前部上斜肌肌腱折叠术矫正成年人外旋转斜视的疗效观察

Clinical observation of anterior tucking of the superior oblique tendon for correction of excyclotropia in adults

目的观察成年人后天性外旋转斜视行前部1/3上斜肌肌腱折叠术的治疗效果。方法回顾性系列病例研究。收集2019年1至12月在天津市眼科医院确诊为后天性上斜肌麻痹并行前部1/3上斜肌肌腱折叠术的患者7例(7只眼),其中男性5例,女性2例,年龄(49±12)岁。所有患者均有闭合性颅脑损伤史,第一眼位存在旋转性复视,眼球运动检查可见受累眼上斜肌麻痹,不伴有明显下斜肌功能运动过强。术前行双眼被动牵拉试验,术中根据被动牵拉试验肌腱松弛情况行前部1/3上斜肌肌腱折叠术。旋转斜视角度以中位数(最小值,最大值)表示,采用配对样本秩和检验对术后第1天及末次随访时的旋转斜视角度与术前进行比较。结果所有患者前部1/3上斜肌肌腱根据肌腱的松弛程度行6.0~10.0 mm折叠,折叠量为(7.7±1.8)mm。术中患者均主诉第一眼位旋转复视明显好转,双马氏杆测量第一眼位主观外旋转度数由术前10°(8°,15°)改善至术后第1天的2°(0°,3°),差异有统计学意义(Z=-2.379;P<0.05)。随访时间为(112±38)d,患者末次随访时第一眼位外旋转度数为2°(2°,5°),与术前比较差异有统计学意义(Z=-2.375;P<0.05)。所有患者末次随访均无旋转复视主诉。结论成年人后天性外旋转斜视行前部1/3上斜肌肌腱折叠术,能够有效改善第一眼位外旋转斜视的临床症状,术后短期随访效果稳定,未发生明显回退。(中华眼科杂志,2021,57:685-688)

Objective To investigate the clinical effect of anterior 1/3 superior oblique tendon tucking in acquired symptomatic excyclotropia adults.Methods Retrospective case series.Seven patients(7 eyes)with acquired symptomatic excyclotropia who underwent an anterior 1/3 superior oblique tendon tuck procedure in Tianjin Eye Hospital from January 2019 to December 2019 were included.There were 5 male patients and 2 female patients,with an average age of(49±12)years old.All the patients had a history of a closed head injury.There was torsional diplopia in primary position,and eye movement examination showed paralysis of the superior oblique muscle in the affected eye,without obvious hyperactivity of the inferior oblique muscle.The anterior 1/3 tendon of the superior oblique muscle was tucked during surgery according to the relaxation of the superior oblique tendon in the forced duction test.The paired-sample nonparametric rank sum test was used to analyze the preoperative and postoperative(at 1 day after surgery and the last follow-up)excyclotropia angle.Results The mean tuck amount was(7.7±1.8)mm(range,6.0 to 10.0 mm).During operation,patients complained that excyclotropia improved markedly.The excyclotropia angle with the double Maddox rod test improved significantly from preoperative 10°(8°,15°)to 2°(0°,3°)at 1 day(Z=-2.379;P<0.05)and 2°(2°,5°)at the last follow-up(Z=-2.375;P<0.05).The follow-up period was(112+38)days.All patients had no complaints of excyclotropia at the last follow-up.Conclusions The anterior 1/3 superior oblique tendon tucking can effectively improve clinical symptoms in the primary position in adults with acquired excyclotropia and diplopia.The short-term postoperative results seem to be stable,without significant regression.(Chin J Ophthalmol,2021,57:685-688)