眶下壁骨折后下直肌麻痹的手术治疗

目的 探讨眶壁骨折后,或眶壁骨折修复手术后发生单独的下直肌麻痹斜视患者的诊断和最佳手术治疗方案.方法 回颐分析诊治的8例下直肌麻痹斜视患者,均有眶壁骨折或眶壁骨折修复手术病史,6例患者正前方垂直斜度小于20△,下方斜度显著,行下直肌缩短加强手术,缩短量从3.5mm到6mm;2例患者正前方垂直斜度大于20△,上转、外转、下转时垂直斜度均较显著,行下直肌缩短联合同侧上直肌后徙手术.手术采用术中调整缝线的方法.结果 5例患者术后正前方正位,复视和代偿头位消失,远期随访眼位维持稳定,2例患者正前方过矫2△,远期随访正前方正位,复视和代偿头位消失.1例患者正前方欠矫4△,复视消失,头位改善.所有8例患者正前方和下方阅读距离视野复视消失.结论 下直肌缩短加强手术对于眶壁骨折后下直肌麻痹斜视患者消除复视,代偿头位是有效的,如果正前方斜度大,并且斜视累及上方视野,可行下直肌缩短联合同侧上直肌后徙手术,可有效增大双眼单视野.

Abstract：

Objective To study the diagnosis and surgical management of isolated inferior rectus paralysis following orbital trauma or caused by contusion at the time of surgical repair of a blow out orbital fracture.Methods In 8 patients with isolated inferior rectus paralysis,all of which had orbital fracture and 7 of them had history of surgical repair for orbital fracture,3.5mm～6mm resection of the paralyzed inferior rectus was done in 6 patients whose vertical deviation was less than 20△ in primary position;resection of inferior rectus combined with ipsilateral recession of superior rectus was done in other 2 patients whose vertical deviation was over 20△.Adjustable suture technique was used during surgery.The patients were followed up for more than 6 months.Results Postoperatively,5 patients were orthophoria without diplopia or abnormal head position,2 patients were 2△ over correction in primary position which became orthophoria during follow up,I patient was 4△ less correction with no diplopia and improved head position.Diplopia in primary and downward gaze position was disappeared in all the patients.Conclusions Resection of paralyzed inferior rectus is effective to correct vertical deviation both in primary and in downward gaze position for isolated inferior rectus paralysis.When the deviation is most pronounced in both downward and upward gaze position and the deviation in primary position is over 20△ resection and recession is effective to increase single binocular vision.

Surgical Management of Isolated Inferior Rectus Paralysis following Traumatic Orbital Fracture

Objective To study the diagnosis and surgical management of isolated inferior rectus paralysis following orbital trauma or caused by contusion at the time of surgical repair of a blow out orbital fracture.Methods In 8 patients with isolated inferior rectus paralysis,all of which had orbital fracture and 7 of them had history of surgical repair for orbital fracture,3.5mm～6mm resection of the paralyzed inferior rectus was done in 6 patients whose vertical deviation was less than 20△ in primary position;resection of inferior rectus combined with ipsilateral recession of superior rectus was done in other 2 patients whose vertical deviation was over 20△.Adjustable suture technique was used during surgery.The patients were followed up for more than 6 months.Results Postoperatively,5 patients were orthophoria without diplopia or abnormal head position,2 patients were 2△ over correction in primary position which became orthophoria during follow up,I patient was 4△ less correction with no diplopia and improved head position.Diplopia in primary and downward gaze position was disappeared in all the patients.Conclusions Resection of paralyzed inferior rectus is effective to correct vertical deviation both in primary and in downward gaze position for isolated inferior rectus paralysis.When the deviation is most pronounced in both downward and upward gaze position and the deviation in primary position is over 20△ resection and recession is effective to increase single binocular vision.