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目的 探讨先天性上斜肌麻痹的有效手术治疗方法 ,总结临床经验。方法 我院近 3年手术治疗的先天性上斜肌麻痹患者 1 43例 ,根据患眼下斜肌亢进程度和垂直斜度大小选择下斜肌徙后术、下斜肌断腱术、下斜肌前转位术 ,以及联合对侧眼下直肌或患眼上直肌手术。结果 1 43例患者术后随访 1～ 3 6个月 ,治愈 1 0 7例 ,占 74 83 % ;好转 2 9例 ,占 2 0 2 8% ;无效 7例 ,占 4 89%。结论 先天性上斜肌麻痹手术术式选择按减弱直接拮抗肌和配偶肌 ,加强麻痹肌及间接拮抗肌原则进行。手术根据患眼下斜肌亢进程度和垂直斜度大小选择下斜肌徙后术、下斜肌断腱术、下斜肌前转位术 ,以及联合对侧眼下直肌或患眼上直肌手术 ,可取得较好的效果。术后随眼位矫正和视功能恢复 ,代偿头位逐渐好转或消失 ,年龄越小 ,恢复越快。有手术指征者应尽早手术
Objective To investigate the effective surgical treatment of congenital superior oblique paralysis and summarize the clinical experience. Methods One hundred and thirty-three patients with congenital superior oblique paralysis treated surgically in the past three years in our hospital were selected according to the degree of oblique angulation and the vertical gradient. The lower oblique muscle tendon surgery, inferior oblique muscle Anterior transposition surgery, as well as joint rectus femoris or rectus oculi surgery. Results One hundred and seventy-three patients were followed up for 1 ~ 36 months, and 107 cases were cured, accounting for 74.83%; 29 cases were improved, accounting for 20.8%; 7 cases were ineffective, accounting for 4 89%. Conclusions Congenital superior oblique paralysis surgical operation choice according to the direct weakening of the antagonist muscle and spleen muscle, strengthen the paralyzed muscle and indirect antagonistic muscle principle. Surgery based on the extent of the affected eyes and the vertical tilt of the vertical tilt of the lower oblique muscle surgery, oblique tendon surgery, inferior oblique anterior transposition surgery, and the contralateral or rectus under the eye rectus muscle surgery , Can achieve better results. After surgery with ocular position correction and visual function recovery, compensatory head position gradually improved or disappeared, the younger, the faster the recovery. Surgery indications should be as soon as possible surgery