.0統(tǒng)計(jì)分析軟件分別對術(shù)前、術(shù)后的觀察指標(biāo)進(jìn)行統(tǒng)計(jì)分析。采用完全隨機(jī)對照t檢驗(yàn);p0.05時(shí),差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:測量數(shù)據(jù)的單位用mm,兩組術(shù)后1個(gè)月MRD1比較:FMS組為2.82±0.907,CFSS組則為2.84±0.068,P0.05,差異無統(tǒng)計(jì)學(xué)意義。兩組術(shù)后6個(gè)月MRD1比為,FMS組則為2.81±0.964,CFSS組則為4.13±0.071,P0.05,差異有統(tǒng)計(jì)學(xué)意義。兩組術(shù)后1個(gè)月上瞼上提量比較:FMS組則為3.69±0.068,CFS組則為4.13±0.071,P0.05,差異有統(tǒng)計(jì)學(xué)意義。兩組術(shù)后6個(gè)月上瞼上提量比為,FMS組術(shù)后則為5.13±0.081,CFSS組術(shù)后則為5.35±0.073,P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。結(jié)論:相對額肌瓣懸吊法,CFSS在矯正重度上瞼下垂的時(shí)具有同等效力,但其術(shù)后眼瞼閉合不全的持續(xù)時(shí)間明顯縮短。
[Abstract]:Background: frontalis Muscle suspension of frontalis Muscle suspension: FMS is a generally accepted method for the treatment of severe blepharoptosis, but its shortcomings are obvious: 1) it is not in accordance with the upper eyelid physiology 2) after operation, the time of eyelid incompetence is longer (3 months to 1 year). Shortening of levator palpebrae muscle is suitable for patients with mild to moderate blepharoptosis. This procedure is more suitable to the physiological requirements of levator palpebrae than frontalis muscle flap, but those with extremely poor or total loss of levator palpebrae muscle are forced to be excised or folded forward. There is also a tendency to cause obvious blepharofissure incompetence after surgery for a longer period of time. In addition, the degree and probability of recurrence of ptosis in the long term were higher. Conjoint Fascial Sheath suspension: CFSS was reported by Hans Holmstrom and Fabio Santanelli in 2002. The authors believe that this method can be used in the treatment of severe blepharoptosis. The eyelid closure time was shorter after upper eyelid physiology. In this study, we compared the distance of light from the cornea to the center of the limbus of the upper lid by using two kinds of quantitative comparison. (the focus of the patient was at the main position. MRD1 was used to evaluate the upper eye.) in this study, we compared the distance between the light of the cornea of the patient and the center of the edge of the upper lid. Upper eyelid elevation: an index to assess the degree of eyelid closure after operation. Test method: the examiner uses the thumb to press the frontal muscle along the long axis of the eyebrow. The patients were told to close their eyes first, and then to look flat. The distance of upper eyelid movement was the amount of upper eyelid lift. In this study, the frontal muscle was still required to participate in the eye opening after suspension of frontalis flap, and its interference could not be ruled out. Objective: to observe the therapeutic effect of combined fascial sheath suspension (CFSS) in the treatment of congenital severe blepharoptosis. Access to patient records and standardized digital photographs before and after surgery combined with in-vivo measurements of patients to obtain research index data, There were 25 patients with congenital severe blepharoptosis with 33 eyes, 8 eyes with binocular and 17 cases with single eye, aged 11-40 years. The average age was 25 years. The patients were divided into two groups: group A: FMS flap group (n = 14), group B (n = 17): group B (n = 11) with combined fascial sheath suspension, group A (n = 11), and group A (n = 16): 1 month and 6 months after operation, the MRD1 and the upper-eyelid volume were measured and analyzed by statistical analysis software SPSS17.0 before operation, respectively. Statistical analysis was made on the observation indexes after operation. Results: the MRD1 of the two groups was 2.82 鹵0.907 鹵2.84 鹵0.068 and 2.84 鹵0.068, respectively. The MRD1 ratio of the two groups was 2.81 鹵0.964CFSS (2.81 鹵0.964CFSS, 4.13 鹵0.071CFSS, 4.13 鹵0.071a, P 0.05) at 6 months after operation. There was significant difference between the two groups at 1 month after operation, and the ratio of upper eyelid lift was 5.13 鹵0.081 in the FMS group, 5.35 鹵0.073 in the CFSS group, and 5.35 鹵0.073 in the CFSS group, but there was no difference between the two groups in the postoperative value of the upper eyelid lift volume in the FMS group (3.69 鹵0.068) and the upper eyelid lift volume ratio in the FMS group was 5.13 鹵0.081CFSS group (5.35 鹵0.073, P 0.05) at 6 months after operation, and there was no difference between the two groups. Conclusion: the relative frontal muscle flap suspension method has the same effect in correction of severe blepharoptosis. However, the duration of eyelid incompetence was significantly shortened after operation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6;R62

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 王振軍;劉柳;王恒;;聯(lián)合筋膜鞘(CFS)懸吊術(shù)治療額肌瓣懸吊術(shù)后復(fù)發(fā)重度上瞼下垂[J];中國美容醫(yī)學(xué);2016年08期

2 林威;徐楊;葉飛輪;;聯(lián)合筋膜鞘懸吊術(shù)與提上瞼肌縮短術(shù)治療先天性中重度上瞼下垂對比[J];國際眼科雜志;2016年06期

3 王振軍;謝立寧;;聯(lián)合筋膜鞘懸吊術(shù)治療提上瞼肌縮短術(shù)后復(fù)發(fā)中重度上瞼下垂[J];中國醫(yī)療美容;2016年03期

4 王振軍;;結(jié)膜上穹窿聯(lián)合筋膜鞘懸吊術(shù)治療先天性重度上瞼下垂[J];世界最新醫(yī)學(xué)信息文摘;2015年98期

5 袁敬東;易陽艷;吳舒;林濤;王朝慧;;額肌瓣懸吊治療重度先天性上瞼下垂[J];中國美容醫(yī)學(xué);2015年08期

6 李向明;陶濤;唐瑛;李瑞蘭;;改良額肌瓣懸吊術(shù)術(shù)中術(shù)后并發(fā)癥分析[J];中華眼外傷職業(yè)眼病雜志;2014年06期

7 范巨峰,岳紀(jì)良;先天性上瞼下垂的基礎(chǔ)研究與手術(shù)矯治進(jìn)展[J];中華整形外科雜志;2003年03期

，

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