| 摘要: |
| 目的探讨先天性双上转肌麻痹的临床表现和不同手术方式的疗效。方法回顾性分析我院眼科近五年收治的13例先天性双上转肌麻痹的病例,对其临床特征、手术方式及效果进行总结。结果 13例患者中男9例,女4例,均为自幼患病,单眼受累,麻痹眼均存在上睑下垂,其中假性上睑下垂10例、混合性上睑下垂2例、真性上睑下垂1例,3例合并有外斜视。根据斜视度大小和眼球运动情况而选择不同的手术方式,其中2例接受患眼上斜肌断腱联合下直肌后徙术,6例接受患眼上斜肌断腱、下直肌后徙联合健眼下斜肌断腱术,5例接受患眼上斜肌断腱、下直肌后退联合健眼上直肌后徙术;2例同期行外斜矫正术,1例Ⅱ期行外斜矫正术;1例Ⅱ期行上睑下垂矫正术。术后随访2~6个月,10例眼位正或基本正位,所有患者术后随着眼位偏斜的改善,假性上睑下垂和代偿头位均有明显好转或消失。结论应根据每位患者垂直和水平眼位偏斜度、注视眼别、麻痹肌的拮抗肌及协同肌的代偿性改变等,合理设计相应个体化的手术方式。同时在临床上对单眼上睑下垂伴斜视的患者应谨慎检查,观察交替注视时上睑变化,以避免将假性上睑下垂误诊为先天性上睑下垂。 |
| 关键词: 双上转肌麻痹 斜视 上睑下垂 手术 个体化 |
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| Clinical Manifestationand Surgical Treatment of Congenital Double Superior Muscle Paralysis |
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Dong Mingrong;Lin Wei1,2
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1.West China Fourth Hospital of Sichuan University;2.Sichuan Provincial People’s Hospital
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| Abstract: |
| Objective To investigate the clinical manifestation and the effect of different surgical methods on congenital double superior muscle paralysis. Methods We carried out a retrospective analysis of 13 cases of congenital double superior muscle paralysis admitted into our department of ophthalmology in recent five years.The clinical features,operation methods and effects of those cases were summarized.Results Of the 13 patients,9 were males and 4 females. All were suffer from double superior muscle paralysis at an early age,with monocular ptosis involvement,including 10 cases of false ptosis,2 cases of mixed ptosis,1 cases of true ptosis,and 3 cases of concomitant exotropia.The surgical method depended on the strabismus angle and the movement of eyeballs.Thus,2 cases were treated with superior oblique muscle tendon rupture and inferior rectus recession. 6 cases suffered from superior oblique muscle tendon rupture and inferior rectus recession combined with inferior oblique muscle tendon rupture of the healthy eye.5 cases accepted the rupture of the superior oblique muscle and the inferior rectus recession combined with the superior rectus recession.2 cases underwent external oblique correction at the same time; 1 cases underwent external oblique correction at stage Ⅱ; and 1 cases underwent stage Ⅱ correction of ptosis.All the patients were followed up for 2 to 6 months after operations,and there were 10 cases whose eyes position were normotopia.With the improvement of ocular deviation,the false ptosis and compensatory head were all improved or disappeared.Conclusion The method of surgery should be individual based on the vertical and horizontal eye tilt,fixation of the eye,the compensatory changes of antagonistic muscle and synergistic muscle of the paralytic muscle.At the same time,the patients with monocular ptosis and strabismus should be examined carefully by the changes of the upper eyelid during alternate gaze so as to avoid the misdiagnosis of false ptosis as congenital ptosis |
| Key words: doublesuperiormuscleparalysis strabismus ptosis surgery individualization |
