成人麻痹性斜视病因分析及手术治疗

目的：观察和探讨成人麻痹性斜视的类型和手术矫正效果。
　　方法：回顾性分析了我院2010－06／2013－06成人麻痹性斜视临床病例46例，将所有病例分为水平斜视组和垂直斜视组，其中水平斜视为主者26例，包括外直肌麻痹16例，内直肌麻痹10例；垂直斜视为主者20例，包括上斜肌麻痹7例，上直肌麻痹8例，下直肌麻痹2例，双上转肌麻痹3例。发病原因：先天性者9例，车祸等外伤所致19例，鼻部或颅脑手术史8例，原因不明者10例。手术方式包括直肌后徙术、直肌缩短术、直肌部分移位术或直肌联结术、下斜肌部分切除术、下斜肌后徙转位术等。采用SPSS10．0统计软件对两组的疗效进行卡方检验，同时对水平斜视组的两种术式改善麻痹眼运动情况进行t检验。
　　结果：末次随访时水平斜视组治愈、好转和无效者分别为20例（77％），5例（19％），1例（4％）；垂直斜视组分别为15例（75％），3例（15％）和2例（10％），两组间统计无显著性差异（P＞0．05）；麻痹眼的眼球运动得到改善。水平斜视中所用的两种术式，均能改善麻痹眼的眼球运动，分别为3．76±0．91，3．72±0．84mm，统计学上无显著性差异（P＝0．93）。
　　结论：成人麻痹性斜视病情复杂，根据不同麻痹肌及麻痹程度不同，采用不同的手术方式，术后可获得眼位的美容正位，改善代偿头位和主要注视野的复视。

Etiology analysis and surgery of paralytic strabismus in adults

AIM: To investigate pathogeny and effects of surgery on paralytic strabismus.

METHODS: A retrospective study was done in 46 patients with paralytic strabismus who underwent squint correction in our hospital from June 2010 to June 2013. Among 26 horizontal strabismus, the cases of extra rectus palsy was 16, internal rectus palsy was 10. Among all20 vertical strabismus, the cases of superior oblique palsy, superior rectus palsy, inferior rectus palsy, double elevator palsy counted for 7, 8, 2 and 3, respectively. Pathogenesis: trauma was 19 cases, followed by 10 cases that the causes could not be identified. Nine was congenital paralytic strabismus, 8 occurred after nose or brain surgery. The surgery methods included rectus muscle recession, rectus muscle resection, partial rectus muscle transposition, Jensen procedure, inferior oblique myectomy and anterior transposition of inferior oblique. Statistical software SPSS10.0 was used in chi-square test between two groups, while the situation of paralysis eye movements improved by two methods in the horizontal strabismus group was compared with t test.

RESULTS: Among all horizontal strabismus the rate of cure, improvement and inefficiency was 20(77%), 5(19%)and 1(4%), respectively. Among vertical strabismus the ratio of cure, improvement and inefficiency was 15(75%), 3(15%)and 2(10%). There was no significantly difference between the two groups(P>0.05). The movements of paralytic eyes were improved. Two procedures used in horizontal strabismus, can improve paralysis eye movements were 3.76±0.91, 3.72±0.84mm, with no significant difference(P=0.93)statistically.

CONCLUSION: Paralytic strabismus in adults had complicated conditions. Choosing different operation methods in treating paralytic strabismus according to the degree of paralysis can result in satisfactory cosmetically alignment of the eyes and modify head position and diplopia.