先天性上斜肌麻痹手术治疗观察.docVIP

先天性上斜肌麻痹手术治疗观察[摘要] 目的:探讨手术治疗先天性上斜肌麻痹的临床疗效。方法:根据患眼的下斜肌功能亢进程度和垂直斜度大小选择不同手术方式治疗。结果:本组术后随访3～24个月,治愈26例,占76.47%;好转7例,占20.59%;无效1例,占2.94%。总有效率为97.06%。结论:先天性上斜肌麻痹治疗的主要目的是矫正斜视,尽可能获得最大的融合功能,消除代偿头位。根据患者下斜肌功能亢进程度和垂直斜视度选择不同术式可获得较好效果。 [关键词] 先天性;上斜肌麻痹;手术治疗;斜视 [中图分类号] R777.4+5 [文献标识码]A [文章编号]1674-4721(2010)05(c)-026-02 Observation of congenital superior oblique palsy treatment ZHANG Li’na (Department of Ophthalmology,Maternal and Child Health Institute of Puyang City, Henan Province, Puyang457000,China) [Abstract] Objective: To evaluate the surgical treatment of congenital superior oblique palsy therapy. Methods: Different surgical treatment options were chose according to the eye in the degree of inferior oblique and vertical gradient of hyperthyroidism size. Results: The patients were followed up 3 to 24 months, cured in 26 cases, accounting for 76.47%; improved in 7 cases, accounting for 20.59%; 1 patient was invalid, accounting for was 2.94%. The total effective rate was 97.06%. Conclusion: The treatment of congenital superior oblique palsy main purpose is to correct strabismus, as far as possible to maximize the integration of functions, elimination of compensatory head posture. According to the degree of hyperthyroidism in patients with inferior oblique and vertical strabismus,choose different surgical options available to better results. [Key words] Congenital; Superior oblique palsy; Surgical treatment; Strabismus 先天性上斜肌麻痹是先天性垂直性斜视中最多见的斜视,发病率为56.2%[1]。若治疗不及时将会诱发颜面、颈部、上胸部和脊柱的畸形。本院2005年3月~2009年6月对34例先天性上斜肌麻痹施行了手术治疗,取得较好效果,现报道如下: 1资料与方法 1.1一般资料 本组先天性上斜肌麻痹患者34例,其中,男22例,女12例;年龄2～30岁,平均11.2岁;单眼患病31例,双眼患病3例;其中29例有代偿头位,单纯上斜视8例,合并外斜视19例,内斜视7例。 1.2术前检查 术前常规检查视力与屈光度数,应用角膜映光法和三棱镜遮盖试验测量33 cm及5 m第一眼位斜视度数,采用Parks三步法诊断上斜肌麻痹[2],术前垂直偏斜角为10△～51△,中位数为20△。所有患者均有继发性下斜肌功能亢进,Bielschowsky征(+),并请外科会诊排除颈部疾患。 1.3手术方法 年龄在9岁以下者采取全身麻醉,10岁以上者局部麻醉。根据垂直斜视度和下斜肌功能亢进程度选择不同术式:垂直斜视度10△～14△且下斜肌功能亢进+1者8例行患眼下斜肌后徙或下斜肌切断并部分切除术;垂直斜视度15△～24△且下斜肌功能亢进+2～+3者共21例行患眼下斜肌前转位术;垂直斜视