双下转肌麻痹的临床表现和手术治疗

Clinical manifestation of double depressor paralysis and its surgical treatment

目的:探讨双下转肌麻痹患者的临床表现、手术治疗方法以及治疗效果。方法:以2009-07/2011-11期间我科收治的6例双下转肌麻痹患者为研究对象。检查眼位、眼球运动、代偿头位和牵拉试验等。采用减弱患眼上直肌、下斜肌转位联合或分次行水平肌手术的治疗原则。综合分析其病例资料、手术方法及随访结果,观察手术疗效。结果:本病的临床特点为患眼上斜视,上斜度≥25△,可同时伴有内斜或外斜,患眼外下转和内下转均明显受限,常以健眼为注视眼,以患眼注视时可表现为健眼假性上睑下垂。经6～24mo随访,6例患者,1次术后眼位矫正5例,1例经第2次行水平肌手术获得外观显著改善。结论:眼球运动检查是诊断双下转肌麻痹直观而有效的方法,斜视度和牵拉试验结果是手术设计的重要依据;手术可使大多数患者获得外观上的改善;合并水平斜视者手术可同期或分期进行;手术原则是减弱患眼上直肌、下斜肌转位联合或分次行水平肌手术。

AIM： To discuss the clinical manifestation of double depressor paralysis （DDP） and evaluate its surgical method and therapeutic effect. METHODS： Six cases of DDP were retrospectively reviewed from July 2009 to September 2011. To examine the eye position, eye movement, compensatory head posture and forced duction test. All patients were operated on the paretic eye. The superior rectus muscle （SR） was weakened and inferior oblique muscle （IO） transferred. The horizontal muscles operation can be executed at the same time or the next time. Clinical characteristics and surgical procedure and the results were summarized. RESULTS： The clinical characteristics of patients were hypertropia of the peratic eye （ ≥ 25△ ）. Significant limitation of lateral-in-fraduction and medial-infraduction was observed. Horizontal deviation can be accompanied. The non- paretic eye is often the fixation eye. Some patients show pseudo- blepharoptosis in the primary position when fixed with the paretic eye. After 6 to 24 months follow-up, 5 patients were cured in one operation and the rest one was greatly improved by the second operation. CONCLUSION： Ocular movement examination is efficient and direct method for DDP diagnosis. The operation project lies on the deviation degree and result of forced duction test. Most patients with DDP gain good results. The operation principles include SR slack, IO transfer, accompanied or unaccompanied with horizontal muscles operation.