下斜肌肌腹转位术治疗小角度先天性上斜肌麻痹的6个月疗效观察

Six months efficacy of inferior oblique muscle belly transposition in treating small angle congenital superior oblique muscle palsy

目的研究下斜肌肌腹转位术治疗合并代偿头位的小角度先天性上斜肌麻痹的临床效果。设计回顾性病例系列。研究对象2019年4月至2022年12月在北京儿童医院保定医院眼科就诊的合并代偿头位的单眼小角度先天性上斜肌麻痹患者18例(18眼)。方法对18例患者均行下斜肌肌腹转位术,即将距离下斜肌止端约10~11 mm处肌腹固定于下直肌颞侧止端后5 mm处。术前与术后6个月用三棱镜测量第一眼位患眼垂直斜视度,根据Hunter分级法评价患眼下斜肌亢进程度,观察代偿头位变化,采用Photoshop 7.0软件测量患者眼底照片黄斑中心凹-视盘中心夹角度数(FDA)。主要指标垂直斜视度、下斜肌亢进程度、代偿头位、FDA。结果术后6个月第一眼位平均垂直斜视度为(0.51±0.60)棱镜度(PD),较术前的(5.03±0.84)PD显著降低(t=14.241,P<0.001)。18眼中术前10眼下斜肌功能亢进程度为2+,术后6眼消失、4眼为1+;术前8眼下斜肌功能亢进程度为1+,术后均消失。术前18例患儿代偿头位均表现为头向健眼侧倾斜,术后12例消失,6例患儿歪头症状明显改善,且未出现反向歪头。术后FDA(4.81±2.53)°较术前的(9.82±5.17)°减少(3.02±0.91)°。术后随访6个月,所有患者均未出现并发症。结论下斜肌肌腹转位术治疗小角度先天性上斜肌麻痹,尤其是合并代偿头位的患者是安全有效的。(眼科,2024,33:61-65)

Objective To investigate the clinical effect of inferior oblique muscle belly transposition in the small angle congenital superior oblique muscle palsy with compensatory head position.Design Retrospective cases series.Participants The 18 patients(18 eyes)who has single eye small angle congenital superior oblique muscle palsy with compensatory head position and treated in the Ophthalmology Department of Baoding Hospital of Beijing Children's Hospital from April 2019 to December 2022.Methods For the above 18 patients,give the surgery of inferior oblique muscle belly transposition.The muscle abdomen was about 10-11 mm away from the inferior oblique muscle end and was fixed 5 mm after the temporal end of the lower rectus muscle.Observe the angle of vertical strabismus at the first-eye position measured with a prism,according to the Hunter grading method inferior oblique muscle hyperactivity of sick eye,compensatory head position,the fovea-disc angle(FDA)of fundus photograph was measured using Photoshop7.0 software.Main Outcome Measures The angle of vertical strabismus,inferior oblique muscle hyperactivity,compensatory head position and FDA.Results The angle of vertical strabismus at the first-eye position at 6 months after surgery was(0.51±0.60)PD,it was significantly lower than before(5.03±0.84)PD(t=14.241,P<0.001).In the 18 eyes,before surgery,the oblique muscle hyperactivity was 2+in 10 eyes,6 eyes disappeared and 4 eyes were 1+after surgery;before surgery the oblique muscle hyperactivity was 1+in 8 eyes,all disappeared after surgery,which was 100%effective.Before surgery all the 18 children showed the head tilt toward the healthy eye side,disappeared after surgery in 12 patients,and the compensatory head position was significantly improved in 6 children,there’s no reverse tilt,which was 100%effective.The FDA after surgery(4.81±2.53)°decreases(3.02±0.91)°than before surgery(9.82±5.17)°.During the 6 months’follow-up,none of the patients developed relevant complications.Conclusion Inferior oblique muscle belly transposition is safe and effective for the treatment of small angle congenital superior oblique muscle palsy,especially in patients with compensatory head position.(Ophthalmol CHN,2024,33:61-65)