先天性上斜肌麻痹的个体化手术治疗

Individualized surgical treatment of congenital superior oblique paralysis

目的探讨先天性上斜肌麻痹的个体化手术治疗效果。方法回顾性分析2015年10月—2018年1月四川大学华西医院眼科收治的131例先天性上斜肌麻痹患者(180只患眼),对其临床特征、手术方式及效果进行总结。结果 131例患者中,49例为双眼先天性上斜肌麻痹,82例为单眼先天性上斜肌麻痹;94例合并水平斜视。17例(26只患眼)行患眼下斜肌减弱术,53例(93只患眼)行患眼上斜肌折叠术,4例行患眼上斜肌折叠联合对侧上直肌缩短术,37例行患眼上斜肌折叠联合对侧下直肌后徙术,6例行患眼下斜肌后徙联合对侧上直肌缩短术,14例行患眼下斜肌转位联合对侧上直肌缩短术;18例同期矫正水平斜视,76例二期矫正水平斜视。治愈116例(88.55%),好转15例(11.45%),无效0例。结论对先天性上斜肌麻痹的诊断应准确,治疗应根据斜视角大小及最大方位,结合各诊断眼位的肌肉运动受限或亢进情况,合理设计相应的个体化手术方式。

Objective To investigate the efficacy of individualized surgical treatment on congenital superior oblique paralysis. Methods A total of 131 patients （180 eyes） undergoing surgery for congenital superior oblique palsy between October 2015 and January 2018 in West China Hospital of Sichuan University were reviewed. The clinical features, surgical methods and efficacy were analyzed. Results Among the 131 cases, 49 cases were bilateral congenital superior oblique palsy, and 82 cases were unilateral congenital superior oblique palsy; 94 cases were combined with horizontal strabismus; 17 cases （26 eyes） underwent inferior oblique recession, 53 cases （93 eyes） underwent superior oblique tuck, 4 cases underwent superior oblique tuck combined with contralateral superior rectus resection, 37 cases underwent superior oblique tuck combined with contralateral inferior rectus recession, 6 cases underwent inferior oblique recession combined with contralateral superior rectus resection, and 14 cases underwent inferior oblique transposition combined with contralateral superior rectus resection; 18 cases underwent horizontal strabismus correction at one stage, and 76 cases underwent horizontal strabismus correction at the second stage. After Surgery, there were 116 cases cured （88.55%）, 15 cases improved （11.45%）, and 0 case invalid. Conclusions The diagnosis of congenital superior oblique paralysis should be accurate. Individualized surgery should be designed according to the size and maximum orientation of the squint and the limitation or hyperactivity of the muscles in each diagnostic eye position.