水平直肌移位术在斜视治疗中作用

目的 探讨斜视手术中施行水平直肌垂直移位术和转位术的作用.方法 手术前后采用三棱镜遮盖法测定62例斜视患者各诊断眼位的斜视角及眼球运动等,并通过同视机检查和眼底照相评估主客观旋转斜视.手术年龄5～33岁,平均14岁.术后随访1～34个月,平均6个月.结果 (1)不伴有斜肌功能异常V型斜视26例,施行双侧水平直肌同方向垂直移位术或施行单眼水平直肌反方向垂直移位术,分别矫正垂直非共同性10～30△和8-25△,并未发现旋转斜视. (2)伴有斜肌功能异常A型斜视25例,单纯施行水平直肌垂直移位术,可矫正垂直非共同性8～30△,原在位与向下注视之间残留斜视角5～25△,而联合双侧上斜肌减弱术组,残留斜视角2～8△. (3)治疗共同性水平斜视伴有小角度垂直斜视8例,双侧水平直肌的向下或向上移位术矫正上斜视2～8△,残余上斜视2～5△. (4)治疗单眼先天性双上转肌麻痹3例,施行水平直肌垂直转位至上直肌肌止端两侧,矫正垂直斜视角25～30△,残余垂直斜视角5△,眼球双上转运动均明显改善.结论 水平直肌垂直移位术能有效地矫正下斜肌功能无异常V型斜视垂直非共同性,联合双侧上斜肌减弱术能更有效解决A型斜视向下注视的斜视角,而治疗共同性垂直斜视的作用则有一定的局限性;转位术治疗单眼先天性双上转肌麻痹疗效较好.

The Role of Vertical Displacement of the Horizontal Rectus Muscles in the Treatment of Strabismns

Obiective To study the role of vertical displacement and transposition of horizontal rectus muscles in the surgical treatment ofstrabismus.Metheds We examinated Sixty-two patients of the deviation in all diagnostic positions by prism and cover test,Binocular motility in preoperation and postoperation.the subjective cyclodeviations were tested by synoptophore and the objective cyclodeviations were showed by fundus photographs.We followed up in a mean period of 6 months (range 1 to 34 months).Results (1)In 26 cases of V-pattern deviation that was not associated with oblique muscle dysfunction, vertical displacement(in the same direction)of bilateral horizontal rectus muscles and vertical displacement (in opposite directions)of monocular horizontal rectus muscles were performed and corrected up 10-30△ and 8-25△ of vertical incomitant deviations respectively.No postoperative cyclodeviation was noted. (2)In 25 cases of A-pattern deviation associated with oblique muscle dysfunction,vertical displacement of the horizontal rectus muscles alone corrected up 8-30△ of vertical incomitant deviations and had residual deviations of 5-25△ between primary position and downgaze position.Combining bilateral weakening of the superior oblique muscles reduced the residual deviations to 2△-8△. (3)In 8 cases of horizontal comitant deviation combined with small angle of vertical deviation, downward transposition or upward transposition of the bilateral horizontal rectus muscles corrected up 2-8△ of hyperdeviation and the residual hyperdeviation was 2-5△. (4)In 3 cases of congenital monocular double elevator palsy,the horizontal rectus muscles were transposed to the two sides of superior rectus tendon to correct up 25-30△ of vertical deviation and the residual vertical deviation was 5△.All of the patients had significant improvement of binocular elevation movements.Comclusions vertical displacement of horizontal rectus muscles can efficiently correct the vertical incomitant deviations of V-pattern strabismus without oblique muscle dysfunction.Bilateral weakening of the superior oblique muscles, along with the vertical displacement of the horizontal rectus muscles, can produce considerable elimination of A-pattern deviations in downgaze;however,this procedure has certain limitations in treating horizontal comitant deviation.Vertical displacement and transposition of horizontal rectus muscles is an effective surgical approach for patients with congenital monocular double elevator palsy.