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目的探讨采用不同术式治疗先天性上斜肌麻痹的疗效及适应症范围。方法对65例(75眼)先天性上斜肌麻痹患者,根据下斜肌亢进程度和垂直斜视度数选择不同的手术方式。25例(29眼)垂直斜视度小于15△(三棱镜度)者,行下斜肌截除或后徙术;15例(15眼)垂直斜视度15△~20△者,行下斜肌截断前转位术;16例(22眼)垂直斜视度20△~25△者,行下斜肌缩短前转位加徙前术;9例(9眼)垂直斜视度大于25△,行下斜肌截除加对侧眼下直肌后徙术。合并内外水平斜视者同时行水平肌的缩短或后徙术。结果治愈42例(49眼),治愈率65.3%(49/75);好转21例(24眼),好转率32%(24/75),无效2例(2眼),占2.7%。结论手术矫正垂直斜视度数下斜肌缩短前转位加徙前术>下斜肌转位术>下斜肌截除术;选择合适的手术方式,可以在最小手术量的基础上获得最佳的治疗效果。掌握手术技巧可以有效避免术后并发症的发生。
Objective To investigate the therapeutic effect and indications of congenital superior oblique paralysis using different surgical procedures. Methods 65 cases (75 eyes) of congenital superior oblique paralysis patients, according to the degree of hypo-elevation and vertical strabismus choose a different surgical approach. Twenty-five eyes (29 eyes) had vertical obliqueness of less than 15 ° (prism), underwent oblique or posterior oblique correction, 15 cases (15 eyes) had vertical obliqueness of 15 △ ~ 20 △, 16 cases (22 eyes) vertical strabismus 20 △ ~ 25 △, under the line of oblique reduction of short anterior transposition plus pre-migration; 9 cases (9 eyes) vertical strabismus greater than 25 △, line down Muscle excision plus the other side of the rectus immediately after the resettlement surgery. Merging internal and external horizontal strabismus at the same time the level of muscle shortening or postoperative resettlement. Results The cure rate was 42 (49 eyes) and the cure rate was 65.3% (49/75). The improvement rate was 21 (24 eyes), the improvement rate was 32% (24/75) and the other 2 patients (2 eyes) were ineffective (2.7%). Conclusions Correction of orthodontics vertical orthopedics oblique shortening anterior transposition plus pre-implantation surgery> inferior oblique transposition> inferior oblique muscle amputation; choose the appropriate surgical approach, the smallest amount of surgery on the basis of the best treatment effect. Mastery of surgical techniques can effectively prevent the occurrence of postoperative complications.