外伤性上斜肌麻痹的手术治疗

The surgical treatment of traumatic superior oblique palsy

目的探讨外伤性上斜肌麻痹的手术治疗。方法回顾性分析12例外伤性上斜肌麻痹患者，根据旋转斜视度和垂直斜视度设计手术。结果行单眼Harada-Ito术3例，旋转方向过矫2例，欠矫1例，垂直和水平方向不受影响；行单眼改良Harada-Ito术3例，旋转方向过矫2例，欠矫1例，垂直和水平方向不受影响；行单眼上斜肌折叠术3例，旋转方向过矫3例，欠矫0例，垂直方向过矫2例，欠矫1例，水平方向不受影响；行单眼Harada-Ito术联合另一眼上斜肌折叠术2例，旋转方向过矫2例，欠矫0例，垂直方向过矫2例，欠矫0例，水平方向不受影响；行双眼Harada-Ito术1例，旋转方向过矫1例，欠矫0例，垂直和水平方向不受影响。以上术式旋转方向过矫量或欠矫量≤5°，垂直方向过矫量或欠矫量≤3°。术后一周9例单眼外伤J生上斜肌麻痹患者症状消失，3例双眼外伤性上斜肌麻痹患者症状改善。结论外伤性上斜肌麻痹患者需制定个体化的手术方案，手术设计需兼顾旋转斜视和垂直斜视，力求旋转和垂直方向上均解决患者的眼位问题，以改善复视、眩晕等症状。

Objective To study the surgical treatment of traumatic superior oblique palsy. Methods Data of 12 cases of traumatic superior oblique palsy were reviewed retrospectively, design operation scheme according to vertical and cyclotorsional deviation. Results Three cases were oper- ated with monocular Harada-Ito procedure, in the rotational direction, overcorrection 2 cases, under- correction 1 case, no effect in the horizontal and vertical direction. Three cases were operated with monocular improved Harada-Ito procedure, in the rotational direction, overcorrection 2 cases, undercor- rection 1 case, no effect in the horizontal and vertical direction. Three cases were operated with monocular superior oblique muscle tuck procedure, in the rotational direction, overcorrection 3 cases, undercorrection 0 case, in the vertical direction, overcorrection 2 cases, undercorrection I case, no ef- fect in the horizontal direction. Two cases were operated with monocular Harada-Ito procedure and superior oblique muscle tuck procedure of another eye, in the rotational direction, overcorrection 2 cases, undercorrection 0 case, in the vertical direction, overcorrection 2 cases, undercorrection 0 case, no effect in the horizontal direction. One case was operated with Harada-Ito procedure in both eyes, in the rotational direction, overcorrection 1 case, undercorrection 0 case, no effect in the hori- zontal and vertical direction. In all this type of operation, overcorrection or undercorrection ≤5° in the rotational direction, overcorrection or undercorrection ≤3° in the vertical direction. After a work, symptoms of 9 cases of monocular traumatic superior oblique palsy disappeared, symptoms of 3 cas- es of traumatic superior oblique palsy in both eyes reduced. Conclusions Individualized operation scheme should be developed in patients of traumatic superior oblique palsy, design operation scheme according to vertical and cyclotorsional deviation to solve the eye position problem in the rotational and vertical direction, and reduce the diplopia and dizziness symptoms.