CAJ | 학술논문

目的探讨斜视手术中施行水平直肌垂直移位术和转位术的作用.方法手术前后采用三棱镜遮盖法测定62例斜视患者各诊断眼位的斜视角及眼球运动等,并通过同视机检查和眼底照相评估主客观旋转斜视.手术年龄5～33岁,平均14岁.术后随访1～34个月,平均6个月.结果 (1)不伴有斜肌功能异常V型斜视26例,施行双侧水平直肌同方向垂直移位术或施行单眼水平直肌反方向垂直移位术,分别矫正垂直非共同性10～30△和8-25△,并未发现旋转斜视. (2)伴有斜肌功能异常A型斜视25例,单纯施行水平直肌垂直移位术,可矫正垂直非共同性8～30△,原在位与向下注视之间残留斜视角5～25△,而联合双侧上斜肌减弱术组,残留斜视角2～8△. (3)治疗共同性水平斜视伴有小角度垂直斜视8例,双侧水平直肌的向下或向上移位术矫正上斜视2～8△,残余上斜视2～5△. (4)治疗单眼先天性双上转肌麻痹3例,施行水平直肌垂直转位至上直肌肌止端两侧,矫正垂直斜视角25～30△,残余垂直斜视角5△,眼球双上转运动均明显改善.结论水平直肌垂直移位术能有效地矫正下斜肌功能无异常V型斜视垂直非共同性,联合双侧上斜肌减弱术能更有效解决A型斜视向下注视的斜视角,而治疗共同性垂直斜视的作用则有一定的局限性;转位术治疗单眼先天性双上转肌麻痹疗效较好.
목적 탐토사시수술중시행수평직기수직이위술화전위술적작용.방법 수술전후채용삼릉경차개법측정62례사시환자각진단안위적사시각급안구운동등,병통과동시궤검사화안저조상평고주객관선전사시.수술년령5～33세,평균14세.술후수방1～34개월,평균6개월.결과 (1)불반유사기공능이상V형사시26례,시행쌍측수평직기동방향수직이위술혹시행단안수평직기반방향수직이위술,분별교정수직비공동성10～30△화8-25△,병미발현선전사시. (2)반유사기공능이상A형사시25례,단순시행수평직기수직이위술,가교정수직비공동성8～30△,원재위여향하주시지간잔류사시각5～25△,이연합쌍측상사기감약술조,잔류사시각2～8△. (3)치료공동성수평사시반유소각도수직사시8례,쌍측수평직기적향하혹향상이위술교정상사시2～8△,잔여상사시2～5△. (4)치료단안선천성쌍상전기마비3례,시행수평직기수직전위지상직기기지단량측,교정수직사시각25～30△,잔여수직사시각5△,안구쌍상전운동균명현개선.결론 수평직기수직이위술능유효지교정하사기공능무이상V형사시수직비공동성,연합쌍측상사기감약술능경유효해결A형사시향하주시적사시각,이치료공동성수직사시적작용칙유일정적국한성;전위술치료단안선천성쌍상전기마비료효교호.
Obiective To study the role of vertical displacement and transposition of horizontal rectus muscles in the surgical treatment ofstrabismus.Metheds We examinated Sixty-two patients of the deviation in all diagnostic positions by prism and cover test,Binocular motility in preoperation and postoperation.the subjective cyclodeviations were tested by synoptophore and the objective cyclodeviations were showed by fundus photographs.We followed up in a mean period of 6 months (range 1 to 34 months).Results (1)In 26 cases of V-pattern deviation that was not associated with oblique muscle dysfunction, vertical displacement(in the same direction)of bilateral horizontal rectus muscles and vertical displacement (in opposite directions)of monocular horizontal rectus muscles were performed and corrected up 10-30△ and 8-25△ of vertical incomitant deviations respectively.No postoperative cyclodeviation was noted. (2)In 25 cases of A-pattern deviation associated with oblique muscle dysfunction,vertical displacement of the horizontal rectus muscles alone corrected up 8-30△ of vertical incomitant deviations and had residual deviations of 5-25△ between primary position and downgaze position.Combining bilateral weakening of the superior oblique muscles reduced the residual deviations to 2△-8△. (3)In 8 cases of horizontal comitant deviation combined with small angle of vertical deviation, downward transposition or upward transposition of the bilateral horizontal rectus muscles corrected up 2-8△ of hyperdeviation and the residual hyperdeviation was 2-5△. (4)In 3 cases of congenital monocular double elevator palsy,the horizontal rectus muscles were transposed to the two sides of superior rectus tendon to correct up 25-30△ of vertical deviation and the residual vertical deviation was 5△.All of the patients had significant improvement of binocular elevation movements.Comclusions vertical displacement of horizontal rectus muscles can efficiently correct the vertical incomitant deviations of V-pattern strabismus without oblique muscle dysfunction.Bilateral weakening of the superior oblique muscles, along with the vertical displacement of the horizontal rectus muscles, can produce considerable elimination of A-pattern deviations in downgaze;however,this procedure has certain limitations in treating horizontal comitant deviation.Vertical displacement and transposition of horizontal rectus muscles is an effective surgical approach for patients with congenital monocular double elevator palsy.