摘要
目的探讨先天性双上转肌麻痹患者的临床特征和手术效果。方法回顾性分析2009年9月至2011年8月在厦门大学附属厦门眼科中心确诊的13例先天性双上转肌麻痹患者的手术方式,观察手术前后眼位、斜视度数、患眼上转功能及双眼视功能的变化。根据被动牵拉试验的结果选择手术方式。2例行患眼内外直肌向上直肌移位术(Knapp手术)合并水平斜视手术,1例行患眼1/2内外直肌与上直肌连接(Jensen)术,5例行患眼下直肌后退合并或不合并水平斜视手术,2例行患眼下直肌后退联合1/2内外直肌向上直肌移位加后固定术(Foster手术),1例行健眼下斜肌切断及上直肌后退术,1例行健眼下斜肌转位及上直肌后徙术,1例行患眼下直肌后退联合健眼上直肌后退术。结果 8例患者术前下直肌被动牵拉试验阳性,10例患者术后眼位矫正达临床治愈(≤10 PD),5例患眼上转功能从术前的不过中线(-4)到术后的仅轻度不足(-1),2例患者手术前后均保存有双眼视觉,其余患者手术前后均没有双眼视。术后随访期间,所有患者没有出现明显的并发症。结论先天性双上转肌麻痹患者临床表现个体差异明显,需要根据其不同的临床检查结果设计个性化手术方案,被动牵拉试验的结果对术式的正确选择至关重要。
Objective To investigate the clinical features of congenital double elevator paralysis( CDEP) and to evaluate different surgical outcomes based on ocular alignment,improvement in elevation and binocular functions. Methods Thirteen patients diagnosed with congenital double elevator paralysis in Xiamen eye center were included in this study from September 2009 to August 2011. The choice of procedure was based on the results of forced duction test( FDT). Two patients underwent Knapp procedure,with horizontal squint surgery, one patient underwent Jensen procedure. Five patients had inferior rectus recession,with or without horizontal squint surgery; two patients had combined inferior rectus recession and Foster procedure; one patient had combined contralateral superior rectus recession and inferior oblique transaction; one patient had combined contralateral superior rectus recession and anterior transposition of inferior oblique and one patient had inferior rectus recession combined with contralateral superior rectus recession. Results FDT was positive in 8 cases before surgery. Ten of 13 patients were aligned to within 10prism diopters( PD). Elevation improved in 5 patients from no elevation above primary position(- 4) to only slight limitation of elevation(- 1). Two patients had preoperative binocular vision and none gained it postoperatively. No significant postoperative complications were observed during the follow-up period.Conclusions Surgical procedures for CDEP must be individualized according to clinical evaluation and the results of FDT. The results of FDT is of vital importance to choose the appropriate surgical procedure.
出处
《中华眼科医学杂志（电子版）》
2012年第1期17-21,共5页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
关键词
眼肌麻痹
临床特征
手术治疗
Ophthalmoplegia
Clinical features
Surgical treatment
