下斜肌转位术在先天性上斜肌麻痹治疗中的应用

Effect of translocation of inferior oblique muscles in treatment of congenital superior oblique muscle palsy

关键词:  先天性  上斜肌麻痹  手术

Key words:  congenital  superior oblique muscle palsy  surgery

摘要:

［目的］观察下斜肌转位术在先天性上斜肌麻痹中的治疗效果。［方法］以下斜肌亢进为主要表现的先天性上斜肌麻痹患者30例，所有患者均伴有不同程度眼科斜颈, 下斜肌作用不同程度亢进。使用三棱镜交替遮盖法测量视近时第一眼位及两侧歪头时的垂直斜视度。行下斜肌转位术观察术后第1周和术后2个月的眼球运动状况和垂直斜视度变化。［结果］术后第1周有4例存在下斜肌功能I度亢进，术后2个月未再出现变化，术前与术后第1周及术后2个月均有显著性差异。术后第1周第一眼位垂直斜视度数平均为4.6△，较术前有显著性差异；术后2个月第一眼位垂直斜视度数平均为4.8△，较术前有显著性差异；术后第1周与术后2个月相比无显著性差异。术后第1周患侧倾斜垂直斜视度数平均为7.1△，较术前有显著性差异；歪头试验有23例仍为阳性，阳性率76.7％。术后2个月患侧倾斜垂直斜视度数平均为8.2△，较术前有显著性差异；歪头试验有24例仍为阳性，阳性率80.0％。术后第1周患侧倾斜垂直斜视度与术后2个月相比无显著性差异。［结论］下斜肌转位术在先天性上斜肌麻痹中的治疗显示了良好的效果。第一眼位垂直斜视度显著性减小或消失，下斜肌功能基本正常，代偿头位消失或明显改善。患侧倾斜垂直斜视度也有明显改善，但歪头试验的阳性率仍较高。

Abstract:

［Objective］To estimate the clinical effect of translocation of inferior oblique muscles in the treatment of congenital superior oblique muscle palsy. ［Methods］ Thirty patients with overacting inferior oblique muscles and ocular torticollis were evaluated quantitatively before and after the operation by the prism alternative cover test. The vertical deviation degree in primary position and the eyeball motility were recorded. ［Results］ Four cases revealed I degree overacting inferior oblique 1 week after surgery. There are significant differences in the overacting inferior oblique muscles pre- and post- operatively. The average vertical deviation degree in primary position were 4.6△ 1 week and 4.8△ 2 months after surgery. There are no significant differences. The comparison with the degree pre-operation shows significant difference. 23 and 24 patients showed positively Bielschowsky head tilt test 1 week and 2 months after surgery. The positive rate were 76.7% and 80.0%. The average vertical deviation degree in the position when head tilted to the affected side were 7.1△ 1 week and 8.2△ 2 months after surgery. There are no significant differences. The comparison with the degree pre-operation shows significant difference. ［Conclusion］ The translocation of inferior oblique muscles is an effective method for congenital superior oblique muscle palsy. The vertical deviation degree in primary position and tilted position highly decrease or disappear. The functions of inferior oblique muscle recover normal. But the positive rates of the Bielschowsky head tilt test are still high.