肉毒杆菌毒素A联合直肌联结术治疗后天性外直肌麻痹的临床观察  

Botulinum toxin A injection with Jensen procedure for the treatment of acquired lateral rectus muscle palsy

作　　者：钟华红[1] 陈静嫦[2] 邓宏伟[1] 刘春民[1] 

机构地区：[1]暨南大学附属深圳市眼科医院深圳眼科学重点实验室,518040 [2]中山大学中山眼科中心

出　　处：《中国斜视与小儿眼科杂志》2016年第1期18-20,24,共4页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的观察肉毒杆菌毒素A（BTXA）水凝胶联合直肌联结术治疗后天性外直肌麻痹患者的临床效果。方法收集发病时间≤3个月的外直肌麻痹患者15例17眼,发病初期麻痹眼内直肌注射BTXA水凝胶（5U/0.05ml/眼）,注药后病情稳定〉6个月,12例（14眼）因眼位欠矫行直肌联结术,术后随访2个月~2年,平均（11.8±5.5）个月。结果 BTXA水凝胶注射后3月,8例8眼≤10△,复视、代偿头位消失;4例4眼15△~25△,症状好转;3例5眼复视症状改善不明显。12例14眼注药3个月后效果逐渐减弱,行直肌联结术后治愈率为83.3%;好转率16.7%。术后平均外转过中线达23.9△±5.5△（10△~35△）。结论后天性外直肌麻痹患者发病早期,BTXA水凝胶注射可以有效防止内直肌挛缩,促进外直肌功能恢复,改善复视症状,可作为手术的辅助措施。后期行直肌联结术可以有效治疗外直肌麻痹。Objective To study the effects of botulinum toxin A and Jensen procedure in the treatment of acquired lateral rectus muscle palsy. Methods Fifteen patients（17 eyes） with acquired lateral rectus muscle palsy of less than 3 months＇ duration were treated by injection of botulinum toxin A（5U/0.05 ml per eye）into the medial rectus muscle. After the stable condition of more than 6 month, Jensen procedure combined with a medial rectus recession was performed on 14 eyes of 12 patients, with an average of 11.8 ±5.5 months follow-up（range from 2 month to 2 years）.Results The squint angle of 8 eyes decreased below 10~△at 3 months of BTXA post-injection. Diplopia and compensatory head posture disappeared. 4 eyes of 4 cases had the squint from 15~△to 25~△.5 eyes of 3 patients had no improvement. The effect became weakened after 3 months of BTXA post-injection in 14 eyes of 12 patients. These patients were had the Jensen procedure. The cure rate and improvement rate were 83.3% and 16.7% respectively after the operation. An average postoperative abduction of 23.9△±5.5△（range from 10△35△） was obtained. Conclusions Injection of BTXA as a preoperative therapy during the early stage of acquired lateral rectus muscle palsy may alleviate medial rectus restinction and promote the recovery of the lateral rectus functions. Jensen procedure is an useful method for the later period of acquired lateral rectus muscle palsy.

关 键 词：肉毒杆菌毒素A 联结术 外直肌 麻痹 

分 类 号：R779.6[医药卫生—眼科]