鼻内镜鼻窦手术所致内直肌损伤的临床特征及治疗  

Clinical characteristics and treatment of medial rectus muscle injury induced by nasal endoscopic sinus surgery

作　　者：郎丽娟[1] 朱豫[1] Lang Lijuan;Zhu Yu(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Henan Provineial Ophthmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2020年第5期330-335,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家卫生健康委科学研究基金-河南省医学科技攻关计划省部共建项目(SB201901013)。

摘　　要：目的:观察鼻内镜鼻窦手术所致内直肌损伤的临床特征和治疗效果。方法:回顾性分析郑州大学第一附属医院2016年10月至2019年5月鼻内镜鼻窦手术所致内直肌损伤的15例临床资料,根据牵引试验、MRI及CT检查结果判断内直肌损伤程度。患者分为两组:内直肌部分离断者6例(A组),内直肌完全离断者9例(B组)。分析对比两组效果。结果:A组治疗前后斜视度分别为(55.83±12.81)PD和(6.67±2.58)PD( t=9.214, P=0.000);B组治疗前后斜视度分别为(90.55±8.08)PD和(17.78±5.07)PD( t=22.891, P=0.000)。A组治疗前后内转受限程度分级分别为(2.50±0.55)级和(1.00±0.00)级( t=6.708, P=0.000);B组治疗前后内转受限程度分级分别为(4.00±0.00)级和(2.11±0.33)级( t=17.000, P=0.000)。治疗后6例正前方注视复视消失,其余9例复视均改善。 结论:鼻内镜鼻窦手术所致内直肌损伤,以影像学检查结果及牵引试验指导设计个性化治疗方案,可取得较好的治疗效果。Objective To observe the clinical characteristics and efficacy of medial rectus muscle injury induced by nasal endoscopic sinus surgery.Methods The clinical data of 15 cases with medial rectus muscle injury induced by nasal endoscopic sinus surgery from Oct.2016 to May 2019 in The First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.The injury degree of medial rectus muscle was estimated according to the results of pull test,MRI and CT.These patients were divided into group A,6 cases with partial dissociation of the medial rectus muscle,and group B,9 cases with complete dissociation of the medial rectus muscle.The efficacy were analyzed and compared between the two groups.Results The exotropia degree before and after treatment in group A was(55.83±12.81)PD and(6.67±2.58)PD(t=9.214,P=0.000).The exotropia degree before and after treatment in group B was(90.55±8.08)PD and(17.78±5.07)PD(t=22.891,P=0.000).The degree grading of restriction of internal rotation before and after treatment in group A was(2.50±0.55)grades and(1.00±0.00)grades(t=6.708,P=0.000).The degree grading of restriction of internal rotation before and after treatment in group B was(4.00±0.00)grades and(2.11±0.33)grades(t=17.000,P=0.000).The symptoms of diplopia were gone in 6 cases and improved in 9 cases.Conclusion The results of imaging examination and pull test can be used to guide and design the individuated treatment plan for medial rectus muscle injury induced by nasal endoscopic sinus surgery,and can obtain good efficacy.

关 键 词：内窥镜检查 耳鼻喉外科手术 手术后并发症 动眼肌 外斜视 眼外科手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]