Helveston综合征的手术治疗

目的：探讨 Helveston 综合征的手术治疗方法。
　　方法：回顾分析我院手术治疗且资料完整的15例30眼Helveston 综合征病例,根据患者上斜肌亢进及分离性垂直偏斜(dissociated vertical deviation,DVD)程度的不同选择不同的手术方式。
　　结果：患者8例16眼行双眼上斜肌鞘内断腱术,术后随访1~3a,A 征均消失,其中3例6眼 DVD 消失,5例10眼DVD 减轻,均未再次行 DVD 矫正手术；患者4例8眼行双眼上直肌后徙联合双眼外直肌后徙并垂直移位术,术后随访1~3a,眼位正位,A 征消失,1例2眼 DVD 消失,3例6眼 DVD 减轻,未再行二次手术；患者3例6眼行双眼水平直肌后徙联合垂直移位术,术后随访6mo,眼位正位,A 征消失,DVD 减轻,未再次行二次手术。
　　结论：Helveston 综合征可根据患者上斜肌亢进及 DVD 程度的不同选择不同的手术方式。

Surgical treatment methods for Helveston syndrome

AIM: To investigate the surgical methods of Helveston syndrome.

METHODS: Fifteen cases(30 eyes)with Helveston syndrome were studied. Surgical method was selected according to the degree of superior oblique muscle overaction and dissociated vertical deviation(DVD).

RESULTS: Binocular superior oblique intrathecal tenectomy was performed in 8 patients(16 eyes). Follow-up period after surgery was 1-3a. Those 8 patients got A-sign correction, of which 3 patients(6 eyes)got DVD vanished and 5 patients(10 eyes)got DVD alleviation. None of the 8 cases needed another operation for DVD. Binocular superior rectus recession and binocular lateral rectus recession with vertical offsets was performed in 4 patients(8 eyes). Follow-up period after surgery was 1-3a. The 4 patients got A sign correction and with orthophoria, of which 1 patient(2 eyes)got DVD vanished and 3 patients(6 eyes)got DVD alleviation. None of the 4 cases needed another operation for DVD. Binocular lateral rectus recession and vertical offsets was performed in 3 patients(6 eyes). Follow-up period after surgery was half a year, with orthophoria, no A sign, DVD weakened, and no second operation was needed.

CONCLUSION: Surgical procedures for Helveston syndrome can be selected according to the degree of superior oblique muscle overaction and DVD.