CAJ | 학술논문

目的探讨上直肌颞侧转位联合内直肌后徙术治疗外展神经全麻痹内斜视的疗效.方法回顾性病例研究.分析11例就诊于天津市眼科医院或徐州市第一人民医院眼科的外展神经全麻痹患者术前、术后末次随访时的斜视度、代偿头位角度、受累眼外转和内转受限的程度.11例患者均行上直肌颞侧转位手术,其中8例同期联合内直肌后徙术.内直肌后徙手术采用术中调整缝线方法,根据术中眼位,确定内直肌后徙的位置.平均随访6个月以上.采用配对t检验比较术前、术后第一眼位内斜度、代偿头位角度、外转及内转受限的程度.结果 10例患者一次手术矫正至正位,患者代偿头位和复视消失,患者均对手术结果满意.1例患者上直肌全肌腹转位联合内直肌后徙术后欠矫,残余代偿头位及复视,3个月后行下直肌颞侧转位术,头位及复视消除.11例患者内斜视从术前31.2°±13.7°矫正至术后3.4°±1.7°(t=7.28,P＜0.01);代偿头位从术前26.1°±7.7°矫正至术后0.9°±3.0°(t=10.75,P＜0.01);外转受限从术前-4.8±0.9矫正至术后-2.0±0.9(t=8.84,P＜0.01);内转受限从术前-0.2±0.4矫正至术后-1.0±0.4(t=4.62,P＜0.05).本组患者术后均未出现垂直或旋转复视.结论上直肌转位联合内直肌后徙术,可以同期进行.单独上直肌转位不会带来新的垂直斜视和旋转斜视.上直肌转位术联合调整缝线下的内直肌后徙术是治疗外展神经全麻痹的有效方法之一.
목적 탐토상직기섭측전위연합내직기후사술치료외전신경전마비내사시적료효.방법 회고성병례연구.분석11례취진우천진시안과의원혹서주시제일인민의원안과적외전신경전마비환자술전、술후말차수방시적사시도、대상두위각도、수루안외전화내전수한적정도.11례환자균행상직기섭측전위수술,기중8례동기연합내직기후사술.내직기후사수술채용술중조정봉선방법,근거술중안위,학정내직기후사적위치.평균수방6개월이상.채용배대t검험비교술전、술후제일안위내사도、대상두위각도、외전급내전수한적정도.결과 10례환자일차수술교정지정위,환자대상두위화복시소실,환자균대수술결과만의.1례환자상직기전기복전위연합내직기후사술후흠교,잔여대상두위급복시,3개월후행하직기섭측전위술,두위급복시소제.11례환자내사시종술전31.2°±13.7°교정지술후3.4°±1.7°(t=7.28,P＜0.01);대상두위종술전26.1°±7.7°교정지술후0.9°±3.0°(t=10.75,P＜0.01);외전수한종술전-4.8±0.9교정지술후-2.0±0.9(t=8.84,P＜0.01);내전수한종술전-0.2±0.4교정지술후-1.0±0.4(t=4.62,P＜0.05).본조환자술후균미출현수직혹선전복시.결론 상직기전위연합내직기후사술,가이동기진행.단독상직기전위불회대래신적수직사시화선전사시.상직기전위술연합조정봉선하적내직기후사술시치료외전신경전마비적유효방법지일.
Objective To use superior rectus transposition (SRT) with adjustable medial rectus muscle recession for the treatment of sixth nerve palsy.Methods This was a retrospective clinical study.Eleven patients with sixth nerve palsy who underwent SRT in Tianjin Eye Hospital or the First People's Hospital of Xuzhou were reviewed.The pre-and postoperative outcomes were compared and included the deviation angle of esotropia in the primary position,the head turn angle,and the limit of abduction.In the 11 cases,8 patients had a medial rectus recession.Adjustable suture medial rectus recession was used to identify the proper positions.The average follow-up time was more than 6 months.Preoperative and postoperative first angle,angle of the compensatory head turn,limited extent of inside and outside duction were compared with a paired t test.Results Postoperatively,10 patients showed orthophoria in the primary position and improved compensatory head turn.The patients were satisfied that there was no diplopia.One patient required a second surgery for under-correction.Compensatory head turn and diplopia were corrected after inferior rectus temporal transposition.In the 11 patients,esotropia improved from 31.2°±13.7° to 3.4°±1.7° (t=7.28,P＜0.01);compensatory head turn improved from 26.1°±7.7° to 0.9°±3.0° (t=10.75,P＜0.01);the abduction limit decreased from-4.8±0.9 to-2.0±0.9 (t=8.84,P＜0.01) while the adduction limit increased from-0.2±0.4 to-1.0±0.4 (t=4.62,P＜0.05).No new vertical or torsional deviation was observed in any of the 11 patients.Conclusion Superior rectus transposition with medial rectus recession can be performed during the same surgery,avoiding the risk of anterior segment ischemia.SRT does not induce new vertical or torsional strabismus.Therefore,SRT with medial rectus recession is an effective approach to treat sixth nerve palsy.