下斜肌转位术治疗先天性上斜肌麻痹的临床效果

Clinical observation of inferior oblique transposition in the treatment of congenital superior oblique palsy

目的观察下斜肌转位术治疗先天性上斜肌麻痹的临床效果。方法回顾性系列病例研究。选取2008年12月至2010年12月在内蒙古通辽市科尔沁第一人民医院眼科就诊的先天性上斜肌麻痹患者24例(24只眼),其中男性14例,女性10例。术前行视力、屈光状态、眼位、眼球运动、双眼视功能、斜视度检查。使用三棱镜交替遮盖法测量视近时第一眼位及患侧歪头时的垂直斜视度。所有患者行下斜肌转位术。术后第1周和术后2个月观察患者下斜肌功能、第一眼位垂直斜视度及患侧倾斜垂直斜视度的变化。计数资料比较采用卡方检验。结果所有患者术前均表现出下斜肌不同程度亢进,其中Ⅲ度5只眼,Ⅱ度19只眼。术后1周24只眼中有3只眼存在下斜肌功能Ⅰ度亢进,术后2个月未再出现变化,手术前后比较差异有统计学意义(χ2=0.67,P<0.05);术前第一眼位垂直斜视度平均为13.6△。术后1周第一眼位垂直斜视度数平均为4.6△,较术前差异有统计学意义(Z=-2.12,P<0.05)。术后2个月第一眼位垂直斜视度数平均为4.8△,较术前差异有统计学意义(Z=-2.15,P<0.05)。术前患侧倾斜时垂直斜视度平均16.2△。歪头试验均为阳性。术后1周患侧倾斜垂直斜视度数平均为7.1△,较术前差异有统计学意义(Z=-2.41,P<0.05)。歪头试验有19例仍为阳性。术后2个月患侧倾斜垂直斜视度数平均为8.2△,较术前差异有统计学意义(Z=-2.35,P<0.05);歪头试验有20例仍为阳性。结论下斜肌转位术治疗先天性上斜肌麻痹效果良好。第一眼位垂直斜视度显著性减小或消失,下斜肌功能基本正常,代偿头位消失或明显改善,患侧倾斜垂直斜视度也有明显改善。但歪头试验的阳性率仍较高。

Objective To evaluate the therapeutic effect of inferior oblique transposition in congenital superior oblique palsy. Methods It was a retrospective case series study. 24 cases with congenital superior oblique palsy in the First People's Hospital of Keerqin from Dec. 2008 to Dec. 2010 were enrolled in the study with Men 14 cases,Female 10 cases. Examined the visual activity,refraction,eye position,eye movement,binocular vision and strabismus degrees. The primary position of eye and vertical squint degree were evaluated quantitatively before and after the operation by the prism alternative cover test.All the patients were undertaken inferior oblique transposition. Inferior oblique muscle function and vertical squint degree were examined 1 week and 2 months after surgery. Enumeration data was analyzed by chi-square test and measurement data with rank sum test. Difference was statistically significant when P <0. 05. Results Inferior oblique muscle overaction existed in all cases before surgery,Ⅲ degrees in5 cases,Ⅱ degrees in 19 cases. 1 week after sugery,only 3 cases with Ⅰ degree. No change was found2 months after. The difference of inferior oblique muscle function before and after surgery was statistically significant( χ2= 0 67,P > 0. 05); The average vertical deviation degree in primary position were 13. 6△before surgery while the average vertical deviation degree in primary position were 4. 6△1 week and 4. 8△2 months after surgery. The comparison with the preoperation shows significant difference( Z =- 2. 12,P < 0. 05,Z =- 2. 15,P < 0. 05). All the patients showed positively in Bielschowsky head tilt test before surgery. The average vertical deviation degree in the position when head tilted to the affected side was 16. 2△before surgery while 7. 1△1 week and 8. 2△2 months after surgery. Difference was statistically significant( Z =- 2. 41,P < 0. 05; Z =- 2. 35,P < 0. 05). 19 cases showed positively in Bielschowsky head tilt test 1 week after surgery and 20 cases 2 months after surgery. Conclusions The translocation of inferior oblique muscles is effective in treating congenital superior oblique muscle palsy. After surgery,the vertical deviation degree in primary position and tilted position highly decreased or disappeared. The functions of inferior oblique muscle recovered. But the positive rates of the Bielschowsky head tilt test are still high.