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目的探讨Helveston综合征的手术治疗方法。方法回顾28例施行手术治疗的Helveston综合征病例,分析手术后眼位、A征、DVD、上斜肌功能和双眼单视功能。结果 28例中,手术后正位26例(92.9%)。A征消失25例(89.3%),术后A征由术前的22.14△±12.94△减少为6.11△±7.50△;术后原在位垂直斜视度由术前的8.14°±4.10°减少为3.14°±1.78°,上斜肌功能眼位的垂直斜视度由术前的15.39°±5.37°减少为4.00°±3.40°;手术前后的A征和垂直斜视度有显著差异,P<0.05。术后7例恢复双眼视觉,其中2例恢复立体视功能。结论 Helveston综合征的手术治疗包括解决外斜A征、上斜肌亢进和DVD,对于A征和上斜肌亢进有效的方法是上斜肌减弱术,其中上斜肌延长术适用于A征≤25△和上斜肌亢进较轻的患者;对于DVD有效的方法是上直肌大量后徙术。
Objective To investigate the surgical treatment of Helveston’s syndrome. Methods A retrospective study of 28 cases of Helveston’s syndrome treated with surgery was performed. The ocular status, A sign, DVD, upper oblique muscle function and binocular single vision function were analyzed. Results Among the 28 cases, 26 cases were positive (92.9%) after operation. A sign disappeared in 25 cases (89.3%), postoperative A sign from preoperative 22.14 △ ± 12.94 △ reduced to 6.11 △ ± 7.50 △; postoperative orthophoria orthophoria from preoperative 8.14 ° ± 4.10 ° reduced to 3.14 ° ± 1.78 °. The vertical skewness of upper oblique muscle was reduced from 15.39 ° ± 5.37 ° before surgery to 4.00 ° ± 3.40 °. There was significant difference between before and after operation A sign and vertical skewness (P <0.05). Postoperative 7 patients recovered binocular vision, of which 2 patients recovered stereopsis. Conclusions Surgical treatment of Helveston’s syndrome, including extroverted A syndrome, supra-oblique hypersomnia and DVD, is effective in the treatment of A syndrome and supra-oblique hyperactivity. Upper oblique muscle lengthening is suitable for A levy ≤ 25 △ and upper oblique hyperthyroidism patients; for DVD effective method is a large number of rectus abdominis surgery.