组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (5): 419-.

• •    下一篇

理念与技术:重度上睑下垂治疗策略

  

  • 出版日期:2025-10-13 发布日期:2025-10-30

Principle and technology: Treatment strategies for severe blepharoptosis

  • Online:2025-10-13 Published:2025-10-30

摘要:

重度上睑下垂功能与外观同步重建一直是临床的难题与挑战。额肌与上睑提肌是提供上睑上提力量的两大来源。围绕这两个动力来源,在重度上睑下垂治疗领域,额肌及其筋膜悬吊、额肌与材料(人工合成或自体异体材料)悬吊、上睑提肌腱膜-米勒肌(Müller’s muscle)复合体前徙缩短(或联合睑板部分切除),以及联合筋膜鞘等术式一直是临床医生的选择。但是各术式的优缺点、适应证始终存在争议。不同的医生根据不同的临床经验和临床视角经常有不同的选择。正是这种不同选择逻辑的分歧,使得具体临床治疗决策变得不统一,也使治疗效果呈现出不确切和不稳定。理解发病机制、熟悉局部解剖生理、明确各种术式的特点和针对性、优化各种术式的技术流程、厘清术式选择的逻辑才
能根据每个临床个案的特点,作出最佳选择、获得最佳效果。

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Abstract:

hallenge. The frontalis muscle and levator palpebrae superioris muscle (LPS) are the two major sources of
force for upper eyelid elevation. Centering on these two power sources, in the field of severe blepharoptosis treatment,surgical procedures such as frontalis muscle and its fascia suspension, frontalis muscle suspension with materials (synthetic or autologous/allogeneic materials), levator aponeurosis-Müller’s muscle complex advancement and shortening (or combined with partial tarsectomy), and conjoint fascial sheath (CFS) surgery have long been adopted by clinicians. However, there have always been controversies regarding their respective advantages and disadvantages as well as their indications. Different surgeons often make different choices based on their varying clinical experience and perspectives. It is precisely this divergence in the logic of different choices that leads to inconsistent decisions in specific clinical treatments, and results in uncertain and unstable treatment outcomes. To make the optimal choice and achieve the best results according to the characteristics of each clinical case, it is essential to understand the pathogenesis, be familiar with the anatomical physiology, clarify the characteristics and target indications of various surgical procedures, optimize the technical process of each procedure, and sort out the logic for surgical procedure selection.

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