上直肌转位联合内直肌后徙术在治疗外展神经全麻痹中的应用  

Superior rectus transposition with medial rectus recession for sixth nerve palsy

作　　者：司明宇[1] 杨士强[2] 郭新[2] 岳以英[2] 邵新香 

机构地区：[1]徐州市第一人民医院眼科,221002 [2]天津市眼科医院,300020

出　　处：《中华眼视光学与视觉科学杂志》2015年第4期201-205,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 探讨上直肌颞侧转位联合内直肌后徙术治疗外展神经全麻痹内斜视的疗效.方法 回顾性病例研究.分析11例就诊于天津市眼科医院或徐州市第一人民医院眼科的外展神经全麻痹患者术前、术后末次随访时的斜视度、代偿头位角度、受累眼外转和内转受限的程度.11例患者均行上直肌颞侧转位手术,其中8例同期联合内直肌后徙术.内直肌后徙手术采用术中调整缝线方法,根据术中眼位,确定内直肌后徙的位置.平均随访6个月以上.采用配对t检验比较术前、术后第一眼位内斜度、代偿头位角度、外转及内转受限的程度.结果 10例患者一次手术矫正至正位,患者代偿头位和复视消失,患者均对手术结果满意.1例患者上直肌全肌腹转位联合内直肌后徙术后欠矫,残余代偿头位及复视,3个月后行下直肌颞侧转位术,头位及复视消除.11例患者内斜视从术前31.2°±13.7°矫正至术后3.4°±1.7°（t=7.28,P＜0.01）;代偿头位从术前26.1°±7.7°矫正至术后0.9°±3.0°（t=10.75,P＜0.01）;外转受限从术前-4.8±0.9矫正至术后-2.0±0.9（t=8.84,P＜0.01）;内转受限从术前-0.2±0.4矫正至术后-1.0±0.4（t=4.62,P＜0.05）.本组患者术后均未出现垂直或旋转复视.结论 上直肌转位联合内直肌后徙术,可以同期进行.单独上直肌转位不会带来新的垂直斜视和旋转斜视.上直肌转位术联合调整缝线下的内直肌后徙术是治疗外展神经全麻痹的有效方法之一.Objective To use superior rectus transposition （SRT） with adjustable medial rectus muscle recession for the treatment of sixth nerve palsy.Methods This was a retrospective clinical study.Eleven patients with sixth nerve palsy who underwent SRT in Tianjin Eye Hospital or the First People＆#39;s Hospital of Xuzhou were reviewed.The pre-and postoperative outcomes were compared and included the deviation angle of esotropia in the primary position,the head turn angle,and the limit of abduction.In the 11 cases,8 patients had a medial rectus recession.Adjustable suture medial rectus recession was used to identify the proper positions.The average follow-up time was more than 6 months.Preoperative and postoperative first angle,angle of the compensatory head turn,limited extent of inside and outside duction were compared with a paired t test.Results Postoperatively,10 patients showed orthophoria in the primary position and improved compensatory head turn.The patients were satisfied that there was no diplopia.One patient required a second surgery for under-correction.Compensatory head turn and diplopia were corrected after inferior rectus temporal transposition.In the 11 patients,esotropia improved from 31.2°±13.7° to 3.4°±1.7° （t=7.28,P〈0.01）;compensatory head turn improved from 26.1°±7.7° to 0.9°±3.0° （t=10.75,P〈0.01）;the abduction limit decreased from-4.8±0.9 to-2.0±0.9 （t=8.84,P〈0.01） while the adduction limit increased from-0.2±0.4 to-1.0±0.4 （t=4.62,P〈0.05）.No new vertical or torsional deviation was observed in any of the 11 patients.Conclusion Superior rectus transposition with medial rectus recession can be performed during the same surgery,avoiding the risk of anterior segment ischemia.SRT does not induce new vertical or torsional strabismus.Therefore,SRT with medial rectus recession is an effective approach to treat sixth nerve palsy.

关 键 词：斜视手术 眼肌麻痹 上直肌转位术 内直肌后徙术 展神经疾病 

分 类 号：R779.6[医药卫生—眼科]