用不同术式治疗先天性上斜肌麻痹的效果分析

先天性上斜肌麻痹是一种先天性眼肌麻痹中最常见的类型,本病多发于幼儿期,其临床表现为上斜视、代偿头位、面部发育不对称,Bieschowshy征阳性。目前对该病的治疗以手术为主。现将我院采取不同术式治疗先天性上斜肌麻痹结果,报告如下:     

不同术式治疗先天性上斜肌麻痹的疗效观察

目的 探讨不同术式治疗先天性上斜肌麻痹的疗效及适应症.方法 本研究回顾分析30例先天性上斜肌麻痹患者手术方式和术后效果.根据下斜肌亢进程度和垂直斜视度数及患眼外旋程度选择不同的手术方式:下斜肌部分切除术、下斜肌前转位术,或联合上直肌或下直肌手术.结果 治愈25例,治愈率83.3%;好转5例,好转率16.7%.结论 根据...     

不同术式治疗先天性上斜肌麻痹疗效分析

目的 探讨先天性上斜肌麻痹的不同手术方式的治疗效果.方法 根据原在位垂直斜视度和眼外肌的功能状况,对47例先天性上斜肌麻痹患者实施不同的手术方式进行分析.结果 术后随访3～24个月,其中40例(85.1%)眼位为正位,7例(14.9%)眼位较前好转.30例(63.8%)代偿头位消失,8例(17.0%)代偿头位减轻.治愈30例(63.8%),好转17例(36.2%),总有效率100%.结论 先天性上斜肌麻痹手术方式的选择按照减弱直接拮抗肌及配偶肌,加强麻痹肌原则进行.根据下斜肌亢进程度和垂直斜视度数选择不同手术方式可达到良好治疗效果.     

先天性上斜肌麻痹的术式探讨

上斜肌为眼球旋转垂直运动眼外肌麻痹中最常见的受累肌。有时是单眼，但两眼上斜肌同时受累者亦较常见。先天性上斜肌麻痹的患者常表现为垂直性斜视和代偿性头位。因此上斜肌麻痹的手术治疗目标，主要在于矫正斜视，使之能获得最大限度的融合功能，消除代偿性头位。先天性上斜肌麻痹的手术方式主要有两类：一是加强麻痹肌即上斜肌折叠术，二是下斜肌减弱术。从１９０８年Ｐｏｓｅｙ首先采用下斜肌减弱术至今已有近百年的历史，人们不但对下斜肌的解剖及其病理生理有了很深的了解，而且采用了先进的影像技术〔１〕和计算机模拟演示的方法〔２〕，从动态上对下斜肌有了更深的认识。下斜肌减弱术有下斜肌断腱术、下斜肌切除术、下斜肌边缘切开术，下斜肌后徙术及下斜肌前转位术。所以对各类下斜肌手术评价是很有必要的，为临床实践提供参考。     

单侧上斜肌麻痹术式分析

目的观察单侧上斜肌麻痹不同术式的疗效。方法124例单侧上斜肌麻痹患者,据Knapp上斜肌麻痹手术方案,结合眼球运动及眼球旋转情况选择术式。垂直斜视角在5△～20△之间行单纯上斜肌折叠或单纯下斜肌后徙术;垂直斜视角>25△者,除上、下斜肌手术外,若麻痹眼为主眼,则同时选择对侧下直肌后徙术;若非麻痹眼为主眼,则同时选择同侧上直肌后徙术。若伴水平斜视,据常规手术量设计,同时予以矫正。结果垂直斜视治愈109例占87.90%,头消失107例占86.29%。其中单纯上斜肌折叠和单纯下斜肌后徙的垂直斜视治愈率分别为84.21%和92.31%,无统计学意义(x2=1.03,p>0.25);头位消失率分别为84.21和86.54%,无统计学意义(x2=0.062,p>0.75)。结论合理选择术式是矫正单侧上斜肌麻痹的关键。     

先天性上斜肌麻痹的手术疗效分析

目的探讨先天性上斜肌麻痹的临床表现、常用检查方法及手术选择的基本原则。方法对40例上斜麻痹患者的不同手术方式进行分析结果40例患者术后随访一年,治愈34例,好转4例,无效2例。结论先天性上斜肌麻痹是垂直眼外肌麻痹中最常见的一种,手术术式选择首选减弱直接拮抗肌和配偶肌,伴内、外斜视者行下斜肌手术同时行内外斜视矫正。     

婴幼儿先天性上斜肌麻痹手术矫正疗效分析

目的 分析3岁前的婴幼儿先天性上斜肌麻痹手术设计、手术近期及远期疗效.方法 回顾分析54例3岁前的婴幼儿上斜肌麻痹矫正手术,女26例,男28例,单眼49例(90.7％),双眼5例(9.3％),合并水平斜视5例(9.3％),合并垂直分离性斜视3例(5.5％),发病年龄3～6个月,结果 术后随访4个月～5年,术后1周眼位正位、轻度欠矫或过矫分别为50％、31.4％;代偿头位消失、明显减轻分别为51.8％、29.6％;Bielschowsky征全部转阴.结论 3岁前的婴幼儿上斜肌麻痹手术矫正的疗效是肯定的,早期手术能尽早改善代偿头位.     

上斜肌麻痹不同术式疗效分析

本文报道１８０例上斜肌麻痹手术患者３～１２岁儿童占７３．３３％。手术方法：斜视角在５～２０△之间单纯下斜肌部分切除;斜视角＞２５△者行下斜肌部分切除＋对侧下直肌后徙或下斜肌部分切除＋同侧上直肌后徙;伴有水平斜视者行下斜肌部分切除＋水平斜视矫正。结果：全愈１４７例占７９．４６％,其中以单纯下斜肌部分切除术效果最好,全愈为９２．５４％。并对有关问题进行了讨论。     

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。     

儿童先天性上斜肌麻痹的手术治疗

目的：对儿童先天性上斜肌麻痹的麻痹的手术治疗临床探讨及疗效的观察。方法：对52例先天性上斜肌麻痹患儿采取了各种检查,如同视机、三棱镜加遮盖、Parks三步法及代偿头位的试验,确诊无误时我们主要采用了下斜肌后徒前转位手术治疗。结果：随访结果,治愈25例（48．07％）,改善23例（44．23％）,失败4例（7．7％）。总有效率（92．3％）;代偿头位术前38例,术后消失32例（84．2％）。结论：治疗先天性上斜肌麻痹主要目的是矫正斜视,尽可能获得最大的融合功能,消除代偿头位,并认为下斜肌后徒前转位术治疗上斜肌麻痹是目前较为理想的手术方式之一,也是近年来人们对该手术方式疗效评价较高的一种术式。     

三维CT在先天性上斜肌麻痹中的应用

目的:用三维CT观察单眼上斜肌麻痹患者的双眼上斜肌影像差异。方法:临床横断面研究。给30例临床诊断单眼先天性上斜肌麻痹的患者进行三维CT检查。在冠状位测量患者双眼上斜肌最大横截面面积和CT值。结果:麻痹眼和非麻痹眼上斜肌肌腹的最大横截面面积分别为4.52±1.49,8.80±1.42mm2;CT值分别为11.57±22.88,35.13±9.74。麻痹眼上斜肌肌腹的最大横截面面积和CT值都明显小于非麻痹眼,差异非常显著,有统计学意义。结论:三维CT扫描显示单眼先天性上斜肌麻痹患者麻痹眼的上斜肌肌腹的横截面面积和CT值明显比非麻痹眼的上斜肌肌腹的横截面面积和CT值小。     

先天性上斜肌麻痹的手术方式选择

目的观察不同手术方式对先天性上斜肌麻痹的治疗效果。方法对我院收治的52例(59眼)先天性上斜肌麻痹的手术方式和疗效作回顾性分析。结果52例(59眼)中11例(13眼)施行了下斜肌断腱术,23例(26眼)施行了下斜肌后徙术,18例(20眼)施行了下斜肌后徙前转位术。18例(20眼)治愈,23例(28眼)好转,总有效率78.85%(41例)。下斜肌断腱术有效率81.82%,下斜肌后徙术有效率78.26%,下斜肌后徙前转位术有效率77.78%。结论上斜≤15Δ可采用下斜肌断腱术或下斜肌后徙术,下斜肌断腱术与下斜肌后徙术具有同样的矫正效果。上斜16Δ~25Δ可采用下斜肌后徙并前转位术,上斜≥25Δ可采用下斜肌后徙并前转位联合配偶肌(对侧眼下直肌)后徙术。     

Effect of unilateral inferior oblique weakening on fundus torsion in bilateral eyes of children with congenital superior oblique palsy

AIM: To determine the frequency and types of retinal diseases in adult patients attending two public eye clinics of Kinshasa, Democratic Republic of Congo, and the extend of the related visual loss. METHODS: Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa, the University Hospital of Kinshasa (UHK) and Saint Joseph Hospital (SJH), from January 2012 to December 2014. Demographics and diagnoses were retrieved and analyzed. Outcome measures were frequency and prevalence of retinal diseases, blindness and low vision. RESULTS: A total of 40 965 patients aged 40y or older were examined during this period in both clinics. Of these, 1208 had retinal disease, giving a 3-year and an annual prevalence of 3% and 1%, respectively. Mean age was 61.7±10.7y, 55.8% of the patients were males. Arterial hypertension (68.1%) and diabetes (43.3%) were the most common systemic comorbidities. Hypertensive retinopathy (41.8%), diabetic retinopathy (37.9%), age-related macular degeneration (14.6%), and chorioretinitis and retinal vein occlusion (7.3% each) were the most common retinal diseases, with 3-year prevalence rates were 1.3%, 1.0%, 0.43%, and 0.21% respectively. Bilateral low vision and blindness were present in 26.8% and 8.4% of the patients at presentation. Major causes of low vision and blindness were diabetic retinopathy (14.8%), age-related macular degeneration (4.9%), retinal detachment (2.8%), and retinal vein occlusion (2.5%). The prevalence was significantly higher among males than females, and at the UHK than SJH. CONCLUSION: Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa. They cause a significant proportion of low vision and blindness.     

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。     

先天性上斜肌麻痹手术治疗的临床观察

目的探讨应用不同手术方式治疗先天性上斜肌麻痹的效果。方法对46例先天性上斜肌麻痹患者,根据原在位垂直斜度和眼外肌的功能情况选择不同的手术方式,术后随访3～24个月,观察治疗效果。结果术后,37例眼位为正位,9例眼位较前改善。32例代偿头位消失,5例代偿头位减轻,2例代偿头位无变化。治愈32例（70%）,好转14例（30%）,总有效率100%。结论对于先天性上斜肌麻痹患者,根据斜度和眼外肌的功能情况选择不同的手术方式治疗可获得良好的效果。     

儿童先天性上斜肌麻痹术后双眼视功能的变化

目的:通过对儿童先天性上斜肌麻痹手术前后双眼视功能的观察,探讨其术后成功重建双眼视觉的影响因素。方法:对30例34眼接受手术治疗的儿童先天性上斜肌麻痹患者进行回顾性分析,所有患者手术前后均用同视机检查双眼视功能,Titmus(立体视检查图)检查近立体视觉。结果:手术后同时知觉、融合功能、远立体视、近立体视较术前均有明显改善,有统计学差异(P<0.05);比较不同视力手术后立体视的变化情况,发现好视力组术后立体视恢复较差视力组好,两者比较有统计学差异(P<0.05);不同斜视度数术后立体视改善情况不同,大度数组术后立体视恢复较小度数组差,两者比较有统计学差异(P<0.05)。比较有无代偿头位,发现有代偿头位组术后立体视好于无代偿头位组,两者有统计学差异(P<0.05)。结论:儿童先天性上斜肌麻痹术后双眼视功能明显改善,视力、斜视度、代偿头位对术后双眼视觉重建均有影响。     

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。     

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。     

Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children

Purpose:

To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery.

Materials and Methods:

A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied.

Results:

The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively (P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees (P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2).

Conclusions:

Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position.     

Inferior oblique weakening surgery on ocular torsion in congenital superior oblique palsy

AIM:To investigate changes in fundus excyclotorsion after inferior oblique myectomy or myotomy.METHODS:The records of 21 patients undergoing strabismus surgery by a single surgeon between 2009 and 2012 were examined. Only patients who had undergone an inferior oblique myectomy or myotomy, with or without horizontal rectus muscle surgery, were evaluated. Digital fundus photographs were obtained, and the angle formed by a horizontal line passing through the optic disc center and a reference line connecting the foveola and optic disc center was measured. Associated clinical factors examined include age at the time of surgery, presence or absence of a head tilt, degree of preoperative vertical deviation, torsional angle, inferior oblique muscle overaction/superior oblique muscle underaction, and surgery laterality. Whether the procedure was performed alone or in combination with a horizontal rectus muscle surgery was also examined.RESULTS:Mean preoperative torsional angle was 12.0±6.4°, which decreased to 6.9±5.7° after surgery (P<0.001, paired t-test). Torsional angle also decreased from 15.1±7.0° to 6.2±4.3° in the myectomy group (P<0.001, paired t-test) but there were no significant changes in the myotomy group (P=0.093, Wilcoxon signed rank test). Multivariable linear regression analysis showed that preoperative torsional angle, degree of inferior oblique overaction, and age at surgery independently and significantly affected postoperative torsional angle.CONCLUSION:Mean torsional angle decreased after inferior oblique myectomy. Degree of preoperative torsional angle, inferior oblique overaction, and age at surgery influence postoperative torsional angle.