Liu Haipeng, Shao Ying, Zhang Duo
From the Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China.
J Craniofac Surg. 2014 Jan;25(1):226-30. doi: 10.1097/SCS.0000000000000371.
The purpose of this study was to evaluate the outcomes after ptosis correction surgery using a modified levator aponeurosis-Müller muscle complex reinsertion technique. In this clinical study, 75 eyelids of 49 patients with congenital blepharoptosis were treated with the modified technique. The results, including complications, were followed up and evaluated. Operation was performed via anterior transcutaneous incision. After separating the preseptal orbicularis oculi muscle, the levator complex, including Müller muscle and the levator aponeurosis, was visualized. The levator complex was cut into 2 parts at the top of the conjunctival fornix to create an upper portion and a lower portion. The detached lower portion of the complex flap combined with the tarsal plate was advanced superiorly and reinserted into the posterior aspect of the upper portion of the complex flap by using 3 horizontal mattress sutures. Preoperative ptosis severity was compared with the degree of ptosis correction using the Cochran-Mantel-Haenszel test. Preoperative levator function was compared with the degree of ptosis correction and the postoperative levator function using Fisher exact test for paired data. Sufficient postoperative correction of ptosis was achieved in 78.7% of eyelids. Postoperative levator function of more than 4 mm was achieved in 82.7% of all eyelids that underwent surgery. We conclude that the modified levator aponeurosis-Müller muscle complex reinsertion technique is effective for correcting congenital blepharoptosis, especially in patients with fair to good (>4 mm) preoperative levator function.
本研究的目的是评估采用改良提上睑肌腱膜-米勒肌复合体重新插入技术进行上睑下垂矫正手术后的效果。在这项临床研究中，对49例先天性上睑下垂患者的75只眼睑采用改良技术进行治疗。对结果（包括并发症）进行随访和评估。手术通过经皮前路切口进行。分离眶隔前眼轮匝肌后，显露包括米勒肌和提上睑肌腱膜的提上睑肌复合体。在结膜穹窿顶部将提上睑肌复合体切成两部分，形成上部分和下部分。将复合体瓣分离的下部与睑板结合，向上推进，并用3根水平褥式缝线重新插入复合体瓣上部的后方。使用 Cochr an-Mantel-Haenszel检验比较术前上睑下垂严重程度与上睑下垂矫正程度。使用配对数据的Fisher精确检验比较术前提上睑肌功能与上睑下垂矫正程度及术后提上睑肌功能。78.7%的眼睑术后上睑下垂得到充分矫正。在所有接受手术的眼睑中，82.7%术后提上睑肌功能超过4mm。我们得出结论，改良提上睑肌腱膜-米勒肌复合体重新插入技术对矫正先天性上睑下垂有效，尤其是对术前提上睑肌功能中等至良好（>4mm）的患者。
