无需肌电仪引导的肉毒素联合或不联合透明质酸钠内直肌注射治疗外伤性外展神经麻痹  

Botulinum toxin injections combined with or without sodium hyaluronate in the absence of electromyography for the treatment of traumatic sixth nerve palsy

作　　者：陈静嫦[1] 邓大明[1] 康瑛[1] 林小铭[1] 吴河坪[1] 颜建华[1] 麦光焕[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼视光学与视觉科学杂志》2013年第9期529-532,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的探讨无需肌电仪引导的A型肉毒素（BTA）联合或不联合透明质酸钠注射治疗外伤性外展神经麻痹的有效性及安全性。方法前瞻性随机对照临床研究。采用抽签法将入选的27例年龄≥16岁病程〈6个月的外伤性外展神经麻痹患者随机分成2组．A组无需肌电仪引导直视下行患眼内直肌注射0．05mlBTA2．5～7．5U联合透明质酸钠；B组无需肌电仪引导直视下行患眼内直肌注射0．03mlBTA溶液2．5～7．5U。分别于注射前、注射后2周、6个月测定患者斜视度、眼球运动功能及睑裂大小。数据采用配对t检验、独立样本t检验和卡方检验。结果2组患者在注射后2周均出现斜视度明显下降（t=8．75、8．79，P均〈0．01）：A、B组的治愈率分别为62％及71％．2组比较差异没有统计学意义（x。=O．297，P〉O．05）；A、B组均未出现并发性上睑下垂及垂直斜视。结论无需肌电仪引导的肉毒素联合或不联合透明质酸钠注射均能有效治疗外伤性外展神经麻痹．而且有较好的安全性。Objective To evaluate the efficacy and safety of botulinum toxin injections combined with or without sodium hyaluronate in the absence of electromyography for the treatment of traumatic sixth nerve palsy. Methods In this prospective, comparative, interventional case series, 27 patients with traumatic sixth nerve palsy who was older than 16 years old and presented within 6 mouths of trauma were randomly divided into 2 groups by drawing lots. In group A, 13 cases were treated with an injection of 2.5-7.5 U BTA combined with sodium hyaluronate in the antagonist medial rectus muscle. In group B, 14 cases were treated with an injection of 2.5-7.5 U BTA solution alone in the antagonist medial rectus muscle. Electromyography was not used in the study. All patients were evaluated preoperatively and 2 weeks and 6 months following the injections. Data were analyzed using paired t test, independent t test and chi-square test. Results The size of deviation was significantly reduced 2 weeks following the injections in both groups （t=8.75, P〈0.01 in group A, t=8.79, P〈0.01 in group B）. The recovery rate in groups A and B were 62% and 71% respectively, which had no statistical significance （X2=0.297, P〉0.05）. No ptosis or vertical deivation was encountered in both groups. Conclusion BTA injections combined with or without sodium hyalnronate in the absence of electromyography demonstrated effectiveness and safety in the treatment of traumatic sixth nerve palsy.

关 键 词：肉毒毒素类 外展神经麻痹 肌电仪 透明质酸 手术后并发症 

分 类 号：R774.6[医药卫生—眼科]