下斜肌减弱术在先天性麻痹性垂直斜视治疗中应用效果观察.docVIP

下斜肌减弱术在先天性麻痹性垂直斜视治疗中的应用效果观察 　　[摘要] 目的 探讨下斜肌减弱术在先天性麻痹性垂直斜视患者中的应用效果。方法 随机选取2009年6月―2014年6月先天性麻痹性垂直斜视例数60例，均给予下斜肌减弱手术，同时，按垂直斜度分成两组（实验组、对照组），分别给予下斜肌截腱术和下斜肌后徙转位前徙术治疗，统计手术效果。 结果 入选病例垂直斜视度治疗总有效率为91.7%（治愈51例，好转4例，5例轻度欠矫）其中，下斜肌肌腱部分截除术组临床治疗总有效率为93.3%，下斜肌后徙转位前徙术组治疗总有效率为83.3%，组间差异无统计学意义（P0.05）；垂直斜度矫正度数3～10°不等，平均（6.32±1.24）°；30例代偿头位患者中，术后25例症状消失或改善；25例患者歪头试验为阳性患者中，术后20例歪头试验转为阴性；此外，术后2例患者有立体视觉，5例患者有融合功能，13例患者有同时视。结论 下斜肌截下斜肌截腱术和下斜肌后徙转位前徙术均能有效治疗先天性麻痹性垂直斜视患者，均具备临床推广价值，值得各级医院应用。 　　[关键词] 下斜肌减弱术；先天性麻痹性垂直斜视；应用效果 　　[中图分类号] R779.6 [文献标识码] A [文章编号] 1674-0742（2015）08（b）-0074-02 　　[Abstract] Objective To observe the effect of inferior oblique muscles weakening in the treatment of congenital paralytic vertical strabismus. Methods 60 patients with congenital paralytic vertical strabismus between June 2009 and June 2014 were given inferior oblique muscles weakening. They were divided into experimental group and control group according to degree of vertical strabismus， in which the disinsertion of the inferior oblique muscle and anterior transposition of the inferior oblique muscle were performed respectively. The effects of the two procedures were recorded. Results Of all the 60 patients， the effective rate was 91.7% with 51 cases cured， 4 cases improved and 5 cases mild under-correction， and statistical difference was found between the experimental group and the control group， which was 93.3% vs 83.3%. The degree of correction was 3～10°with an average of （6.32±1.24）°. Of 30 patients with compensatory head posture， 25 experienced symptom disappearance or improvement； of 25 patients with positive responses in head tilting test， 20 became negative after operation. In addition， after operation， stereoscopic vision was found in 2 cases， fusion function in 5 cases and simultaneous perception in 13 patients. Conclusion Disinsertion of the inferior oblique muscle， as well as anterior transposition of the inferior oblique muscle， can effectively treat congenital paralytic vertical strabismus， ther