先天性上斜肌麻痹手术的临床观察

The clinical operation effect of congenital superior oblique palsy

目的观察先天性上斜肌麻痹手术治疗的临床效果.方法 26例(29眼)实施了手术治疗.其中15例(17眼)行下斜肌单纯切断术;合并分离性垂直偏斜3例(4眼)行下斜肌前转位术;垂直斜视度在20△以上者5例(5眼)行下斜肌切断加对侧眼下直肌后徙术;术前没有下斜肌亢进者3例(3眼),行单纯下直肌后徒术.合并内外水平斜视者同时行水平肌的缩短或后徙术.结果治愈22例(25眼),治愈率86.21%(25/29).有效3例(3眼).其中2例(2眼)行单纯的下斜肌切断,术后残留垂直斜视度6△～10△;1例(1眼)合并DVD者,术中将下斜肌切断并前转位于下直肌旁,术后仍残留有10△的垂直斜视度.无效1例(1眼),合并间歇性外斜视,术前有40△的垂直斜度,术中将下斜肌前移位,同时行内外直肌的手术,术后仍有20△的垂直斜度.患者放弃治疗.结论选择合适的手术方式,早期实施手术,可取得良好的治疗效果.

Objective To observe the operation effect of congenital superior oblique palsy. Methods The operation methods were chosen according to the degree of hyperdeviation in primary position and accompanying with hyperfunction of inferior oblique muscle in disease eye or other oblique. In 15 cases 17 eyes,under 20 prism diopters, using inferior oblique myectomy. Accompanied with DVD,3 cases 4 eyes using anterior transposition of the inferior oblique muscle. In 5 cases 5 eyes above 20 prism diopters, associate inferior oblique myectomy with inferior rectus of the sound eye recession. In 3 cases 3 eyes without hyperfunction of inferior oblique muscle in disease eye, using inferior rectus of the sound eye recession. Result After operation, 22 （25eyes） cases obtained satisfaction. The cure rate of all was 86.2% （25/29）. 2 cases was effective. 1 cases was no recovery. Conclusion Choosing different operation methods according to the degree of hyperdeviation in primary position can get a good clinical effect.