上斜肌前部前徙术治疗上斜肌麻痹的外旋斜的研究

The study of intraoperative adjustable suture Harada-Ito procedure for excyclotorsion of superior oblique palsy

目的 观察术中可调整缝线的上斜肌前部前徙术治疗上斜肌麻痹的外旋斜的效果。方法 对 6例 ( 9眼 )外旋斜患者 (其中双眼外旋斜和单眼外旋斜各 3例 )行此术式 ,在术前、术中、术后 1周分别行双马多氏杆检查第一眼位的主观旋转斜。分析旋转斜度与手术量的关系及治疗效果。结果 6例患者术前都存在正前方及下方双眼复视症状 ,第一眼位的外旋斜 5～ 15° ,平均 10 5°。术毕双马多氏杆检查第一眼位为 0°～内旋斜 5° ,平均内旋斜 3 7°。术后所有患者正前方及向下看复视症状消失 ,术后 1周为外旋 2°～内旋 4° ,平均内旋 1 4°。其中 2例患者术后 7个月复诊 ,一例外旋斜 3° ;另一例为旋转斜 0° ,都未出现明显复视症状。结论 术中可调整缝线的上斜肌前部前徙术是一种安全可靠的矫正上斜肌麻痹的外旋斜的手术方式 ,常需要过矫至内旋 5°左右来代偿术后出现的回退。

ObjectiveTo investigate the effect of intraoperative adjustable suture Harada-Ito procedure on excyclotorsion of superior oblique palsy (SOP).MethodsSix patients including 3 bilateral and 3 unilateral excyclotorsion accepted this procedure ,and the double Maddox rod test in primary position were carried out preoperatively during the surgery and 1 week postoperatively.The relationship between the operation quantities and the postoperative outcome was analyzed.ResultsAll patients complained of torsional diplopia in primary position and downgaze,and the excyclotorsion values in primary position were 5°-15°(mean 10.7°)in preoperation.All eyes were adjusted to cyclotorsion 0°-incyclotorsion 5°(mean incyclotorsion 3.7°) intraoperatively.A functional care,defined as absence of torsional diplopia in primary position and downgaze,was achieved in all patients after operation.The cyclotortion values were excyclotorsion 2°-incyclotorsion 4°(mean incyclotorsion 1.7°)at 1 week after operation.Seven months later,slight regression occurred in 2 patients,but no diplopia recurred.ConclusionThe intraoperative adjustable suture Harada-Ito procedure is an effective and safe surgery for excyclotorsion of SOP.Overcorrection to incyclotorsion 5°intraoperatively may be helpful to the compensation of postoperative regression.