189例先天性上斜肌麻痹的手术效果

目的 探讨不同手术方式治疗先天性上斜肌麻痹（CSOP）的疗效，进一步明确各种术式的适用范围。 方法 对189例（222眼）先天性上斜肌麻痹的患者，根据术前检查设计不同的手术方式，分别行下斜肌断腱术(A组)、下斜肌部分切除术(B组)、下斜肌徙后术(C组)、健眼下直肌徙后术(D组)、下斜肌减弱联合直肌的手术(E组)、一眼下斜肌断腱术另一只眼下斜肌部分切除术(F组)、一眼下斜肌部分切除术另一眼下斜肌延长术(G组)。结果 术后观察2~24个月，治愈167例（88.36%），好转22例（11.64%），总有效率为100％。结论 手术治疗CSOP疗效确切。手术方式的原则为减弱直接拮抗肌和/或配偶肌，加强麻痹肌。根据术前检查选择不同手术方式可获得较高的治愈率，减少再次手术的风险。

Surgical effects of congenital superior oblique palsy in 189 patients

Objective To evaluate the effectiveness of different surgical approaches for congenital superior oblique paralysis（CSOP） patients and thus investigate the indications of different surgeries. Methods One hundred and eighty-nine patients（222 eyes）with superior oblique palsy were treated with seven different surgical procedures on the basis of their preoperative examinations. Group A accepted disinsertion of the inferior oblique muscle; Group B accepted inferior oblique myectomy; Group C accepted inferior oblique recession; Group D accepted contralateral inferior rectus muscle recession; Group E accepted other surgical procedures of weakening inferior oblique muscle in combination with rectus muscle; Group F accepted disinsertion of the inferior oblique muscle on one eye and inferior oblique myectomy on the other eye; Group G accepted inferior oblique myectomy on one eye and marginal myotomy of inferior oblique tendon on the other eye. Results The mean post operative follow-up was 2-24 months. One hundred and sixty-seven(88.36%) cases were cured, and 22 (11.64%) cases were improved. The total effectiveness rate was 100%. Conclusion Effects of the surgeries for congenital superior oblique paralysis patients are definite. The principle for surgical approaches is to weaken direct antagonist muscle and/or yoke muscle to augment the paralytic muscle. The proper surgical approaches based on the preoperative examinations can obtain higher recovery rates and reduce the risk of second or more operation.