上斜肌麻痹的手术治疗

The surgery of superior oblique paralysis

目的探讨单侧先天性上斜肌麻痹的手术治疗方法。方法98例单侧先天性上斜肌麻痹,垂直斜度≤15△时行单纯下斜肌切除术。垂直斜视度大于>15△时,如健眼为注视眼,则行下斜肌切除联合患眼上直肌减弱术;如患眼为注视眼,则行下斜肌切除联合健眼下直肌减弱术。结果62例单纯下斜肌切除术:治愈46例,好转11例,无效5例。27例下斜肌切除联合患眼上直肌减弱术:治愈20例,好转5例,无效2例。9例下斜肌切除联合健眼下直肌减弱术:治愈6例,好转2例,无效1例。均无过度矫正者。结论先天性上斜肌麻痹的手术方式,按减弱直接拮抗肌和配偶肌,加强间接拮抗肌的原则进行,根据患者下斜肌功能亢进程度、垂直斜视度大小和注视眼别选择不同术式可获得良好的效果。

Objective To discuss the surgery methods of the congenital superior oblique paralysis（SOP）. Methods when the hypertropia≤15^△ ,The myectomy of inferior oblique were taken on 62 SOP,when the hypertropia 〉 15^△ ,The myectomy of inferior oblique and contralateral inferior rectus weakening were taken on 9 SOP, which fixing eye is paralysis, The myectomy of inferior oblique and ipsilatera superior rectus weakening were taken on 27 SOP. Which fixing eye is health. Results In the group of myectomy of inferior oblique ,46 cases were cured, 11 cases were improved, and 5 case received no effective. In the group of myectomy of inferior oblique and ipsilatera superior rectus weakening,20 cases were cured, 5 cases were improved, and 2 case received no effective. In the group of myectomy of inferior oblique .and contralateral inferior rectus weakening： 6 cases were cured, 2 cases were improved, and 1 case received no effective, no overcorrection was found. Conclusions The principle for the surgery of congenital superior oblique paralysis is to weaken direct antagonist and yoke muscles, or strengthen controlateral antagonist. Which can get ideal effects if performed according to the excess degree of the superior oblique muscle and the degree of the vertical strabismus.