内直肌与外直肌同时后徙治疗Duane眼球后退综合征的疗效分析

Recession of both horizontal rectus muscles in Duane Retraction Syndrome with significant globe retraction

目的评价内、外直肌同时后徙治疗Duane眼球后退综合征的临床疗效。方法回顾性研究。对16例因Duane眼球后退综合征而采用内、外直肌同时后徙的手术方式治疗的患者进行回顾性总结分析，观察项目包括患者的性别、年龄、Duane眼球后退综合征的类型和临床表现、手术方式和效果。所有患者随访3个月到1年。结果单眼受累15例，双眼受累1例。I型患者共3例，其中内斜视1例，原在位无斜视2例；m型患者共13例，其中内斜视6例（7只眼），外斜视1例，原在位无斜视6例。10例患者存在明显的代偿头位，所有患者患眼企图内转时存在急速上转和（或）下转现象及不同程度的眼球后退症状。所有患者均行内、外直肌同时后徙，根据斜视类型不同，内直肌后徙量为5～7mm，外直肌后徙量为3—9mm，其中2例联合外直肌Y形劈开。术后患者原在位眼位均为正位，代偿头位明显改善或消失，眼球后退现象及睑裂变化明显改善。患眼内转时急速的上转、下转现象改善或消失，联合外直肌Y形劈开加后徙术式的患者，效果更为明显。结论单眼内、外直肌同时后徙能有效的改善Duane眼球后退综合征患者的眼球后退症状及内转时急速的上转、下转现象，对于Ⅲ型原在位无明显斜视及代偿头位但伴有明显眼球后退的患者可采用此法改善外观。内、外直肌后徙联合外直肌Y形劈开对解决患眼内转时急速的上转、下转现象作用明显。

Objective To evaluate the effect of Recession of both horizontal rectus muscles in Duane Retraction Syndrome with significant globe retraction. Methods Sixteen cases with DRS were summarized retrospectively. All patients had undergone surgery with recession of both horizontal rectus muscles. All clinical records, including sex, age, types of DRS, clinical features, surgical methods and clinical outcomes were analyzed. All patients were followed up for 3 months to 1 year. Results Fifteen cases had only monocular involvement while one had both eyes. The number of type I DRS was 3 cases, 1 case was esotropia while others were orthotropia in primary position. Type III DRS was observed 13 cases. Esotropia was seen in 6 cases （7 eyes）, exotropia of 1 cases and orthotropia in primary position of 6 cases. 10 cases exhibited marked face turn. An upshoot or downshoot and variable severity of retraction of globe were found in all patients on attempt adduction of the affected eye. All patients had undergone surgery with recession of both horizontal rectus muscles. The medical rectus muscles were recessed from 5 mm to 7 mm and lateral rectus muscles 3 mm to 9 mm simultaneously, which was based on the amount of primary position deviation. Among these 2 cases were combined with Y-splitting of lateral rectus muscle. After surgery, all patients were orthotropia in primary position. Their symptom of unacceptable abnormal head position, significant globe retraction, noticeable narrowing of tbe palpebral fissure and significant npshoot or downshoot were ameliorated or disappeared. Especially the recession of lateral rectus muscle in addition to Y-splitting combining with the simultaneous medial rectus recession resulted in further amelioration of globe retraction in addition to upshoot and downshoot. Conclusion Recession of both horizontal rectus muscles is effective in the treatment of significant globe retraction in Duane syndrome. Type m DRS with significant globe retraction but has no marked deviation and face turn can adopt this method to ameliorate their aspect. The method of lateral rectus muscle in addition to Y-splitting plays an important role in the treatment of upshoot and downshoot.