获得性上斜肌麻痹的临床表现及术式选择

目的探讨获得性上斜肌麻痹的临床特点、术式选择及手术效果。方法回顾分析我院收治的21例（41眼）获得性上斜肌麻痹患者的病因、临床特点及手术治疗，对术前及术后1周、4周、3个月结果进行分析比较。结果获得性上斜肌麻痹以双侧为主，病因主要为闭合性颅脑外伤，常有昏迷病史，有旋转复视主诉，代偿头位以下颌内收多见，斜视检查表现为双下方为主的外旋。本组病例中35眼行Harada—Ito术，5眼行上斜肌折叠术，1眼行下斜肌减弱术。术中及术后随访未见并发症，术后所有患者旋转复视消失，1例仍有轻微头向肩倾斜的代偿头位。41眼术前同视机检查上方注视野外旋（9．1±2．1）°，正前方注视野外旋（11．0±2．4）°，下方注视野外旋（15．0±3．3）°，与术后1周分别为内旋（7．5±2．3）°，内旋（4．7±2．4）°，内旋（2．2±2．4）°]，术后4周分别为内旋（5．3±1．9）°，内旋（3．5±2．3）°，内旋（1．9±2．3）°]，术后3个月分别为内旋（1．8±2．2）°，外旋（1．4±2．1）°，外旋（4．2±2．3）°]相比，旋转斜视度差异均有显著统计学意义（P均〈0．01），随着时间推移，术后旋转斜视度有一定程度的回退趋势。结论获得性上斜肌麻痹的主要临床表现为旋转性复视，需依据临床检查结果选择Harada—Ito术、上斜肌折叠术或下斜肌减弱术进行手术治疗，手术以适度过矫为宜。手术安全可靠，效果显著。

Clinical characteristics and surgical management of acquired superior oblique palsy

Objective To investigate the clinical characteristics and surgical treatment of acquired superior ob- lique palsy. Methods The clinical characteristics, pathogen and surgical treatment of 21 patients （41 eyes） with ac- quired superior obligue palsy were analyzed retrospectively. Torsion was evaluated at before surgery, 1,4 weeks, and 3 months post-operation using Maddox Double Rod Test and synoptophore. Results In this retrospective study, 21 patients （41 eyes） with acquired superior oblique palsy showed a characteristic bilateral torsion caused by a traumatic closed head and brain injury accompanied by a short-term coma,double vision complain, and compensative head position of chin de- pression showing a biocular inferior excyclotorsion. Thirty-five eyes of patients with acquired superior oblique palsy were treated with Harada-lto procedure, 5 with superior oblique muscle tuck, and 1 with inferior oblique muscle recession. All patients had no complain of torsional diplopia and saw clearly after the surgery. No complications were found during or post-operation. Synopotophore examination showed significant （P 〈 0.01 ） decrease in parameters of superior,front, infe- rior excylotropia at 1,4 weeks, and 3 months, （7.5±2.3）°, （4.7 ± 2.4） °, （2.2 ±2.4）° ; （ 5.3 ± 1.9 ）°, （ 3.5 ±2.3）°,（1.9±2.3）°; （1.8±2.2）°,（1.4±2.1）°,（4.2±2.3）°, respectively, （9.1 ±2.1）°,（11.0±2.4）°, （ 15.0±3.3）° ]. However, there was regression of the torsion effect after surgery. Conclusions Harada-Ito procedure, superior oblique tucking and inferior oblique myectomy were safe and effective for the treatment of patients with acquired excylotropia. Diplopia and torsion, especially downward gaze might be a major post-operation complain. An initial over- correction might be considered as a long-term success of this procedure.