上斜肌减弱术治疗痉挛性脑瘫伴斜视A征患儿临床疗效分析

The surgical efficacy of weakening the overaction of superior oblique muscle in children with cerebral palsy and A-pattern strabismus

目的探讨上斜肌减弱术对上斜肌亢进导致的痉挛性脑瘫伴斜视A征患儿的手术特点及临床疗效。方法选取2015年6月~2016年12月我院收治的上斜肌亢进的痉挛性脑瘫伴斜视A征患儿16例,其中单眼2例,双眼14例,共30眼。16例痉挛性脑瘫患儿中2例患儿行单眼上斜肌减弱术(上斜肌肌腱延长),其余行双眼上斜肌功能减弱术。比较术前与术后半年随访的斜视相关资料,分析上、下转25°眼位的水平斜视度,评价手术对A征的治疗效果。结果术后半年随访大部分患儿A征较术前明显好转或消失,其中3例患儿发生不同程度回退,但与术前比较上斜肌亢进程度仍有好转,矫正成功率81.25%(13/16)。术前与术后半年上、下转25°眼位的水平斜度差比较差异有统计学意义(t=5.65,P<0.05);7例患儿(43.75%)在术中发现有上斜肌肌肉肥厚增粗,肌肉力量过强等现象。术后无一例发生继发性上斜肌麻痹或继发V型斜视等现象。结论上斜肌减弱术可有效改善痉挛性脑瘫伴斜视A征患儿上斜肌功能亢进的现象;但由于此类患儿肌肉力量过强,手术设计量应作相应调整,避免矫正不足。

Objective To analyze the surgical efficacy of weakening the overaction of superior oblique muscle in children with cerebral palsy and A-pattern strabismus. Methods 16 patients with overaction superior oblique with cerebral palsy and A-pattern strabismus, including 2 cases with monocular disease and 14 cases with binocular disease, 30 eyes, treated in our hospital from June 2015 to December 2016 were selected. The overaction of superior oblique muscle was weakened by lengthening its tendon. The pre-operative and post-operative （half-year after operation） strabismus angles were recorded when the patients look up or down 25°. The efficacy of the surgery was evaluated. Results 16 children took the surgery with both eyes except 2 took with one eye had only one eye with superior oblique muscle overacting. A-pattern Strabismus in most patients turned to become much better or even recovered by lengthening the superior oblique muscle, with 3 patients recrudesced in varying degrees turned to be still better comparing with their pre-operation situation. The success rate of the operation was 81.25% （13/16）. The A-pattern strabismus showed obviously changed comparing with pre- and post-operation （t=5.65,P〈0.05）. Among all the patients, 7 children presented difference a- bout their superior oblique muscle showed up much stronger and thicker than those in normal strabismus patients. No case had secondary superior oblique palsy or V-pattern after surgery. Conclusion The results show that the surgery of weakening the overaction of superior oblique muscle is an effective way to change the A-pattern strabismus, with the individualized design for the spastic cerebral palsy patients who may have stronger muscular strength of extraocular muscles.