摘要/Abstract

摘要： 目的·探讨显微镜下垂直直肌部分移位联合内直肌后徙术治疗外展神经麻痹性内斜视的临床效果。方法·纳入2015年3月—2017年6月在上海交通大学医学院附属苏州九龙医院眼科诊治的9例外展神经麻痹性内斜视患者，在显微镜下行内斜视矫正手术，术式采用垂直直肌部分移位联合内直肌后徙术。术后随访，观察疗效。结果·术后1周，7例患者的第一眼位基本正位（±10Δ内），2例欠矫（分别为+15Δ、+20Δ），所有患者外转功能明显改善，麻痹眼外转均可过中线；术后1个月，6例患者眼位基本正位（±10Δ内），3例患者欠矫（分别为+15Δ、+15Δ、+30Δ）；术后1年，5例患者眼位基本正位（±10Δ内），4例患者欠矫（分别为+15Δ、+15Δ、+30Δ、+40Δ）。结论·显微镜下垂直直肌部分移位联合内直肌后徙术治疗外展神经完全麻痹性内斜视效果明显，不仅可以改善眼位，还可有效改善麻痹眼的外转功能，但远期易欠矫。
关键词: 外展神经麻痹, 内斜视, 垂直直肌移位, 内直肌后徙术
Abstract:
Objective · To investigate the clinical effect of partial transposition of the vertical rectus combined with medial rectus recession on the treatment of abducens nerve palsy esotropia under the microscope. Methods · Nine patients with abducens nerve palsy esotropia were treated in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to June 2017. The strabismus surgery was performed under the microscope, with partial transposition of the vertical rectus combined with medial rectus recession. Postoperative follow-up was performed to observe the effect. Results · After 1 week, 7 patients’ primary position were orthotopic(within ±10Δ), and 2 patients were undercorrection (+15Δ and +20Δ). Abduction function of all the patients improved significantly. The eyes could cross the midline. After 1 month, 6 patients’ primary position were orthotopic (within ±10Δ), 3 patients were undercorrection(respectively +15Δ, +15Δ and + 30Δ). After 1 year, 5 patients’ primary position were almost orthotropia (within ±10Δ), and 4 patients were undercorrection (respectively +15Δ, +15Δ, +30Δ and +40Δ). Conclusion · Partial transposition of the vertical rectus combined with medial rectus recession under the microscope is a safe and effective surgical method in treatment of complete abducens nerve palsy esotropia. It can not only improve the ocular position, but also effectively improve the abduction function of the paralytic eye. However, it is easy to be undercorrection in the long-term.
Key words: abducent palsy, esotropia, transposition of vertical rectus, medial rectus recession


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