肉毒素注射后上直肌移位联合改良肌联结术治疗麻痹性内斜视  

Treatment of paralytic esotropia by transposition of superior rectus muscle combined with modified muscle connection surgery after botox injection

作　　者：邵新香 司明宇[1] 范可顺[1] 

机构地区：[1]徐州市第一人民医院眼科徐州市眼病防治研究所,221002

出　　处：《中国斜视与小儿眼科杂志》2017年第4期11-13,共3页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的观察内直肌肉毒素注射后,上直肌移位联合改良肌联结术治疗麻痹性内斜视的手术效果。方法麻痹性内斜视20例(20眼),内直肌肉毒素注射12例(12眼)为A组,未行肉毒素注射组8例(8眼)为B组,两组均经半年以上保守治疗和观察,斜视度稳定后,采用上直肌移位联合改良肌联结术,并同时行内直肌超常量后徙术治疗。观察术后第一眼位斜视度、代偿头位、眼球运动及复视的改善。结果术后A组治愈10例(10眼),第一眼位0^+7~△,正前方代偿头位和复视消失,眼球运动外展受限≤3mm,治愈率91.7%;术后B组治愈4例(4眼)治愈率75.0%。A、B两组,术后眼底照相和马氏杆检查无旋转斜视发生,舒适度满意率90.0%,无眼前节缺血并发症发生。结论上直肌移位联合改良肌联结术治疗麻痹性内斜视,是有效和安全的方法。A、B两组术后病人眼位、复视和代偿头位恢复无明显差异。但手术中发现肉毒素注射组内直肌挛缩程度明显比非注射组轻。Objective To observe the efficacy of superior rectus shift joint improved muscle connection to treat paralytic esotropia previously received botulinum toxin injection. Methods 20 patients（eyes） with paralytic esotropia were included. 12 patients（eyes） were divided into Group A, in which botulinum toxin was injected to medial rectus and 8 patients（eyes） were divided into Group B, in which botulinum toxin was not injected. Two groups were treated conservatively and observed for more than 6 months. After the degree of strabismus reached stability, superior rectus shift joint improved muscle connection and extra large recession of medial rectus was performed in both groups simultaneously. The improvement of primary eye position, degree of strabismus, compensatory head posture, eye movement and diplopia after surgery was observed. Results Group A after surgery： 10 patients（eyes） were cured. Their primary eye position ranged from 0 to ＋7 and their front compensatory head posture and diplopia disappeared. The limitation of abversion eye movement was 3 mm. The cure rates reached 91.7%. Group B after surgery： 4 patients（eyes） were cured. The cure rates reached 75.0%. There was no cyclodeviation in both groups using Fundus photography and Maddox examination after surgery. Satisfaction rate of comfort was 90.0%. No anterior segment ischemia occurred. Conclusion Superior rectus shift joint improved muscle connection is an effective and safe way to treat paralytic esotropia. There were no obvious differences in the recovery of eye position, diplopia and compensatory head posture after surgery between Group A and Group B. However, it was observed during operation that the degree of medial rectus contracture in Group A was obviously less than in Group B.

关 键 词：麻痹性内斜视 上直肌移位 内直肌超常量后徙 

分 类 号：R779.6[医药卫生—眼科]