内镜鼻窦术后早期内直肌损伤分级评估及预后判断

Grade assessment and prognosis of medial rectus injury after endoscopic sinus surgery

目的分析内镜鼻窦术后早期内直肌损伤,评估预后的观察指标,指导处理策略。方法回顾性分析2015-01~2020-06郑州大学第二附属医院耳鼻咽喉科收治的内镜鼻窦术后早期内直肌损伤病例,以半年后是否手术分为非手术组和手术组,检查斜视度、牵拉试验、眼眶影像学等,分级评估损伤程度。结果 13例患者,非手术组(9例):眼球内转-1~-2级,斜视度≤20 PD,被动牵拉(-),主动收缩(+)。眼眶影像示内直肌完整,周围软组织受损。手术组(4例):眼球内转-3~-4级,外转0~-2级,斜视度>20 PD,被动牵拉(+),主动收缩(-)。眼眶影像示内直肌后段不同程度离断损伤。结论内镜鼻窦术后早期内直肌损伤应结合斜视度、牵拉试验、眼眶影像学等特征分级评估严重程度,行针对性处理。

OBJECTIVE Assessing the severity of ocular motility disorders in the initial stage after endoscopic sinus surgery and evaluating the factors of prognosis in order to guide the development of the appropriate treatment strategies.METHODS Retrospective analysis of the clinical data of the patients with ocular dyskinesia in the initial stages after endoscopic sinus surgery in the Second Affiliated Hospital of Zhengzhou University during Jan,2015 to June,2020 were performed.These cases were divided into two groups based on whether the second-stage eye surgery will be performed after half a year.To observe and compare the characteristics of ocular motility disorders after endoscopic sinus surgery between the two groups,which were strabismus measurement,forced duction test,Hess screen examination,and orbital CT or MRI examination,in order to assess the severity of diseases.RESULTS There were 13 cases with ocular dyskinesia in the initial stages after endoscopic sinus surgery in this study.There were 9 cases in the nonoperative group with-1--2 of adduction,no more than 20 PD in deviation,forced duction testing(-),active force generation test(+),normal in lateral graph and partly contracted in nasal graph of the Hess screening,and the orbital CT or MRI showed normal medial rectus muscle and surrounding soft tissue damaged.There were 4 cases in the operative group with-3--4 of adduction,0--2 of abduction,over than 20 PD in deviation,forced duction testing(+),active force generation test(-),normal or slightly contracted in lateral graph and obviously contracted in nasal graph of the Hess screening,and the orbital CT showed different degree of detachment damage in the posterior segment of medial rectus muscle.CONCLUSION The ocular motility disorders exhibited multiple types,especially the limited adduction in the initial stage after endoscopic sinus surgery.We should carry out different treatments according to the specific characteristics of ocular motility disorders,such as deviation,forced duction test,Hess screening,and orbital imaging features.