先天性双上转肌麻痹的临床表现和手术治疗探讨

目的 探讨先天性双上转肌麻痹的临床表现和不同手术方式的疗效.方法 回顾性分析1987年10月～2011年1月收治的先天性双上转肌麻痹的病例.结果 共20例,临床表现和相关检查结果分别为(例/例):弱视:16/20;真、假性、混合性上睑下垂:4、8、1；代偿头位:3/20;合并水平斜视:13/20；同视机检查同时视、融合和立体视:10/20,7/20,4/20;随机点图立体视检查8例仅1例阳性.17例接受下直肌徙后或/和上斜肌鞘内切腱术为主选术式共计25次手术.结论 对视力和双眼视机能损害较重,应尽早手术.分期手术为常规.下直肌徙后或/和上斜肌鞘内切腱联合垂直肌手术疗效满意.

The clinical symptoms and the surgical effects of the congenital double elevator palsy

Objective To observe the clinical presentations and effections to surgical treatment of congenital double elevator palsy（DEP）.Methods 20 consecutive patients with DEP are retrospectively reviewed from october 1987 to january 2011.Results The clinical feature and examinations（case/case）： amblyopes： 13/20;optosis and pseudoblepharoptosis and mixed： 4、8、1;head tilt：3/20;horizontal tropia： 13/10;synoptophoreⅠ、Ⅱ、Ⅲ degree functions： 10/20、7/20、4/20;in the examination of 8 congenital cases,only one have the near distance stereoacuity.The surgical treatment of 17 cases are inferior rectus recession or/and tenectomy of the ipsilateral superior oblique muscle in combination with vertical muscle recession on either one.Conclusions The congenital ocular DEP have the severe damage to the binocular vision,the surgical treamtment should be executed as soon as possible.Inferior rectus recession or/and tenectomy of the ipsilateral superior oblique muscle is executed on paretic eye in combination with vertical muscle recession on either eye have the obvious effection on the DEP.