下斜肌前转位术治疗双眼先天性上斜肌麻痹临床观察

目的:探讨下斜肌前转位术治疗双眼先天性上斜肌麻痹伴下斜肌亢进的临床疗效。方法:对28例双眼垂直偏斜角为15△～30△的先天性上斜肌麻痹患者行下斜肌前转位手术治疗,合并水平斜视者同期手术矫正,观察手术前后其原在位垂直斜视度、头位变化、下斜肌亢进程度。结果:患者26例垂直偏斜角为15△～25△的患者行下斜肌前转位术,全部治愈,代偿头位消失。1例双眼垂直偏斜角为>25△的患者行双下斜肌前转位术后,残余部分双下斜肌功能亢进,欠矫度为7.8△,行二期双下直肌后徙术后,垂直斜视好转,代偿头位明显改善。1例伴外斜视患者同时行水平肌手术后出现眼球外展轻度受限,能过中线。结论:对伴双眼下斜肌功能亢进,原在位垂直斜视度较大的先天性上斜肌麻痹患者,行双眼下斜肌前转位手术矫正有操作简便、疗效显著、复发率低等优点,且适用于双眼不等量下斜肌功能亢进患者,值得推广。     

两种下斜肌减弱术在先天性上斜肌麻痹治疗中的运用

目的探讨二种下斜肌减弱术在先天性上斜肌麻痹治疗中的效果。方法85例先天性上斜肌麻痹患者,33例垂直眼位<15~Δ行下斜肌部分切除术,52例垂直眼位>15~Δ行下斜肌移位术。结果85例患者中垂直眼位<15~Δ行下斜肌部分切除术者,治愈及好转29人(87.9%),>15~Δ行下斜肌转位术者,治愈及好转41人(78.8%)。术前有代偿头位者均消失或改善。结论先天性上斜肌麻痹垂直眼位<15~Δ可行下斜肌部分切除术,>15~Δ者可行下斜肌移位术。     

下斜肌部分切除术治疗先天性上斜肌麻痹

目的探讨下斜肌部分切除术治疗先天性上斜肌麻痹的效果。方法观察17例接受下斜肌部分切除术治疗的先天性上斜肌麻痹术前术后9方位眼位，歪头试验及代偿头位的变化。结果垂直眼位变化小于15^△的先天性上斜肌麻痹患者术后眼位及代偿头位均恢复，大于15^△的仍残留部分眼位异常及代偿头位。结论下斜肌部分切除术对垂直眼位变化小于15^△的先天性上斜肌麻痹有效。     

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.     

先天性上斜肌麻痹手术的临床观察

目的观察先天性上斜肌麻痹手术治疗的临床效果。方法26例(29眼)实施了手术治疗。其中15例(17眼)行下斜肌单纯切断术;合并分离性垂直偏斜3例(4眼)行下斜肌前转位术;垂直斜视度在20△以上者5例(5眼)行下斜肌切断加对侧眼下直肌后徙术;术前没有下斜肌亢进者3例(3眼),行单纯下直肌后徒术。合并内外水平斜视者同时行水平肌的缩短或后徙术。结果治愈22例(25眼),治愈率86.21%(25/29).有效3例(3眼)。其中2例(2眼)行单纯的下斜肌切断,术后残留垂直斜视度6△~10△;1例(1眼)合并DVD者,术中将下斜肌切断并前转位于下直肌旁,术后仍残留有10△的垂直斜视度。无效1例(1眼),合并间歇性外斜视,术前有40△的垂直斜度,术中将下斜肌前移位,同时行内外直肌的手术,术后仍有20△的垂直斜度。患者放弃治疗。结论选择合适的手术方式,早期实施手术,可取得良好的治疗效果。     

伴下斜肌亢进的分离性垂直偏斜的手术治疗

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19例(25眼)伴有下斜肌亢进的DVD患者应用下斜肌缩短4-5mm后徙前移法。依据上斜程度,确定下斜肌新附着点的位置。垂直分离小于10△者3眼,下斜肌固定于下直肌附着点颞侧水平后1mm;11△-20△12眼,下斜肌固定于下直肌附着点颞侧水平;21△-30△12眼,下斜肌固定于下直肌附着点颞侧前1mm处,术中检查仍向上分离15△-18△者2眼,联合同侧上直肌后退4-5mm。对合并水平斜视者,则采用水平直肌徙后或缩短术同时矫正水平斜视。结果本文19例(25眼)术后良好者23眼(92%),好转者1眼(4%),无1例无效者。1例行右眼下斜肌转位后,发现左眼向上分离<5△未术。24眼术后下斜肌亢进均获矫正,无1例上转受限者。结论下斜肌缩短4-5mm后徙前移术是治疗伴有下斜肌亢进DVD的有效手术方式。     

先天性上斜肌麻痹的手术治疗

目的探讨先天性上斜肌麻痹的各种手术方法与疗效及适应症。方法回顾性分析112例先天性上斜肌麻痹患者分别行患眼下斜肌断腱、下斜肌部分切除、下斜肌后徙转位、下斜肌后徙转位联合健眼下直肌后徙术的术后效果。结果术后平均随访22月（7～36月）,下斜肌断腱术22例,术后满意率86.36%,下斜肌部分切除术16例,术后满意率87.5%,两者治疗效果相当,无明显统计学差异;下斜肌后徙转位54例,术后满意率88.89%;下斜肌后徙转位联合健眼下直肌后徙术20例,术后满意率80%。结论先天性上斜肌麻痹患者应根据术前垂直斜视度的大小选用不同的手术治疗方法,且应该早期治疗。下斜肌断腱和下斜肌部分切除术治疗效果相当,适用于矫正垂直斜视度〈15~△者;下斜肌后徙转位适用于矫正垂直斜视度15~△～25~△者;下斜肌后徙转位联合健眼下直肌后徙术适用于矫正垂直斜视度〉25~△者。     

下斜肌前转位术后抗上转综合征的临床分析

先天性上斜肌麻痹是先天性眼外肌麻痹中最常见的一种,以患眼上斜视和代偿头位为特征,常合并DVD,手术设计以减弱患眼亢进的下斜肌为主,如垂直斜视在10△～15△选用下斜肌后徙术,15△～25△选用下斜肌前转位术,大于25△,联合对侧眼下直肌后徙术。本文总结我院2009年1月至2013年1月4年间对先天性上斜肌麻痹继发下斜肌功能亢进斜视度在15△～25△的患者,采取下斜肌前转位术的资料齐全的51例患者,随访发现,有10例出现抗上转综合征（发生率19％）,经随访观察6个月,症状无好转,7例行下斜肌探查＋断腱＋部分切除术,术后眼位满意,达到改善外观的目的,现总结如下。     

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。     

不同量下斜肌转位术治疗双眼不对称DVD

目的:通过不同量的下斜肌转位术对双眼不对称的分离性垂直斜视(DVD)的治疗,观察眼位矫正效果和并发症情况。方法:选择双眼垂直斜度不相等的DVD患者15例,均伴有下斜肌功能亢进+～+++,上斜度为15△～20△眼采取下斜肌部分转位术,上斜度>20△眼采取下斜肌全部转位术。术后观察眼位矫正情况及睑裂变化、眼球运动情况。结果:术后双眼第一眼位上斜明显改善,下斜肌功能亢进均消失,双眼睑裂大小基本对称,向上注视时上转程度相等。结论:DVD患者双眼上斜程度往往不对称,可根据第一眼位垂直斜度大小分别采取下斜肌全部转位和部分转位,以减少术后双眼睑裂不等大或上转程度不相等的并发症。     

Comparison of anterior transposition and recession of the inferior oblique muscle in unilateral superior oblique paresis

PURPOSE: Both anterior transposition and graded recession have been shown to be effective procedures in weakening the inferior oblique muscle. Anterior transposition may work in part by converting the inferior oblique muscle from an elevator to a depressor of the globe. In theory, this would be useful in treating the inferior oblique overaction associated with superior oblique paresis. We compared inferior oblique recession and anterior transposition for the surgical correction of Knapp's class III unilateral superior oblique paresis. METHODS: Four patients underwent 14 mm recession, and five underwent anterior transposition of the inferior oblique muscle for the hypertropia in superior oblique paresis. Prism cover test measurements were made in all cardinal fields of gaze and were compared before and after operation between the two groups. RESULTS: The mean preoperative hyperdeviation in the primary position was 12 prism diopters in the recession group and 15 prism diopters in the anterior transposition group. The mean postoperative hyperdeviation was 1 prism diopter in the recession group and 3 prism diopters in the anterior transposition group. Postoperative results in the inferior oblique field of action demonstrated a mean 3 prism diopter hypertropia in the recession group and a 2 prism diopter hypotropia in the anterior transposition group. CONCLUSIONS: Anterior transposition and graded recession gave similar results in correcting the primary position hyperdeviation in Knapp's class III superior oblique paresis. Both procedures also markedly improved the hyperdeviation in the field of action of the inferior oblique muscle and superior oblique muscle. However, anterior transposition was more likely to result in postoperative hypodeviation in upgaze.     

Recession and anterior transposition of the inferior oblique for treatment of superior oblique palsy

We evaluated the effectiveness of inferior oblique recession with anterior transposition in treating 12 patients with superior oblique palsy. Mean decreases of hypertropia measured 17 prism diopters in the primary position, 24 prism diopters in adduction, and 21 prism diopters on ipsilateral head tilt. Head tilt and diplopia were uniformly eliminated. No surgical complications were encountered. Postoperative deviations were mild and infrequent. Only one patient demonstrated postoperative underaction of the recessed inferior oblique.     

下斜肌减弱术治疗下斜肌功能亢进

目的观察下斜肌减弱术治疗下斜肌功能亢进的治疗效果。方法下斜肌功能亢进92例,以正前方的垂直斜视度为依据:斜视度在15△以内者(43例),采用下斜肌截除术;斜视度在15△以上者(49例),采用下斜肌截除术联合对侧眼下直肌后徙术或同侧眼上直肌后徙术。结果79例(85.87%)原位眼垂直斜视度得到矫正,68例代偿头位患者中62例(91.18%)代偿头位消失或减轻。结论根据正前方的垂直斜视度采用不同的下斜肌减弱术,可获得较好的临床治疗效果。     

先天性单侧上斜肌麻痹的手术方式分析

目的：探讨先天性单侧上斜肌麻痹的手术治疗方法。

方法：本研究回顾分析对68例先天性单侧上斜肌麻痹患者,根据患眼的下斜肌功能亢进程度和原在位垂直斜度大小选择下斜肌切断并部分切除、下斜肌切断并前转位、下斜肌部分切除联合对侧眼下直肌或同侧眼直肌手术。伴有水平斜视者按水平斜视矫正原则一期或分期手术矫正。

结果：治愈58例,治愈率85.3%,好转7例,好转率10.3%,无效3例,无效率4.4%。

结论：根据下斜肌亢进程度、垂直斜视度及水平斜度选择不同手术方式,通过一期或分期手术,可有效获得较高治愈率。     

Superior rectus muscle recession for residual head tilt after inferior oblique muscle weakening in superior oblique palsy

Purpose

Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment.

Methods

The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher''s exact test.

Results

The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003).

Conclusions

Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.     

先天性上斜肌麻痹52例临床分析

目的:探讨先天性上斜肌麻痹的临床特点和治疗方法。方法:回顾分析52例61眼伴有先天性上斜肌麻痹病例的资料。结果:先天性上斜肌麻痹在先天性垂直眼外肌麻痹中常见;年龄较小,有较好的双眼视觉;有典型的代偿头位;歪头试验阳性;一般无复视。结论:先天性上斜肌麻痹一经确诊应尽早行手术治疗。     

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。