显微镜下垂直直肌部分移位联合内直肌后徙术治疗外展神经麻痹性内斜视的效果分析  

Effect analysis of partial transposition of vertical rectus combined with medial rectus recession under microscope on treatment of complete abducens nerve palsy esotropia

作　　者：李斌[1] 李超[1] 徐庆[1] 牛燕 LI Bin;LI Chao;XU Qing;NIU Yan(Department of Ophthalmology,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215028,China;Department of Optometry,Suzhou Eye Hospital,Suzhou 215003,China)

机构地区：[1]上海交通大学医学院附属苏州九龙医院眼科,苏州215028 [2]苏州市眼视光医院视光门诊部,苏州215003

出　　处：《上海交通大学学报（医学版）》2020年第7期990-994,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·探讨显微镜下垂直直肌部分移位联合内直肌后徙术治疗外展神经麻痹性内斜视的临床效果。方法·纳入2015年3月—2017年6月在上海交通大学医学院附属苏州九龙医院眼科诊治的9例外展神经麻痹性内斜视患者,在显微镜下行内斜视矫正手术,术式采用垂直直肌部分移位联合内直肌后徙术。术后随访,观察疗效。结果·术后1周,7例患者的第一眼位基本正位(±10^Δ内),2例欠矫(分别为+15^Δ、+20^Δ),所有患者外转功能明显改善,麻痹眼外转均可过中线;术后1个月,6例患者眼位基本正位(±10^Δ内),3例患者欠矫(分别为+15^Δ、+15^Δ、+30^Δ);术后1年,5例患者眼位基本正位(±10^Δ内),4例患者欠矫(分别为+15^Δ、+15^Δ、+30^Δ、+40^Δ)。结论·显微镜下垂直直肌部分移位联合内直肌后徙术治疗外展神经完全麻痹性内斜视效果明显,不仅可以改善眼位,还可有效改善麻痹眼的外转功能,但远期易欠矫。Objective·To investigate the clinical effect of partial transposition of the vertical rectus combined with medial rectus recession on the treatment of abducens nerve palsy esotropia under the microscope.Methods·Nine patients with abducens nerve palsy esotropia were treated in Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine from March 2015 to June 2017.The strabismus surgery was performed under the microscope,with partial transposition of the vertical rectus combined with medial rectus recession.Postoperative follow-up was performed to observe the effect.Results·After 1 week,7 patients’primary position were orthotopic(within±10^Δ),and 2 patients were undercorrection(+15^Δand+20^Δ).Abduction function of all the patients improved significantly.The eyes could cross the midline.After 1 month,6 patients’primary position were orthotopic(within±10^Δ),3 patients were undercorrection(respectively+15^Δ,+15^Δand+30^Δ).After 1 year,5 patients’primary position were almost orthotropia(within±10^Δ),and 4 patients were undercorrection(respectively+15^Δ,+15^Δ,+30^Δand+40^Δ).Conclusion·Partial transposition of the vertical rectus combined with medial rectus recession under the microscope is a safe and effective surgical method in treatment of complete abducens nerve palsy esotropia.It can not only improve the ocular position,but also effectively improve the abduction function of the paralytic eye.However,it is easy to be undercorrection in the long-term.

关 键 词：外展神经麻痹 内斜视 垂直直肌移位 内直肌后徙术 

分 类 号：R777.4[医药卫生—眼科]