Duane眼球后退综合征21例手术治疗临床观察

目的探讨眼球后退综合征（DRS）的临床特点和手术方法。方法21例眼球后退综合征根据术前不同的斜视度、斜视类型、牵拉实验结果、同视机检查结果以及眼球内转时是否伴有上射和（或）下射现象，在解除限制因素的前提下分别采取内直肌后退或悬吊术，外直肌后退或悬吊术，内外直肌同时后退或悬吊术以及外直肌Y型劈开联合后退术。结果术后内转眼上射和（或）下射现象及代偿头位有不同程度的改善或消失。14例内斜视术后12例斜视度≤10^△，2例斜视度〉10△.其中2例在行内直肌后退术后出现外斜视。7例外斜视中，5例行外直肌后退或悬吊术，2例行外直肌Y型劈开联合后退术，其中6例术后斜视度≤10△，1例斜视度〉10△。结论在解除限制因素的前提下，水平直肌大量后退可以消除或改善代偿头位，亦可恢复原在位的眼位。对于斜视度≤20△且有代偿头位的DRS患者，可以戴棱镜矫正。直肌Y型分开联合后退术或水平直肌同时后退术在解决内转眼上射和（或）下射现象时有显著疗效。

Clinical analysis of surgical treatment for 21 cases with Duane's retraction syndrome

Objective To investigate the characters of Duane's retraction syndrome (DRS) and the individualized surgical plan.Methods According to the character of DRS,we treated it with four methods:the medial rectus recession combined with ventrofixation,external rectus recession combined with ventrofixation,medial rectus and external rectus muscle simultaneously combined ventrofixation or external rectus muscle Y-shaped division.Results Upshoot and/or downshoot phenomenon and the head compensation position improved or cured postoperatively.Deviation angle of 12 patients was≤ 10△ in 14 patients with esotropia.Two cases appeared exotropia after medical rectus recession.Deviation angle of 6 cases of 7 patients with exotropia was ≤ 10△.In which five cases were performed external rectus muscle recession combined with ventrofixation; 2 cases were performed external rectus muscle Y shaped division.Conclusion Excluding the limiting factor,adequate recession of horizontal rectus could improve or remove the compensation head position.To help the patient with the head compensation position and strabismus ≤20△,we could give prismatic glasses.The curative effect is notable when the rectus Y shaped division with recession or both horizontal rectus recession simultaneously was done for upshoot or downshoot phenomenon.