上斜肌断腱术与部分切除术治疗上斜肌亢进疗效观察

The efficacy of superior oblique tenotomy and superior oblique partial tenectomy in the treatment of superior oblique overaction

目的 探讨上斜肌亢进患者的临床特征,以及上斜肌断腱术与部分切除术治疗上斜肌功能亢进的疗效.方法 对2008年6月至2013年11月在四川大学华西医院就诊的167例（306只眼）上斜肌功能亢进患者行上斜肌断腱术与部分切除术,并比较手术前后上斜肌功能、垂直方向斜视度及A征矫正情况等,以此综合评价上斜肌断腱术与部分切除术治疗上斜肌亢进的疗效.结果 167例（306只眼）上斜肌亢进患者平均年龄为（14.92±7.13）岁,108只眼行上斜肌断腱术,198只眼行上斜肌肌腱部分切除术.其中,21只眼术后出现上斜肌功能不足,占6.9％ （21/306）;26只眼术后上斜肌功能仍然呈不同程度亢进,占8.5％ （26/306）;38只眼继发下斜肌功能亢进,占12.4％ （38/306）.131例伴发A型外斜视的患者中,有21例患者术后仍为A征,但A征均较术前明显减小.垂直方向斜视度矫正在不同注视眼位分别为：正前方视近均值为6.96△、正前方视远为7.36△、眼球上转为7.78△、眼球下转为9.27△.此外,17例伴有A外斜的患者术后转变为V型外斜视,11例患者出现10△以内垂直方向的斜视.结论 上斜肌功能亢进患者常伴有A型外斜视;上斜肌断腱术与部分切除术能有效矫正上斜肌功能亢进、A征,单眼手术可有效矫正垂直方向的斜视度.

Objective To evaluate the efficacy of superior oblique partial tenectomy and tenotomy in the treatment of superior oblique overaction with respect to collapse of A-pattern strabismus.Methods Retrospectively reviewed 167 patients （306 eyes） who had superior oblique （SO） weakening with either SO tenotomy or SO partial tenectomy and had been followed for a mean follow-up of 137 days.The degree of A-patter,vertical deviation and SO function were analyzed in all patients before and after surgery.Results A total of 167 patients （mean age,14.92±7.13 years） underwent SO weakening,of whom 83 patients （108 eyes） had been treated with superior oblique tenotomy and 112 patients （198 eyes） with superior oblique partial tenectomy.The mean preoperative amount of A-pattern for all patients was 20.37±10.04△ with a mean collapse of （15.96±10.22△,0 to 33△）.The mean degree of preoperative vertical deviation in the group were 6.96△ in the primary position at near distance,7.36△ in the primary position at distance,7.78△ of 25-degree upgaze,and 9.27△ of 25-degree downgaze at distance.There were no surgical complications,except in 11 patients,who manifested mild inferior oblique overaction.Conclusions The results show that superior oblique tenotomy and superior oblique partial tenectomy can effectively collapse A-pattern deviation with mild to moderate SO overaction and reduce associated vertical deviation.