189例先天性上斜肌麻痹患者不同术式治疗的临床分析

发布时间：2018-04-09 00:16

本文选题：先天性上斜肌麻痹　切入点：手术　出处：《山东大学》2012年硕士论文

【摘要】：目的：探讨不同手术方式治疗先天性上斜肌麻痹的疗效,进一步明确各种术式的适用范围。方法：对2007年5月至2011年6月于我院行手术治疗的189例(232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A组下斜肌断腱术、B组下斜肌部分切除术、C组下斜肌徙后术、D组一眼下斜肌断腱术另一只眼下斜肌部分切除术、E组一眼下斜肌部分切除术另一眼下斜肌延长术、F组健眼下直肌徙后术、G组下斜肌减弱联合直肌的手术。结果：术后观察2-24个月,A组6例下斜肌断腱术：4例代偿头位消失(66.67%),2例(33.33%)代偿头位明显减轻；5例(83.33%)眼位为正位,1例(16.67%)眼位较前好转；6例(100%)毕氏征阴性；治愈5例(83.33%),好转1例(16.67%)；平均矫正垂直斜视9.01±4.13△。B组142例下斜肌部分切除术(合并水平斜视29例)：130例(91.55%)代偿头位消失,12例(8.45%)代偿头位明显减轻；124例(87.32%)眼位为正位,18例(12.68%)眼位较前好转；142例(100%)毕氏征阴性；治愈131例(92.25%),好转11例(7.75%)；平均矫正垂直斜视12.75±4.98△。C组3例下斜肌徙后术：2例(66.67%)代偿头位消失,1例(33.33%)代偿头位明显减轻；2例(66.67%)眼位为正位,1例(33.33%)眼位较前好转；3例(100%)毕氏征阴性；治愈2例(66.67%),好转1例(33.33%)；平均矫正垂直斜视13.15±5.06△。D组15例一眼下斜肌断腱另一眼斜肌切除术(水平斜视11例)：13例(86.67%)代偿头位消失,2例(13.33%)代偿头位明显减轻；12例(80.00%)眼位为正位,3例(20.00%)眼位较前好转；15例(100%)毕氏征阴性；治愈13例(86.67%),好转2例(13.33%)。E组5例一眼下斜肌切除术另一眼下斜肌延长术：4例(80.00%)代偿头位消失,1例(20.00%)代偿头位明显减轻；4例(80.00%)眼位为正位,1例(20.00%)眼位较前好转；5例(100%)毕氏征阴性；治愈4例(80.00%),好转1例(20.00%)。F组8例下直肌徙后术(合并水平斜视2例)：7例(87.50%)代偿头位消失,1例(12.50%)代偿头位明显减轻；6例(75.00%)眼位为正位,2例(25.00%)眼位较前好转；8例(100%)毕氏征阴性；治愈7例(87.50%),好转1例(12.50%)G组10例下斜肌合并其他直肌手术：8例(80.00%)代偿头位消失,2例(20.00%)代偿头位明显减轻；7例(70%)眼位为正位,3例(30%)眼位较前好转；10例(100%)毕氏征阴性；治愈8例(80%),好转2例(20%)。总治愈168例(88.88%),好转21例(11.12%)。总有效率为100%。结论：手术治疗先天性上斜肌麻痹疗效确切。手术方式选择的总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。单眼下斜肌减弱术矫正垂直斜视度数的效果为下斜肌部分切除术下斜肌断腱术,下斜肌徙后术下斜肌断腱术,下斜肌部分切除术与下斜肌徙后术差异无显著性。
[Abstract]:Objective:To explore the therapeutic effect of different surgical methods for congenital superior oblique palsy and to further clarify the scope of application of various surgical methods.Methods:From May 2007 to June 2011, 189 patients (232 eyes) with congenital superior oblique palsy underwent surgical treatment in our hospital.Partial resection of inferior oblique muscle in group A and partial resection of inferior oblique muscle in group B and partial resection of inferior oblique muscle in group D and partial resection of inferior oblique muscle in group EOperation of inferior oblique muscle combined with rectus muscle in G group.Results:The eye position was better in 142 cases than that in the anterior group (n = 100) Bi's sign was negative;Two cases were cured and 1 case was improved. The average correction of vertical strabismus was 13.15 卤5.06 .D group (15 cases with inferior oblique tendon amputated another eye oblique muscle resection (11 cases with horizontal strabismus, 13 cases with 86.67 cases)), the compensatory head position disappeared in 2 cases (13.33%) and the compensatory head position significantly decreased in 12 cases (80.005%).The ocular position was better in 15 cases than that in the anterior position (15 / 100) and the Bi's sign was negative in 3 cases with positive position and 20.00% (P < 0.05).Eight cases were cured and 2 cases were improved.168 cases were cured, 21 cases improved 11.12%.The total effective rate is 100.Conclusion:Surgical treatment of congenital superior oblique paralysis is effective.The general principle of operation was to weaken the direct antagonistic muscle and / or spousal muscle and to strengthen the paralytic muscle.According to the preoperative examination, different operative methods can obtain higher cure rate and reduce the risk of reoperation.The results showed that partial resection of inferior oblique muscle, inferior oblique muscle recession, partial resection of inferior oblique muscle and inferior oblique muscle recession had no significant effect on correction of vertical strabismus.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

【参考文献】