改良提上睑肌切除术改善术后兔眼和上睑迟滞。
A Modified Levator Resection to Improve Postoperative Lagophthalmos and Eyelid Lag.
机构信息
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Ophthalmology, College of Medicine, Al-Azhar University, Cairo, Egypt.
出版信息
Ophthalmic Plast Reconstr Surg. 2020 Jan/Feb;36(1):38-44. doi: 10.1097/IOP.0000000000001454.
PURPOSE
To assess the effect of releasing the central attachment between the Whitnall's ligament (WL) and the levator palpebrae superioris muscle on the postoperative levator function (LF), eyelid lag, and degree of lagophthalmos.
METHODS
This retrospective case-control study included patients with moderate and severe simple congenital ptosis who underwent skin approach levator aponeurosis resection (LR) as a primary procedure with a minimum of 6-month follow up. Patients were divided into 2 groups; the first group underwent LR without WL release (control group) while the second group underwent LR with WL release. Preoperative demographics and clinical data were reviewed. Postoperative LF, eyelid lag, and degree of lagophthalmos as well as surgical outcomes were compared and analyzed in both groups.
RESULTS
A total of 81 patients (88 eyelids) were included in this study. There were 50 males (61.7%). The mean age was ±SD 12.0 ± 9.5 years. The first group included 43 eyelids while the second had 45 eyelids. There was no statistical difference in demographics and preoperative data between both groups. The postoperative LF was higher in the second group (10.7 ± 2.1 mm) with less consecutive eyelid lag compared with the control group (7.8 ± 1.9 mm) (p < 0.001). The control group had acquired more postoperative lagophthalmos compared with the second group (p < 0.001). Complete surgical success was achieved in 82.2% in the second group compared with 60.5% in the control group (p = 0.024).
CONCLUSIONS
Releasing the central attachment between WL and levator palpebrae superioris muscle has achieved an improvement in LF with minimal postoperative eyelid lag, lagophthalmos, and corneal complications.Releasing the central attachment between levator palpebrae superioris muscle and Whitnall's ligament during levator aponeurosis resection allows better levator excursion and minimizes postoperative lagophthalmos, eyelid lag, and corneal complications.
目的
评估释放Whitnall 韧带（WL）和提上睑肌之间的中央附着对术后提肌功能（LF）、上睑迟滞和睑裂闭合不全程度的影响。
方法
本回顾性病例对照研究纳入了接受皮肤入路提上睑肌肌腱膜切除术（LR）作为主要手术的中度和重度单纯性先天性上睑下垂患者，且至少随访 6 个月。患者分为两组；第一组行 LR 但不释放 WL（对照组），第二组行 LR 并释放 WL。回顾并比较了两组患者的术前人口统计学和临床资料。比较和分析了两组患者的术后 LF、上睑迟滞和睑裂闭合不全程度以及手术结果。
结果
本研究共纳入 81 例患者（88 只眼），其中男性 50 例（61.7%），平均年龄为±SD 12.0±9.5 岁。第一组 43 只眼，第二组 45 只眼。两组患者的人口统计学和术前资料无统计学差异。第二组术后 LF 更高（10.7±2.1mm），与对照组（7.8±1.9mm）相比，连续上睑迟滞更少（p<0.001）。与第二组相比，对照组术后发生更多的睑裂闭合不全（p<0.001）。第二组的完全手术成功率为 82.2%，对照组为 60.5%（p=0.024）。
结论
释放 WL 和提上睑肌之间的中央附着可以改善 LF，同时术后上睑迟滞、睑裂闭合不全和角膜并发症最小。在提上睑肌肌腱膜切除术中释放提上睑肌和 Whitnall 韧带之间的中央附着，可以使提肌运动更好，并最大限度地减少术后睑裂闭合不全、上睑迟滞和角膜并发症。
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