Byun Jin Suk, Hwang Kun, Lee Sang Yun, Kim Hak Tae, Kim Kenneth
*S leaders Aesthetic Surgical Clinic, Daegu †Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea ‡University of California, Los Angeles, CA.
J Craniofac Surg. 2017 Oct;28(7):1849-1851. doi: 10.1097/SCS.0000000000003815.
The authors innovated the levator aponeurosis and Muller muscle plication reinforced with levator sheath advancement (AMPSA) for blepharoptosis correction. The orbital septum was opened 1 mm above its fusion with the levator aponeurosis. The preaponeurotic fat was retracted and the thickened part of the levator sheath was identified. Two plication sutures were made: medial suture at the medial border of the pupil and lateral between the lateral border of the pupil and the lateral limbus. A needle with 6-0 nylon thread first bit the tarsal plate approximately 1 mm below its upper border, then bit the levator aponeurosis and the Muller muscle together at 3 to 6 mm above the upper border of the tarsal plate. The needle bit 1 to 3 mm of the thickened part of the levator sheath and the suture was tied. A total of 116 eyes were operated on using levator aponeurosis and Muller muscle plication (AMP), and 79 eyes using AMPSA. The mean follow-up period was 11.4 months. In the AMP group, the postoperative marginal reflex distance-1 (MRD-1) (3.8 ± 0.2 mm) was significantly greater than the preoperative MRD-1 (2.7 ± 0.3 mm) (P < 0.001). In the AMPSA group, the postoperative MRD-1 (3.5 ± 0.3 mm) was also significantly greater than the preoperative MRD-1 (1.7 ± 0.4 mm) (P < 0.001). The improvement in MRD-1 was greater in the AMPSA group (1.7 ± 0.4 mm) than in the AMP group (1.1 ± 0.3 mm) (P < 0.001). The difference in the MRD-1 outcome between AMPSA and AMP (0.6 mm) was obtained by advancing the thickened part of the levator sheath. AMPSA may be an effective procedure for correcting blepharoptosis.
作者创新了提上睑肌腱膜和米勒肌折叠术，并采用提上睑肌鞘推进术进行加强（AMPSA）来矫正上睑下垂。在眶隔与提上睑肌腱膜融合处上方1毫米处打开眶隔。将腱膜前脂肪回缩，识别提上睑肌鞘增厚的部分。制作两根折叠缝线：一根位于瞳孔内侧缘的内侧缝线，另一根位于瞳孔外侧缘与角膜缘之间的外侧缝线。一根带有6-0尼龙线的针首先在睑板上缘下方约1毫米处刺入睑板，然后在睑板上缘上方3至6毫米处同时刺入提上睑肌腱膜和米勒肌。针穿过提上睑肌鞘增厚部分1至3毫米并打结缝线。共有116只眼采用提上睑肌腱膜和米勒肌折叠术（AMP）进行手术，79只眼采用AMPSA进行手术。平均随访期为11.4个月。在AMP组中，术后边缘反射距离-1（MRD-1）（3.8±0.2毫米）显著大于术前MRD-1（2.7±0.3毫米）（P<0.001）。在AMPSA组中，术后MRD-1（3.5±0.3毫米）也显著大于术前MRD-1（1.7±0.4毫米）（P<0.001）。AMPSA组MRD-1的改善（1.7±0.4毫米）大于AMP组（1.1±0.3毫米）（P<0.001）。通过推进提上睑肌鞘增厚部分，AMPSA和AMP之间MRD-1结果的差异为0.6毫米。AMPSA可能是一种矫正上睑下垂的有效方法。
