下斜肌转位术对伴下斜肌功能亢进DVD患者疗效研究

Research of the treatment for DVD with inferior oblique over-action by anterior transposition of the inferior oblique muscle

目的评价下斜肌转位术对伴有下斜肌功能亢进的垂直分离性偏斜的疗效。方法临床病例系列研究。对2009年2月至2013年8月在广西医科大学第一附属医院眼科就诊的22例（26只眼）行下斜肌转位治疗伴有下斜肌功能亢进的分离性垂直偏斜（DVD）病例资料进行回顾性分析，比较手术前后33cm及5m垂直斜视度变化、下斜肌功能减弱情况以及单双眼下斜肌转位术后发生抑制上转综合征（AES）的情况。结果（1）22例患者术前33em平均垂直斜视度（21．12±9．49）PD，术后（3．92±6．35）PD（t=9．026，P=0．000）；术前5m平均垂直斜视度（21．00±8．83）PD，术后（4．12±7．25）PD（t=8．819，P=0．000）。（2）术前下斜肌亢进平均（3．04±0．79），术后平均（0．20±0．87），差异有统计学意义（z=4．432，P=0．000）。（3）双眼下斜肌转位4例中1例以及单眼下斜肌转位加对侧眼下斜肌切断7例中1例术后出现抑制上转综合征（AES），仅行单眼下斜肌转位11例中6例术后出现AES。结论下斜肌转位术是治疗合并下斜肌亢进的DVD的有效手术方式，双眼下斜肌亢进的DVD可采取双侧下斜肌转位或者单侧下斜肌转位联合对侧下斜肌切断，单眼下斜肌亢进的DVD不建议首选下斜肌转位术。

Objective To evaluate the efficacy of anterior transposition of the inferior oblique muscle （ATIO） for the treatment of dissociated vertical deviation （DVD） combined with inferior oblique overaction （IOOA）. Methods Twenty-two patients （26 eyes） that treated surgically at the first affiliated Hospital of Guangxi Medical University, Nanning, China from February 2009 to Au- gust 2013 were studied retrospectively. All patients were performed ATIO for DVD with coexisting IOOA. The amount of vertical deviation in primary position was compared between pre-and post-op- eration at either 5m or 33cm distance respectively. The degree of inferior oblique over-action was compared between pre-and post-operation. The incidence of anti-elevation syndrome （AES） was com- pared between the cases performing unilateral and bilateral ATIO. Results The mean vertical devia- tion in primary position at 33cm was （21.12±9.49）PD preoperatively. It had decreased to （3.92±6.35） PD postoperatively （t =9.026, P =0.000）. The mean vertical deviation in primary position at 5m was （21.00±8.83）PD preoperatively, and was （4.12±7.25）PD aider operation （t =8.819, P =0.000）. Mean in- ferior oblique over-action decreased from （3.04±0.79） to （0.20±0.87） （z =-4.432, P =0.000）. It was statistically significant difference. There were 1 of the 4 cases who performing bilateral ATIO, 1 of the 7 cases who performing unilateral ATIO while the other eye underwent myotenotomy of the infe- rior blique muscle, and 6 of the 11 cases who only performing unilateral ATIO showed AES after the operation. Conclusions ATIO is an effective treatment for DVD combined with IOOA. The DVD with bilateral inferior oblique over-action can be taken the bilateral inferior oblique transposi- tion or tmilateral inferior oblique transposition jointly contralateral inferior oblique cut, but monocu- lar inferior oblique transposition surgery is not the first choice of monocular inferior oblique over-ac- tion DVD.