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目的 探讨A型肉毒毒素 (botulinumtoxinA ,BTXA)治疗外展神经麻痹致麻痹性内斜视(paralyticesotropia ,PE)的方法和效果。方法 将 89例PE患者分为两组 ,注射组 6 2例PE患者行BTXA眼外肌注射治疗 ,其中 16例患者在BTXA眼外肌注射治疗后 3～ 2 8个月因眼位欠矫行二期手术治疗 ;手术组 2 7例PE患者行BTXA眼外肌注射联合手术治疗。手术方法包括内直肌后退及外直肌截除术、眼外肌边缘切开及截除术、Jenson术和上下直肌转位术等。术后随访时间 3～ 33个月 ,平均 7 5个月。结果 注射组中 ,35例患者经 1～ 4次BTXA眼外肌注射治疗后眼位恢复至正位并获得双眼单视功能 ;11例患者术后眼位恢复至正位 ,矫正的平均斜视度数 (△)为 4 2 7△ ± 32 2 △ 。手术组中 ,术后14例患者眼位恢复至正位 ,矫正的平均斜视度数为 90 0 △ ± 4 0 1△ 。 14例术后患者恢复融合功能 ,双眼注视野范围为 2 0°～ 70°。结论 BTXA眼外肌注射方法可有效防止内直肌挛缩并促进外直肌肌力恢复 ,使部分患者眼位恢复至正位 ,是治疗PE的有效方法之一。同时其作为手术治疗PE的辅助措施 ,可为手术治疗奠定良好的基础
Objective To investigate the efficacy and safety of botulinumtoxin A (BTXA) in the treatment of paralyticesotropia (PE) induced by abducens nerve palsy. Methods Eighty-nine patients with PE were divided into two groups. One hundred and twenty-two PE patients in the injection group were treated with BTXA extra-ocular muscle injection. Among them, 16 patients underwent BTXA extraocular muscle injection 3 to 28 months after the eye- Two surgical treatment; surgical group of 27 cases of PE patients underwent BTXA extra-ocular muscle injection combined with surgical treatment. Surgical methods include rectus and rectus abdominis rectus muscle removal, margins and excision of extraocular muscle, Jenson surgery and rectus superior rectus and so on. The follow-up time was 3 to 33 months, with an average of 75 months. Results In the injection group, 35 patients returned to the positive position and got the binocular single vision function after 1 ~ 4 times of BTXA extracorporeal injection. In 11 patients, the position returned to the positive position and the corrected average strabismus (△) is 4 2 7 △ ± 32 2 △. In the operation group, the position of 14 patients returned to the normal position after operation, and the corrected average strabismus degree was 90 0 ± 4 0 1 △. Fourteen patients recovered fusion function, the field of vision of both eyes ranged from 20 ° to 70 °. Conclusion BTXA extraocular muscle injection can effectively prevent the contracture of the rectus abdominis muscle and promote the recovery of the muscle strength of the lateral rectus and restore the eye position of the patients to the positive position. It is an effective method for the treatment of PE. At the same time as an adjunct to the surgical treatment of PE, which can lay a good foundation for surgical treatment