155例儿童单眼上斜肌麻痹性眼性斜颈的临床特征及手术效果

Analysis of clinical characteristics and surgical results of 155 cases of children with unilateral superior oblique paralysis of ocular torticollis

目的:分析儿童单眼上斜肌麻痹性眼性斜颈的临床特征,评估手术效果。方法:选取2012年3月至2016年4月在南京医科大学附属南京儿童医院眼科入院的斜视患儿,筛选出155例因单眼上斜肌麻痹引起的斜颈患儿进行回顾性分析,记录手术方法与预后效果。结果:155例患儿中选择下斜肌部分切除术50例,下斜肌转位术40例,内外直肌、上下直肌的后徙或缩短术40例,上斜肌折叠术25例。4种不同手术方式的术后疗效对比差异无统计学意义(F=0.000,P>0.05)。155例患儿术后精细立体视100例,粗略立体视55例,不同手术方式的组间近立体视对比差异无统计学意义(P>0.05)。155例患儿术后视觉一级功能124例,二级功能30例,三级功能1例,不同手术方式的组间视觉功能对比差异无统计学意义(P>0.05)。结论:手术能改善儿童单眼上斜肌麻痹性眼性斜颈的视觉功能与近立体视状况,但是需要根据患儿临床特征选择合适的手术方案,以促进术后疗效的提高。

Objective To analysis the clinical characteristics of children with monocular superior oblique paralysis of ocular torticollis, and assess the effect of surgery. Methods During the period from April 2012 to March 2016 in ophthalmic hospital affiliated to Nanjing Medical University, Nanjing Children＇s Hospital, 155 children suffering a simple unilateral superior oblique paralysis caused by torticollis were enrolled as retrospectively analysis about the surgical methods and prognosis. Results There were 50 children were given the transposition of the inferior oblique muscle, 40 children were given medial and lateral rectus, 40 children were given inferior rectus recession or shortening and 25 children were given superior oblique muscle plication. The effective rates in the four kinds of different surgical methods were no statistical significance （F = 0.000, P 〉 0.05）, and the effective rate were more than 95%. There were 100 children with postoperative fine three- dimensional visual, 55 children with rough three-dimensional visual that were significantly better than the preoperative 85 children and 70 children （P 〈 0.05）, but there were no significant difference among the groups in different surgical methods （P 〉 0.05）. There were 124 children were postoperative first visual function, 30 children were secondary functions, and 1 child were third functions that were significantly better than preoperative 97 children, 23 children and 35 children （P 〈 0.05）, but there were no significant difference among the groups in different surgical methods （P 〉 0.05）. Conclusion Children with unilateral oblique paralysis of ocular tortieollisin clinical is more common. The surgery can improve visual function and near stereoscopic depending on the situation. However in order to improve the curative effect after operation, it needs select the appropriate surgery program according to the clinical characteristics of children.