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。

Clinical analysis of surgical treatment to 75 cases of vertical strabismus

Objective To discuss the operation designs and evaluate the operation effects of vertical stra- bismus. Methods Reviewing and analyzing the 75 cases of vertical strabismus. According to the original vertical angle of strabismus, the degree of inferior oblique muscle hyperfunction and the different complications, six methods can be used to treat vertical strabismus： the inferior oblique muscle can be cut off, myectomy, and combined am- putation with transposition, combined amputation and transposition with superior rectus recession of the ipsilateral eye/inferior rectus recession of the opposite eye. Based on the correct principles of horizontal strabismus, the pa- tients were successfully treated if they also have horizontal strabismus problems. Superior and inferior rectus reces- sion operations can be applied for patients who have no oblique muscle hyperfunction. Each case had more than a three-year fallow-up visit on average. Results 57 cases were cured （76%）, 12 cases were improved （16%） and 6 cases had no effective improvement （8%）. The total effective rate is 92%. Conclusions No stereotype treatment mode exists because of the protean and complex manner of presentation in patient with vertical strabismus and op- eration programs must apply the procedures flexibly according to the signs and symptoms of individual patient. Six operation methods in this article are feasible in correcting vertical strabismus. Most vertical strabismus patients can be cured by one-stage operation.