单侧先天性上斜肌麻痹的手术方式选择

Different Surgical Procedures of the Unilateral Superior Oblique Muscle Paralysis

目的探讨单眼先天性上斜肌麻痹不同手术方式的治疗效果。方法对69例单眼先天性上斜肌麻痹患者，根据下斜肌亢进程度和垂直斜视度数选择不同手术方式，垂直斜视度在7^△～15^△，行下斜肌断腱或部分切除术；垂直斜视度大于15^△，行下斜肌部分切除加对侧眼下直肌后徙术；若麻痹眼下转功能明显不足，则行下斜肌转位术，必要时健眼同时行下直肌后徙术。结果23例（33．3％）治愈，45例（65．3％）好转，1例（1．4％）无效。结论先天性上斜肌麻痹以减弱直接拮抗肌和配偶肌为主要手术方式，根据下斜肌亢进程度和垂直斜视度数选择不同手术方式可达到良好治疗效果。

Objective To evaluate the effectiveness of different surgical procedures for the congenital superior oblique muscle paralysis. Methods Sixty-nine cases of unilateral superior oblique muscle paralysis received different surgical procedures based on the degrees of the overaction of superior oblique muscle and the extension of vertical deviation. When the degrees of deviation were lower than 15^△ , inferior oblique muscle myotomy was chosen. When the degree of deviation was lager than 15^△ , inferior oblique muscle myotomy or anterior transposition, and the contralateral inferior rectus muscle recession were performed. Results Twenty-three cases were cured （33.3%）, 45 improved （65.3%） and 1 case was unefficient （1.4%）. Conclusion The surgical procedure of weakening inferior oblique muscle or anterior transposition in combination with the contralateral inferior rectus muscle recession was sale and effective in treating the congenital superior oblique paralysis.