内窥镜鼻窦手术后内直肌损伤外斜视的手术治疗

Management of large exotropia with medial rectus muscle transection following endoscopic sinus surgery

目的 探讨内窥镜鼻窦手术后内直肌损伤致外斜视的斜视手术治疗效果.方法 5例经鼻窦内窥镜手术后大角度外斜,内转受限的患者,眼眶CT显示内直肌肌腹中部完全断裂.3例患者,内直肌断裂后3个月内,拮抗肌挛缩不明显,2例行垂直肌全肌腹水平转位联合后固定手术,另1例行垂自肌鼻侧1/2肌腹水平转位联合后固定手术.2例患者,内直肌断裂后超过6个月,外自肌挛缩明显,手术分两次进行,先后行外自肌后徙手术,和垂直肌腹水平转位联合后固定手术,两次手术间隔3个月.内转受限按程度分为-1至-8.患者随访超过6个月.结果 5例患者术后正位或小于-5°,4例正前方没有复视,1例配戴三棱镜后正前方复视消失.全部患者内转受限程度改善为-2至-5.无1例发生前节缺血等不良并发症.结论 垂自肌移位手术治疗内窥镜鼻窦手术后大角度外斜视有较好的疗效,手术时机以伤后3个月为佳.

Objective To evaluate and compare the effect of surgeries in large exotropic patients who underwent a medial rectus muscle （MR） transection after endoscopic sinus surgery （ESS）. Methods In 5 patients with exotropia （XT） and a lack of adduction after ESS, orbital CT revealed a complete transection of the midportion of the MR. 3 patients was treated within 3 months after injury. Foster procedure months after ESS with lateral rectus contraction. Surgery was divided into two stages. The adduction deficits were divided into - 1 through to - 8. The patients were followed up for more than than 6months. Results Postoperatively, 5 patients showed orthophoria or small exophoria within -5°among which 4 had no diplopia in the primary position, another one avoid diplopia by prism lens. The adduction deficits improved to -2 to -5. Conclusions Surgical management （vertical rectus muscle transposition） is effective in correcting a large exotropia secondary to a medial rectus transection after ESS. The best time for surgery is 3 months after injury.