华西医学

华西医学

先天性上斜肌麻痹的个体化手术治疗

查看全文

目的 探讨先天性上斜肌麻痹的个体化手术治疗效果。 方法 回顾性分析 2015 年 10 月—2018 年 1 月四川大学华西医院眼科收治的 131 例先天性上斜肌麻痹患者(180 只患眼),对其临床特征、手术方式及效果进行总结。 结果 131 例患者中,49 例为双眼先天性上斜肌麻痹,82 例为单眼先天性上斜肌麻痹;94 例合并水平斜视。17 例(26 只患眼)行患眼下斜肌减弱术,53 例(93 只患眼)行患眼上斜肌折叠术,4 例行患眼上斜肌折叠联合对侧上直肌缩短术,37 例行患眼上斜肌折叠联合对侧下直肌后徙术,6 例行患眼下斜肌后徙联合对侧上直肌缩短术,14 例行患眼下斜肌转位联合对侧上直肌缩短术;18 例同期矫正水平斜视,76 例二期矫正水平斜视。治愈 116 例(88.55%),好转 15 例(11.45%),无效 0 例。 结论 对先天性上斜肌麻痹的诊断应准确,治疗应根据斜视角大小及最大方位,结合各诊断眼位的肌肉运动受限或亢进情况,合理设计相应的个体化手术方式。

Objective To investigate the efficacy of individualized surgical treatment on congenital superior oblique paralysis. Methods A total of 131 patients (180 eyes) undergoing surgery for congenital superior oblique palsy between October 2015 and January 2018 in West China Hospital of Sichuan University were reviewed. The clinical features, surgical methods and efficacy were analyzed. Results Among the 131 cases, 49 cases were bilateral congenital superior oblique palsy, and 82 cases were unilateral congenital superior oblique palsy; 94 cases were combined with horizontal strabismus; 17 cases (26 eyes) underwent inferior oblique recession, 53 cases (93 eyes) underwent superior oblique tuck, 4 cases underwent superior oblique tuck combined with contralateral superior rectus resection, 37 cases underwent superior oblique tuck combined with contralateral inferior rectus recession, 6 cases underwent inferior oblique recession combined with contralateral superior rectus resection, and 14 cases underwent inferior oblique transposition combined with contralateral superior rectus resection; 18 cases underwent horizontal strabismus correction at one stage, and 76 cases underwent horizontal strabismus correction at the second stage. After Surgery, there were 116 cases cured (88.55%), 15 cases improved (11.45%), and 0 case invalid. Conclusions The diagnosis of congenital superior oblique paralysis should be accurate. Individualized surgery should be designed according to the size and maximum orientation of the squint and the limitation or hyperactivity of the muscles in each diagnostic eye position.

关键词: 斜视; 先天性; 上斜肌麻痹; 手术

Key words: Strabismus; Congenital; Superior oblique palsy; Surgery

引用本文: 董明蓉, 魏红, 刘陇黔. 先天性上斜肌麻痹的个体化手术治疗. 华西医学, 2018, 33(11): 1367-1370. doi: 10.7507/1002-0179.201809065 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Kekunnaya R, Isenberg SJ. Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children. Indian J Ophthalmol, 2014, 62(3): 322-326.
2. Yang HK, Kim JH, Hwang JM. Congenital superior oblique palsy and trochlear nerve absence: a clinical and radiological study. Ophthalmology, 2012, 119(1): 170-177.
3. Khawam E, Ghazi N, Salti H. " Jampolsky syndrome”: superior rectus overaction-contracture syndrome: prevalence, characteristics, etiology and management. Binocul Vis Strabismus Q, 2000, 15(4): 331-342.
4. 中华眼科学会全国儿童弱视斜视防治学组. 斜视疗效评价标准. 中国斜视与小儿眼科杂志, 1996, 4(4): 145.
5. 赵堪兴. 斜弱视学. 北京: 人民卫生出版社, 2015: 97-102.
6. Durnian JM, Marsh IB. Superior oblique tuck: its success as a single muscle treatment for selected cases of superior oblique palsy. Strabismus, 2011, 19(4): 133-137.
7. Li Y, Zhao K. Superior oblique tucking for treatment of superior oblique palsy. J Pediatr Ophthalmol Strabismus, 2014, 51(4): 249-254.
8. Sekeroğlu HT, Sanac AS, Arslan U, et al. Superior oblique surgery: when and how?. Clin Ophthalmol, 2013, 7: 1571-1574.
9. Keskinbora KH. Anterior transposition of the inferior oblique muscle in the treatment of unilateral superior oblique palsy. J Pediatr Ophthalmol Strabismus, 2010, 47(5): 304-307.
10. Gräf M, Lorenz B, Eckstein A, et al. Superior oblique tucking with versus without additional inferior oblique recession for acquired trochlear nerve palsy. Graefes Arch Clin Exp Ophthalmol, 2010, 248(2): 223-229.
11. Kaeser PF, Klainguti G, Kolling GH. Inferior oblique muscle recession with and without superior oblique tendon tuck for treatment of unilateral congenital superior oblique palsy. J AAPOS, 2012, 16(1): 26-31.
12. Miyata M, Shibata K, Hamasaki I, et al. Predictive factors for corrective effect of inferior rectus recession for congenital superior oblique palsy. Graefes Arch Clin Exp Ophthalmol, 2018, 256(2): 403-409.
13. 赵堪兴. 斜视矫正术设计的思考. 中华眼科杂志, 2002, 38(8): 507-509.
14. Dotan G, Roarty JD, Baker JD. Masked bilateral superior oblique palsy in children. J Pediatr Ophthalmol Strabismus, 2014, 51(6): 333-336.
15. Erkan Turan K, Taylan Sekeroglu H, Sanac AS. Are we overlooking masked bilateral congenital superior oblique palsy in children: is it possible to diagnose before surgery?. Int Ophthalmol, 2018, 38(4): 1653-1657.
16. 陈丽萍, 张伟. 上斜肌折叠手术前后Bielschowsky歪头试验的变化. 中华眼科杂志, 2016, 52(8): 589-595.
17. Chang MY, Coleman AL, Tseng VL, et al. Surgical interventions for vertical strabismus in superior oblique palsy. Cochrane Database Syst Rev, 2017, 27(11): CD012447.
18. 亢晓丽, 韦严. 关注上斜肌麻痹的临床分型及治疗的个性化设计. 中华眼科杂志, 2017, 53(12): 881-884.