后固定术对上直肌转位治疗外展神经 全麻痹疗效的影响

目的：探讨后固定术在上直肌转位（SRT）治疗外展神经全麻痹中对外展受限的改善效果及并发症情 况。方法：回顾性研究。选择徐州市第一人民医院2014年3月至2019年1月行上直肌转位术治疗外 展神经全麻痹患者21例，其中SRT联合后固定术者作为A-SRT组（10例），为外展不能过中线的严重 病例。单纯行SRT术者作为SRT组（11例）。比较2组间手术前后水平、垂直、旋转斜视变化，外展 受限的改善和出现内转受限等情况。随访时间为10～12个月。数据采用Wilcoxon秩和检验、MannWhitney检验分析。结果：SRT组手术前后内斜视度差值为28.0°（25.0°～30.0°），A-SRT组为40.0° （36.0°～45.0°），组间手术前后差值的差异有统计学意义（Z=-2.940，P<0.001）。SRT组手术前后眼球 外展受限差值为1.0（1.0～1.0），A-SRT组为2.0（1.0～2.0），组间差值的差异有统计学意义（Z=-3.272， P=0.001）。组间手术前后内转受限加重变化差值、垂直斜视度变化差值的差异均无统计学意义（Z= -1.855，P=0.064；Z=-1.505，P=0.132）。SRT组双马氏杆主观旋转检查眼球发生内旋变化为0.0° （0.0°～ 2.0°），A-SRT组为3.0°（0.0°～4.25°），2组间变化差异有统计学意义（Z=-2.228，P=0.026），但2组患 者均无旋转、垂直复视发生，也无其他并发症。结论：后固定术在SRT治疗外展神经全麻痹时，有 引起轻度的眼球内旋及内转受限可能，但可增强外展受限改善程度，原在位内斜矫正好，患者无明 显的主观垂直、旋转复视，故此术式安全、有效。

The Effect of Augmentation with a Posterior Fixation Suture in Superior Rectus Transposition for Abducens Nerve Palsy

Objective: To investigate the effect and complications of augmentation with a posterior fixation suture in superior rectus transposition (SRT) for abducens nerve palsy. Methods: Two groups of patients with abducens nerve palsy treated with either SRT combined with a posterior fixation suture (A-SRT group, n=10) or SRT (SRT group, n=11) were analyzed retrospectively from March 2014 to January 2019 in Xuzhou No.1 People's Hospital. Changes in esotropia, vertical deviation, cyclotropia, and improvements in abduction and adduction limitation were compared between the two groups. The follow-up time was 10-12 months. The data were analyzed by a Wilcoxon rank sum test and Mann-Whitney test. Results:There were significant differences between the A-SRT and SRT groups in esotropia (Z=-2.940, P<0.001) and abduction limitation (Z=-3.272, P=0.001). The variations in esotropia were 40.0° (36.0°-45.0°) in the A-SRT group and 28.0° (25.0°-30.0°) in the SRT group and the variations in abduction limitation were 2.0 (1.0-2.0) and 1.0 (1.0-1.0), respectively. There was no significant difference between the two groups in adduction limitation (Z=-1.855, P=0.064) or vertical deviation (Z=-1.505, P=0.132). There was a significant difference between the two groups in the variation of subjective in cyclotropia inspected by adouble Maddox rod (Z=-2.228, P=0.026). There was an incyclotorsional shift of 3.0° (0.0°-4.25°) in the A-SRT group and 0.0° (0.0°-2.0°) in the SRT group. But there were no complaints of rotational or vertical discomfort in either group. Conclusion: In augmentation with a posterior fixation suture in SRT for abducens nerve palsy, although there is a possibility of slight in cyclotropia or adduction limitation, abduction limitation was optimally corrected and the correction of esotropic deviation in the primary position was perfect without any obvious subjective complaints of vertical or torsional diplopia.