上斜肌转位治疗动眼神经麻痹

目的探讨上斜肌转位手术治疗动眼神经麻痹的临床效果。方法回顾我院1999年1月～2007年9月采用上斜肌转位术矫正动眼神经麻痹所致重度外斜视病例,并观察分析。结果20眼动眼神经麻痹行外直肌后退,内直肌折叠,上斜肌转位术。下斜视者3眼加下直肌后退术,上斜视6眼二次手术行上直肌超常量后退及下直肌超常量缩短术。患者外观取得满意效果,随访6月～3年眼位无明显改变。结论上斜肌转位术矫正动眼神经麻痹性斜视是可行的。     

上斜肌劈开延长术治疗A型斜视临床疗效

目的探讨上斜肌劈开延长术治疗A型斜视的临床疗效。方法回顾性系例病例研究。收集A型斜视患者7例,均行双眼上斜肌劈开延长术联合水平斜视矫正术。随访4～10个月。手术前后分别测量患者第一眼位水平斜视度、A征程度、眼底旋转程度。上斜肌亢进分级为+1～+4。采用Wilcoxon秩和检验对数据进行分析。结果7例患者均一次手术矫正至正位,水平斜视度在±10△之内。A征均治愈。上斜肌亢进程度由术前平均+2改善至术后平均0;眼底照相结果显示,由术前平均内旋2.5°,改善至术后平均外旋2.0°,没有患者表现为主观外旋。2例术前有代偿头位的患者,术后代偿头位消失。患者术前均无垂直斜视,术后亦未出现垂直斜视。结论上斜肌劈开延长术可有效改善A型斜视和上斜肌亢进,是一种安全、有效的上斜肌减弱方法。     

上斜肌手术方式的探讨

目的 探讨上斜肌折叠或肌腱切断手术的特殊性，掌握其手术适应证。方法 对18例先天性上斜肌麻痹施行上斜肌折叠术；对7例外斜视A征和7例动眼神经麻痹施行上斜肌肌腱切断术。观察手术中上斜肌解剖的特点及手术前后眼位、斜视角和临床特征的改变。结果 先天性上斜肌麻痹单侧12例、双侧6例行上斜肌折叠手术，均联合下斜肌减弱术。术中见上斜肌异常者9／18（50．00％），表现为肌腱松弛、肌止端附着点位于上直肌的鼻侧止端。手术矫正了原在位上斜视15^△～25^△，矫正鼻侧方向最大上斜视15^△～40^△。术后眼位恢复正位15眼，欠矫3眼，无过矫。外斜视A征伴双上斜肌亢进7例行双眼上斜肌肌腱切断术联合水平直肌手术，矫正了上下外斜角之差别20^△～30^△，消除了A征，未发现过矫，术后4例恢复双眼视觉。单侧动眼神经麻痹7例行上斜肌肌腱切断术矫正了原在位下斜视平均15^△，术后垂直斜视矫正6例，欠矫1例。结论 上斜肌肌止端解剖异常是先天性上斜肌麻痹发病原因之一；上斜肌折叠或肌腱切断术主要改善旋转功能和矫正鼻下方垂直斜角，宜联合下斜肌或水平直肌手术。     

不同术式治疗垂直分离性斜视的临床疗效分析

目的探讨治疗垂直分离性斜视（DVD）的最佳手术方式。方法对43例（72眼）DVD根据不同的术前检查结果选择不同的术式。有下斜肌亢进者首选下斜肌切断加转位,根据亢进程度不同决定下斜肌在转位之前的截除量。无下斜肌亢进者首选上直肌后退术。双眼DVD不伴有下斜肌功能亢进者,且上斜程度相等者行双跟上直肌等量后徙术;双眼上斜程度不等者行双眼上直肌不等量后徙,或先行上斜明显眼手术,改期行另眼手术;合并水平斜视者尽可能同时完成,否则先矫正水平斜视,半年后矫正DVD。结果52眼疗效良好（72．22％）,16眼好转（22．22％）,4眼（5．56％）无效,1眼（1．38％）退上直肌和双眼外直肌后出现继发内斜视和对侧眼下斜肌亢进。结论对不同类型的DVD采用不同的术式可获得良好的疗效。     

40例V型斜视的临床分析

目的探讨V型斜视的临床特征,手术矫正效果及手术方式。方法总结顺义区医院小儿眼科40例V型斜视,行水平肌垂直移位术,下斜肌部分切除 水平肌手术,下斜肌后徙 转位术 水平肌矫正术,观察术后眼位,下斜肌功能。结果下斜肌部分切除 水平肌手术对V型斜视疗效满意。结论斜肌功能亢进是V型斜视发病的主要原因,V型斜视手术方式主要是下斜肌部分切除 水平肌手术。     

下斜肌减弱术在先天性麻痹性垂直斜视治疗中的应用

目的探讨下斜肌减弱术在不同类型先天性麻痹性垂直斜视治疗中的效果及手术选择的基本原则。方法分析近2年行手术治疗的先天性麻痹性垂直斜视患者65例(82眼),根据垂直斜视的度数分别行下斜肌截腱术,下斜肌后徙转位前徙术和下斜肌后徙转位前徙联合上下直肌徙后术。结果垂直斜视的治愈好转率达89.1%,行断腱术者60眼,平均矫正8.33±4.25°;转位术18眼平均矫正13.45±5.91°;联合术4眼,平均矫正22.00±9.79°。术后46例代偿头位改善或消失,66眼下斜肌功能亢进改善或消失;术后出现同时视者22例,建立融合功能者5例,获得立体视觉者3例。结论下斜肌减弱术是治疗先天性麻痹性垂直斜视的首选术式,该术式简单易行,疗效可靠,术后早期疗效明显,有一定促进双眼单视恢复的功能。     

分离性垂直偏斜的手术治疗

目的探索治疗分离性垂直斜视(DVD)的更有效的手术方法.方法对21例(24眼)不同程度DVD患者行不同量手术,评定不同量手术的效果.结果24眼术后外观均取得较满意效果.23眼术后第一眼位垂直斜度＜5°,1眼术后第一眼位垂直斜度为8°.结论上直肌大量后徙联合下斜肌切断移位术对DVD患者的斜视矫正能取得较满意效果,未联合下斜肌转位术的效果稍差.     

分离性垂直偏斜的手术治疗

目的探讨分离性垂直斜视的手术治疗。方法 22例患者（34只眼）,分别采用上直肌大量后徙术和下斜肌后徙转位术,对其疗效进行比较分析。结果 11例（16只眼）行上直肌后徙术,满意14只眼（满意率87.5%）,改善2只眼（改善率12.5%）,11例（18只眼）行下斜肌后徙转位术,满意13只眼（满意率72.2%）,改善5只眼（改善率27.8%）。结论上直肌大量后徙和下斜肌后徙转位均为治疗垂直分离性偏斜的有效手术,合并下斜肌亢进时,可首选下斜肌后徙转位术,无下斜肌亢进时,首选上直肌后徙术。     

垂直斜视75例手术临床分析

目的探讨垂直斜视手术治疗方法,评价疗效。方法回顾分析75例垂直斜视手术患者。根据原在位垂直斜度、下斜肌亢进程度及其合并症不同分别采取下斜肌截断术、下斜肌截除术、下斜肌截除+转位术、下斜肌截除+转位+同侧眼上直肌后徙/或对侧眼下直肌后徙术、伴有水平斜视者按水平斜视矫正原则联合水平斜视矫正术、对无下斜肌亢进者行上直肌和/下直肌后徙术共6种手术方式,并进行平均3年以上的随访。结果 75例患者,通过6种手术方式进行一期手术,治愈57例(76%);好转12例(16%);无效6例(8%),其中欠矫4例(5.3%),过矫2例(2.7%),总有效率为92%。结论垂直斜视临床表现复杂,没有固定的手术模式,需根据术前详细的检查结果制定合理的手术方案,本文6种手术方法对治疗垂直斜视是可行的,绝大部分垂直斜视可通过一期手术获得临床治愈。     

下斜肌后徙转位术治疗分离性垂直斜视

目的探索伴有下斜肌亢进的分离性垂直偏斜的有效手术方式。方法对54例95眼伴有下斜肌亢进的DVD患者应用下斜肌后徒转位法。依据上斜程度确定下斜肌新附着点的位置。上斜小于6△16眼转位到下直肌止端水平后1mm;上斜7～11△45眼,转位到下直肌止端水平;上斜大于11△34眼,前移到下直肌止端前1mm或2mm(1mm25眼,2mm9眼)其中1例单眼上斜50～80△者联合同侧上直肌后徙6mm,对合并水平斜视者,则采用水平直肌后徙和缩短术同时矫正水平斜视。结果术后满意者93眼(97.89%),好转者2眼(2.11%),无1例无效者。95眼术后下斜肌亢进均消失,无1例上转受限者。结论下斜肌后徒转位术是治疗伴有下斜肌亢进分离性垂直斜视的有效手术方式。     

67例V型斜视的手术探讨

目的 探讨V型斜视的临床特征及不同手术方法及效果.方法 回顾性分析了67例V型斜视的手术治疗.其中外斜V征46例,内斜V征21例,依据是否伴有下斜肌功能亢进及亢进程度,行下斜肌减弱术或水平直肌垂直移位术,所有患者按原在位水平偏斜度常规矫正水平斜视.观察手术前后的眼位、斜肌功能和双眼视觉.结果 67例手术中,49例行下斜肌后徙术或后徙转位术,术后43例上、中、下均正位,V征消失;术前无下斜肌功能亢进或下斜肌功能亢进"+"者13例,行水平直肌垂直移位术后11例正位,V征消失.67例患者术后19例恢复双眼视.结论 下斜肌后徙,后徙转位术适用于下斜肌功能亢进(++)-(+++)的V征,水平直肌垂直移位术适用于无下斜肌功能亢进或下斜肌功能亢进+的V征,应根据下斜肌功能亢进程度选择手术方式.     

下斜肌后徙转位术后的安全性分析

目的 通过比较下斜肌(Inferioroblique IO)后徙术与IO后徙转位术,术后至少3年的疗效,评价IO后徙转位术的安全性.方法 比较IO后徙术组(22例33只眼)和IO后徙转位术组(27例33只眼)病例手术后IO运动程度和眼球上转程度,分析可能的相关因素.结果 (1)IO后徙转位术组左右眼手术后远期IO运动程度、眼球上转程度均明显低于IO后徙术组,差别有统计学意义,P＜0.001.(2)术后IO运动程度不足与手术年龄、有无弱视、屈光状态、是否同时行水平斜视手术、术前IO功能亢进程度和斜视度均无关.(3)IO后徙转位术组术后远期IO运动程度、眼球上转程度均低于近期(1周至1个月),有明显统计学差异,P＜0.001.术后中期(3～6个月)与远期IO运动程度、眼球上转程度之间差异无统计学意义,P＞0.05.结论 IO后徙转位术式存在术后眼球上转功能不足,IO功能不足的缺点,并且在术后持续存在.     

Surgical management of V-pattern strabismus and oblique dysfunction in craniofacial dysostosis

INTRODUCTION: Strabismus affects as many as 60% to 70% of patients with craniofacial dysostosis. V-pattern strabismus with severe oblique muscle dysfunction is the most common ocular motility problem seen and can be difficult to manage. Few studies have reported on the results of strabismus surgery in this condition. METHODS: We retrospectively reviewed the surgical management and outcomes of 14 patients with craniofacial dysostosis who underwent 16 operations to determine the optimal surgical procedure and to report on extraocular muscle anomalies noted at the time of surgery. Operations performed included medial rectus muscle infraplacement (n = 2), inferior oblique (IO) recession (n = 3), IO myectomy (n = 3), IO anterior transposition (n = 3), and IO denervation/extirpation (n = 5). RESULTS: All patients had significant residual ocular motility dysfunction postoperatively. No beneficial effect was noted after IO anterior transposition or after medial rectus muscle infraplacement. Modest improvement of the V-pattern and oblique muscle dysfunction was noted after denervation/extirpation and myectomy of the IO muscle. Bilateral absent or anomalous superior oblique tendons were noted in 8 of 9 patients in whom the superior oblique tendon was examined at surgery. CONCLUSIONS: Strabismus in craniofacial dysostosis is complex and difficult to cure with surgery. Denervation/extirpation and myectomy of the IO muscle offered modest benefits, though neither procedure resulted in normalization of ocular motility. Agenesis of the superior oblique tendon may be causally related in a large proportion of affected patients.     

不同术式矫正A-V综合征临床分析

目的:分析A-V型斜视发病率、病因,探讨A-V型斜视不同术式的治疗效果。方法:按第一眼位斜视度数设计水平方向的手术量,对合并轻度上?下斜肌功能亢进(A-V征15Δ～20Δ)及仅有水平肌功能异常者行水平直肌垂直移位术;上?下斜肌功能亢进明显者(+2～+3),行上?下斜肌减弱术。结果:62例A-V综合征中合并上?下斜肌功能异常者35例,仅有水平肌功能异常者27例。行上、下斜肌减弱术21例,行水平直肌垂直移位术41例,两种手术效果无显著差异。结论:产生A-V综合征的因素较多,多数A-V型斜视都有斜肌功能异常,对上?下斜肌功能亢进明显者,行上?下斜肌减弱术,对合并上?下斜肌功能亢进较轻及仅有水平肌功能异常者行水平直肌垂直移位术,手术效果良好,两种术式效果无显著差异。     

Unilateral anterior transposition of the inferior oblique muscle for correction of hypertropia in primary position.

PURPOSE: To evaluate the correction of hypertropia in primary position with unilateral inferior oblique (IO) anterior transposition (IOAT). METHODS: Ten patients with idiopathic (nonparalytic, restrictive, or dissociated vertical deviation) hypertropia with marked IO overaction, who underwent unilateral IOAT, were prospectively evaluated to observe the correction of the hypertropia in primary position. No previous ocular muscle surgery had been performed. Four patients had esotropia and two had exotropia. In addition to the proposed surgery, horizontal procedures were performed to correct horizontal deviation, but no vertical transposition of horizontal muscles was done. Four patients had hypertropia and IO overaction, without horizontal strabismus, and IOAT was the only procedure performed. The IO muscle was reinserted 1 mm laterally to the lateral extremity of the inferior rectus muscle insertion using only one suture. The statistical analysis was performed by Wilcoxon rank sum test. RESULTS: The mean absolute correction in primary position was 18.1 prism diopters (PD) (range, 4 to 33), directly proportional to the size of the hypertropia before surgery. Nine of the 10 patients had a residual vertical deviation of 相似文献   

下斜肌减弱术治疗下斜肌亢进的临床分析

目的探讨下斜肌减弱手术不同方式治疗下斜肌亢进和V征的临床效果。方法下斜肌亢进122例160眼,包括原发下斜肌亢进20例37眼及继发下斜肌亢进102例123眼,采用不同手术方式,对其手术效果进行比较。结果122例中术前82例有代偿头位(67.21%)者,术后82例中代偿头位消失50例,好转28例,无效4例。下斜肌减弱术的手术方式:断腱术6眼;部分切除24眼;后徙80眼;前转位50眼。术前下斜肌亢进程度 1,21眼; 2,91眼; 3,42眼; 4,6眼;术后残留下斜肌 1,3眼;其余均得到矫正。术前V型斜视48例,术后V征消失38例,好转10例。单纯下斜肌减弱矫正原在位垂直斜度≤15△。结论下斜肌部分切除、后徙及前转位术矫正下斜肌亢进及V征同样安全有效。     

下斜肌截除及前转位术治疗大度数垂直斜视临床分析

目的 评价下斜肌截除及前转位术治疗大度数垂直斜视的疗效.方法 以2001年1月至2009年6月收治的53例大度数垂直斜视(≥15△)患者为研究对象,均采取下斜肌截除(3～8mm)及前转位术,即转位于下直肌颞侧缘前1 mm处.对于垂直斜度在15△～25△之间者,下斜肌截除3～5mm;垂直斜度在25△以上者,下斜肌截除6mm及前转位后,术中照影观察,将残留的垂直斜度按1∶1.5的原则分配在该眼的上直肌与另一眼的下直肌(上、下直肌后徙1mm可解决1.5°的垂直偏斜);对于垂直斜度在60△以上的先天性下直肌缺如合并小角膜患者,下斜肌截除6～8mm及前转位术.伴有水平斜视时,按水平斜视矫正原则进行一并矫正.结果 经3～36mo随访,平均18mo.53例大度数垂直斜视患者Ⅰ期治愈40例(75.5%),好转9例(17.0%),未愈4例(7.5%).总有效率92.5%.结论 在大度数垂直斜视患者中,伴有下斜肌功能亢进者,首选下斜肌截除及前转位术,不足以矫正垂直偏斜时,联合该眼的上直肌与另一眼的下直肌后徙术,合并水平斜视时,均可Ⅰ期矫正.     

婴幼儿眼性斜颈的临床特征与早期手术效果

目的:探讨婴幼儿眼性斜颈的临床特征,评估眼性斜颈早期手术效果。方法:对70例患儿进行回顾性分析。通过获取歪头试验、九方位眼球运动检查及眼底照相的结果,分析眼球肌肉异常的类型,对眼性斜颈做出定性诊断。采用计算机辅助斜视诊断技术,精确测量出水平斜视度数。对眼性斜颈患者中,上斜肌麻痹、下斜肌功能亢进者,行下斜肌部分切除术。其它原因引起的眼性斜颈,根据眼球肌肉异常类型的不同,设计不同的手术方法。对合并水平斜视者以计算机辅助下斜视测量软件测量出的水平斜视角度为根据,定量设计手术。随访时间6～12mo。结果:本组病例中,均找到眼部病因,以单纯性单眼上斜肌麻痹最常见,54例(77%)。全部患儿均接受手术治疗。一次手术后,单纯性单眼上斜肌麻痹患儿,6mo内治愈或改善者53例(占所有单纯性单眼上斜肌麻痹患儿的98%)。所有患儿6mo内治愈或改善者64例(91%),手术失败者6例。其中3例接受第二次手术,术后3例均治愈或改善。合并水平斜视者11例(16%),一次手术后水平斜视全部矫正。结论:婴幼儿眼性斜颈是一组包含不同类型病因的斜视。明确病因后尽早手术可获得满意头位矫正效果。     

Myectomy versus anterior transposition for inferior oblique overaction

BACKGROUND: Inferior oblique overaction can be either secondary (as a sequela of ipsilateral superior oblique palsy) or primary (commonly associated with horizontal strabismus). Superior oblique underaction often coexists with both primary and secondary inferior oblique overaction. This retrospective case series compares the efficacy of inferior oblique myectomy versus anterior transposition in improving inferior oblique overaction and superior oblique underaction in eyes with either primary or secondary inferior oblique overaction. METHODS: One hundred twenty eyes of 81 patients were included in this retrospective case series, of which 20 had anterior transposition of the inferior oblique and 100 eyes underwent myectomy. Inferior oblique myectomy was compared with inferior oblique anterior transposition in improving inferior oblique overaction and superior oblique underaction in each diagnostic subgroup. Postoperative outcome was qualitatively and quantitatively assessed. Fisher's exact test was used to compare the outcomes. The quantitative improvement of function in terms of inferior oblique overaction and superior oblique underaction was analyzed by regression analysis. RESULTS: When postoperative inferior oblique overaction was considered, there was no statistically significant difference between myectomy and anterior transposition in both primary and secondary inferior oblique overaction. Myectomy was superior to anterior transposition in improving superior oblique underaction in both primary inferior oblique overaction (OR = 0.14; 95% CI, 0.015-1.45; p = 0.056) and secondary inferior oblique overaction (OR = 0; 95% CI, 0-0.027; p < 0.001). The quantitative improvement of function showed a significant difference between procedures for superior oblique underaction (t-test; p = 0.005; 95% CI, 0.25-1.3) but not inferior oblique overaction (t-test; p = 0.8; 95% CI, -0.67-0.54). CONCLUSIONS: This study demonstrates both inferior oblique myectomy and inferior oblique anterior transposition to be effective in correcting primary and secondary inferior oblique overaction. Myectomy is more effective in improving superior oblique underaction associated with both primary and secondary inferior oblique overaction. On this basis, we feel that inferior oblique myectomy has some advantage over anterior transposition in treating combined inferior oblique overaction and superior oblique underaction and can be considered the procedure of choice.