蒋艳 代天均 杜祥会

[摘要]目的：探究眶隔筋膜瓣聯合额肌瓣悬吊矫正老年性重度上睑下垂的美学效果。方法：选取2017年1月-2020年1月笔者医院眼科收治的老年性重度上睑下垂患者92例，以随机数字表法分为额肌瓣悬吊组（n=46）、联合组（n=46）。额肌瓣悬吊组行额肌瓣悬吊术治疗，联合组行眶隔筋膜瓣联合额肌瓣悬吊术治疗。比较两组术后3个月临床疗效，术后1周、1个月、3个月上睑回缩情况，术前、术后3个月眼睑生理功能，术后3个月美学效果评分及术后并发症发生情况。结果：术后3个月，联合组总有效率为94.57%，高于额肌瓣悬吊组的77.17%，差异有统计学意义（P<0.05）。术后1周、1个月、3个月，随时间延长，两组上睑回缩量均逐渐增大，联合组上睑回缩量均低于额肌瓣悬吊组，差异有统计学意义（P<0.05）。与术前比较，术后3个月，联合组上睑活动度高于额肌瓣悬吊组，眼睑自然闭合时睑裂高度低于额肌瓣悬吊组，差异有统计学意义（P<0.05）。术后3个月，联合组上睑轮廓评分、双眼睑高度对称性评分、重睑形成效果评分以及总分均高于额肌瓣悬吊组，差异有统计学意义（P<0.05）。术后，联合组并发症总发生率为5.43%，低于额肌瓣悬吊组的19.57%，差异有统计学意义（P<0.05）。结论：老年性重度上睑下垂治疗中，眶隔筋膜瓣、额肌瓣悬吊术相结合可降低上睑回缩量，美学效果好，疗效显著，且安全性较好，值得临床进一步推广。

[关键词]上睑下垂;重度;老年;眶隔筋膜瓣;额肌瓣悬吊术;美学效果

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）05-0012-04

Aesthetic Effect of Orbital Septum Fascia Flap Combined with Frontalis Muscle Flap Suspension in the Treatment of Senile Severe Blepharoptosis on Elderly Patients

JIANG Yan，DAI Tian-jun，DU Xiang-hui

（Department of Medical Cosmetology，Jiangyou Second People's Hospital，Jiangyou 621700，Sichuan，China）

Abstract： Objective  To explore the aesthetic effect in senile severe ptosis in the elderly by combination of orbital septum fascia flap and frontalis muscle flap suspension. Methods  A total of 92 elderly patients with severe ptosis admitted to ophthalmology in our hospital from January 2017 to January 2020 were selected as research objects， and were divided into the frontal muscle flap suspension group （n=46） and the combined group （n=46） by random number table method. The frontal muscle flap suspension group was treated with frontal muscle flap suspension， while the combined group was treated with orbital septal fascia flap and frontal muscle flap suspension. The clinical effect in the two groups after 3 months operation， the upper eyelid retraction in the two groups at 1 week， 1 month and 3 months after operation， the physiological function of eyelid before and 3 months after operation， the aesthetic effect scores of the two groups at 3 months after operation， the complications of the two groups after operation were compared. Results  After 3 months operation， the total effective rate in the combined group was 94.57%， higher than the frontal muscle flap suspension group（77.17%）， the difference was statistically significant （P<0.05）. With the prolongation of time from 1 week to 3 months after operation， the retraction of upper eyelid in the two groups increased， and the retraction of upper eyelid in the combined group was lower than that in the frontal muscle flap suspension group （P<0.05）. Compared with preoperatively， after 3 months operation， the upper eyelid range in the combined group was higher than that in the frontal muscle valve suspension group （P<0.05）. The height of the palpebral fissure when the eyelids was naturally closed was lower than that in the frontal muscle flap suspension group （P<0.05）. After 3 months operation， the score of upper eyelid contour， double eyelid height symmetry， double eyelid formation effect and total score in the combined group were all higher than those in the frontal muscle flap suspension group （P<0.05）. After 3 months operation， the total incidence of complications in the combined group was 5.43%， lower than the frontal muscle flap suspension group （19.57%， P<0.05）. Conclusion  In the treatment of severe ptosis in the elderly， the combination of orbital septum fascia flap and frontalis muscle flap suspension can reduce the retraction of upper eyelid， with good aesthetic effect， significant curative effect and the safety is good， which is worthy of further clinical promotion.

Key words： ptosis; severe; elderly; orbital septum fascia flap; frontalis muscle flap suspension; aesthetic effect

重度上睑下垂为眼科常见病，其中又以老年群体较为常见，是由于上睑肌肉功能丧失所致，可呈上睑大部分或全部下垂[1]。重度上睑下垂可遮盖瞳孔，影响患者面部外观美观度、视力等，手术是其有效方法[2]。目前临床多采用额肌瓣悬吊术治疗重度上睑下垂，但术后易出现睑外翻、矫正不满意等问题[3]。眶隔筋膜瓣悬吊术则可进一步增强悬吊稳定性，并减少组织撕脱，近年来，采用眶隔筋膜瓣联合额肌瓣悬吊术治疗老年性重度上睑下垂逐渐成为研究热点[4]。故设立本研究，以期为临床治疗老年性重度上睑下垂提供一定参考，现报道如下：

1  资料和方法

1.1 一般资料：选择92例2017年1月-2020年1月笔者医院眼科收治的老年性重度上睑下垂患者，均知情同意，以随机数字表法分为额肌瓣悬吊组（n=46）、联合组（n=46）。……