获得性上斜肌麻痹的临床表现及术式选择  

Clinical characteristics and surgical management of acquired superior oblique palsy

作　　者：刘艳[1] 张晓慧[1] 刘睿[1] 邹蕾蕾[1] 刘红[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2012年第6期364-367,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：浦东新区社会发展局卫生科技项目(PW2012D-5)

摘　　要：目的探讨获得性上斜肌麻痹的临床特点、术式选择及手术效果。方法回顾分析我院收治的21例(41眼)获得性上斜肌麻痹患者的病因、临床特点及手术治疗,对术前及术后1周、4周、3个月结果进行分析比较。结果获得性上斜肌麻痹以双侧为主,病因主要为闭合性颅脑外伤,常有昏迷病史,有旋转复视主诉,代偿头位以下颌内收多见,斜视检查表现为双下方为主的外旋。本组病例中35眼行Harada-Ito术,5眼行上斜肌折叠术,1眼行下斜肌减弱术。术中及术后随访未见并发症,术后所有患者旋转复视消失,1例仍有轻微头向肩倾斜的代偿头位。41眼术前同视机检查上方注视野外旋(9.1±2.1)°,正前方注视野外旋(11.0±2.4)°,下方注视野外旋(15.0±3.3)°,与术后1周[分别为内旋(7.5±2.3)°,内旋(4.7±2.4)°,内旋(2.2±2.4)°],术后4周[分别为内旋(5.3±1.9)°,内旋(3.5±2.3)°,内旋(1.9±2.3)°],术后3个月[分别为内旋(1.8±2.2)°,外旋(1.4±2.1)°,外旋(4.2±2.3)°]相比,旋转斜视度差异均有显著统计学意义(P均<0.01),随着时间推移,术后旋转斜视度有一定程度的回退趋势。结论获得性上斜肌麻痹的主要临床表现为旋转性复视,需依据临床检查结果选择Harada-Ito术、上斜肌折叠术或下斜肌减弱术进行手术治疗,手术以适度过矫为宜。手术安全可靠,效果显著。Objective To investigate the clinical characteristics and surgical treatment of acquired superior ob- lique palsy. Methods The clinical characteristics, pathogen and surgical treatment of 21 patients （41 eyes） with ac- quired superior obligue palsy were analyzed retrospectively. Torsion was evaluated at before surgery, 1,4 weeks, and 3 months post-operation using Maddox Double Rod Test and synoptophore. Results In this retrospective study, 21 patients （41 eyes） with acquired superior oblique palsy showed a characteristic bilateral torsion caused by a traumatic closed head and brain injury accompanied by a short-term coma,double vision complain, and compensative head position of chin de- pression showing a biocular inferior excyclotorsion. Thirty-five eyes of patients with acquired superior oblique palsy were treated with Harada-lto procedure, 5 with superior oblique muscle tuck, and 1 with inferior oblique muscle recession. All patients had no complain of torsional diplopia and saw clearly after the surgery. No complications were found during or post-operation. Synopotophore examination showed significant （P 〈 0.01 ） decrease in parameters of superior,front, infe- rior excylotropia at 1,4 weeks, and 3 months, （7.5±2.3）°, （4.7 ± 2.4） °, （2.2 ±2.4）° ; （ 5.3 ± 1.9 ）°, （ 3.5 ±2.3）°,（1.9±2.3）°; （1.8±2.2）°,（1.4±2.1）°,（4.2±2.3）°, respectively, （9.1 ±2.1）°,（11.0±2.4）°, （ 15.0±3.3）° ]. However, there was regression of the torsion effect after surgery. Conclusions Harada-Ito procedure, superior oblique tucking and inferior oblique myectomy were safe and effective for the treatment of patients with acquired excylotropia. Diplopia and torsion, especially downward gaze might be a major post-operation complain. An initial over- correction might be considered as a long-term success of this procedure.

关 键 词：旋转斜视 复视 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]