中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
8期
739-742
,共4页
张黎%Aaron Fay%邢枫%王丽娅
張黎%Aaron Fay%邢楓%王麗婭
장려%Aaron Fay%형풍%왕려아
眼睑整容术/方法学%面神经麻痹/手术%眼睑闭合不全%眼睑/手术%植入物%金属弹簧植入%回顾性研究
眼瞼整容術/方法學%麵神經痳痺/手術%眼瞼閉閤不全%眼瞼/手術%植入物%金屬彈簧植入%迴顧性研究
안검정용술/방법학%면신경마비/수술%안검폐합불전%안검/수술%식입물%금속탄황식입%회고성연구
Blepharoplasty/method%Facial paralysis/surgery%Lagophthalmos%Eyelid/surgery%Prostheses and implant%Palpebral spring placement%Retrospective study
背景 瞬目和眼睑闭合功能障碍是面神经麻痹患者所共有的症状,其治疗方法包括上睑植入机械性装置,帮助眼睑闭合.一种新型的植入装置为金属弹簧,国内尚无关于金属弹簧植入治疗面神经麻痹性眼睑闭合不全的报道. 目的 评价眼睑金属弹簧植入术治疗面神经麻痹性眼睑闭合不全和暴露性角膜病变的临床疗效.方法 采用回顾性系列病例观察设计,收集2010年8月至2012年11月在河南省眼科研究所&河南省立眼科医院因面神经麻痹性眼睑闭合不全行眼睑金属弹簧植入术的患者11例11眼,所有患者均由同一名手术医师完成.金属弹簧由直径0.3 mm的镍合金丝制成,术中将弹簧下臂末端用涤纶布包裹并缝合于上睑睑板表面.手术前后均进行详细的外眼检查,对手术前后眼睑闭合不全的程度、上睑缘到瞳孔中心的距离(ULMD)、眼睑运动的幅度等进行比较.术后随访8~38个月,观察术后的不良反应和并发症.结果 术眼术后眼部酸痛不适症状逐渐消失,术眼睁眼、闭眼自然.术眼术前及术后ULMD值分别为(3.51±0.73)mm和(3.20±0.86)mm,差异无统计学意义(t=1.36,P=0.10);术眼手术前后眼睑闭合不全程度分别为(5.94±1.57) mm和(1.06±0.98) mm,差异有统计学意义(t=9.42,P=0.00);术后患眼眼睑运动幅度为(5.89±0.70)mm,较术前的(0.11±0.33)mm明显改善,差异有统计学意义(t=22.97,P=0.00).术后患眼的暴露性角膜病变均得到明显改善.本组术眼中除1例患者术眼因受外伤需要进行金属弹簧调整,其他术眼未发生金属弹簧暴露、金属疲劳、术区感染等并发症. 结论 眼睑内金属弹簧植入术治疗面神经麻痹性眼睑闭合不全的手术安全有效,术后上睑的提睑和闭合功能明显改善.
揹景 瞬目和眼瞼閉閤功能障礙是麵神經痳痺患者所共有的癥狀,其治療方法包括上瞼植入機械性裝置,幫助眼瞼閉閤.一種新型的植入裝置為金屬彈簧,國內尚無關于金屬彈簧植入治療麵神經痳痺性眼瞼閉閤不全的報道. 目的 評價眼瞼金屬彈簧植入術治療麵神經痳痺性眼瞼閉閤不全和暴露性角膜病變的臨床療效.方法 採用迴顧性繫列病例觀察設計,收集2010年8月至2012年11月在河南省眼科研究所&河南省立眼科醫院因麵神經痳痺性眼瞼閉閤不全行眼瞼金屬彈簧植入術的患者11例11眼,所有患者均由同一名手術醫師完成.金屬彈簧由直徑0.3 mm的鎳閤金絲製成,術中將彈簧下臂末耑用滌綸佈包裹併縫閤于上瞼瞼闆錶麵.手術前後均進行詳細的外眼檢查,對手術前後眼瞼閉閤不全的程度、上瞼緣到瞳孔中心的距離(ULMD)、眼瞼運動的幅度等進行比較.術後隨訪8~38箇月,觀察術後的不良反應和併髮癥.結果 術眼術後眼部痠痛不適癥狀逐漸消失,術眼睜眼、閉眼自然.術眼術前及術後ULMD值分彆為(3.51±0.73)mm和(3.20±0.86)mm,差異無統計學意義(t=1.36,P=0.10);術眼手術前後眼瞼閉閤不全程度分彆為(5.94±1.57) mm和(1.06±0.98) mm,差異有統計學意義(t=9.42,P=0.00);術後患眼眼瞼運動幅度為(5.89±0.70)mm,較術前的(0.11±0.33)mm明顯改善,差異有統計學意義(t=22.97,P=0.00).術後患眼的暴露性角膜病變均得到明顯改善.本組術眼中除1例患者術眼因受外傷需要進行金屬彈簧調整,其他術眼未髮生金屬彈簧暴露、金屬疲勞、術區感染等併髮癥. 結論 眼瞼內金屬彈簧植入術治療麵神經痳痺性眼瞼閉閤不全的手術安全有效,術後上瞼的提瞼和閉閤功能明顯改善.
배경 순목화안검폐합공능장애시면신경마비환자소공유적증상,기치료방법포괄상검식입궤계성장치,방조안검폐합.일충신형적식입장치위금속탄황,국내상무관우금속탄황식입치료면신경마비성안검폐합불전적보도. 목적 평개안검금속탄황식입술치료면신경마비성안검폐합불전화폭로성각막병변적림상료효.방법 채용회고성계렬병례관찰설계,수집2010년8월지2012년11월재하남성안과연구소&하남성립안과의원인면신경마비성안검폐합불전행안검금속탄황식입술적환자11례11안,소유환자균유동일명수술의사완성.금속탄황유직경0.3 mm적얼합금사제성,술중장탄황하비말단용조륜포포과병봉합우상검검판표면.수술전후균진행상세적외안검사,대수술전후안검폐합불전적정도、상검연도동공중심적거리(ULMD)、안검운동적폭도등진행비교.술후수방8~38개월,관찰술후적불량반응화병발증.결과 술안술후안부산통불괄증상축점소실,술안정안、폐안자연.술안술전급술후ULMD치분별위(3.51±0.73)mm화(3.20±0.86)mm,차이무통계학의의(t=1.36,P=0.10);술안수술전후안검폐합불전정도분별위(5.94±1.57) mm화(1.06±0.98) mm,차이유통계학의의(t=9.42,P=0.00);술후환안안검운동폭도위(5.89±0.70)mm,교술전적(0.11±0.33)mm명현개선,차이유통계학의의(t=22.97,P=0.00).술후환안적폭로성각막병변균득도명현개선.본조술안중제1례환자술안인수외상수요진행금속탄황조정,기타술안미발생금속탄황폭로、금속피로、술구감염등병발증. 결론 안검내금속탄황식입술치료면신경마비성안검폐합불전적수술안전유효,술후상검적제검화폐합공능명현개선.
Background The dysfunction of the blink reflex the eyelid-closure ability appears in the patients with facial paralysis,and its management is the implantation of mechanical-assisted eye-closure device in the upper eyelid.A novel device is palpebral spring implant.However,there is no similar study in China.Objective This study was to evaluate the clinical efficacy of palpebral spring placement for lagophthalmos caused by facial nerve palsy.Methods This clinical research complied with Helsinki declaration and the protocol was approved by Ethic Committee of Henan Eye Institute & Henan Eye Hospital.Written informed consent was obtained from each patient prior to the surgery.A retrospective serial case-observational study was performed.The medical records of 11 patients who underwent palpebral spring placement for hypophasis due to facial nerve palsy were reviewed at Henan Eye Hospital from August 2010 to November 2012.Palpebral spring placement was performed by the same surgeon to ensure a more even outcomes.Palpebral spring was made by nickel wire,with the diameter of 0.3 mm and implanted on tarsal plate in 11 eyes of 11 patients with symptomatic facial nerve palsy.The lower tip of Levine spring was encased into a small terylene bag and sutured to the anterior tarsal surface during the surgery.Preoperative and postoperative symptoms,upper eyelid margin to mid pupil distance (ULMD),degree of lagophthalmos and eyelid moving scope were examined and compared between before and after operation.The operating complication was followed-up for 8-38 months.Results The discomforted symptoms disappeared in all the operated eyes.The ULMD was (3.51±0.73) mm in preoperation and (3.20±0.86) mm in posteration,without significant difference between them (t=1.36,P=0.10).The degree of lagophthalmos was (5.94±1.57) mm and (1.06±0.98) mm in preoperation and postoperation respectively,showing a significant difference between them (t =9.42,P =0.00).The eyelid moving scope was (5.89±0.70) mm in postoperation,which was significantly increased in comparison with (0.11 ±0.33) mm of preoperation (t =22.97,P =0.00).The palpebral spring implant was regulated in 1 patient during the follow-up duration due to the trauma.No complication in other 10 patients appeared during the follow-up duration,such as implant exposure,metal fatigue or infection.Conclusions Palpebral spring placement is safe and effective for lagophthalmos in patients with facial nerve palsy.