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目的为了避免上斜肌断腱术引起的上斜肌麻痹,手术不能定量,术后发生过矫,及因断端丢失造成再次手术困难等缺点,行改良的上斜肌腱延长术,既能减弱上斜肌的作用,又能在术中及时调整,以达到部分的,可逆的上斜肌减弱效果。方法颞上象限打开球结膜及Tenon氏囊,暴露鼻上象限术野,暴露上斜肌肌腱,用小斜视钩沿上直肌腱走行方向,向后轻轻钩起白色的上斜肌肌腱,分离肌鞘,用两根非吸收线,分别在肌腱上缝两个预置缝线,相距约4mm,在两个缝线之间剪断肌腱,两根缝线互相打活结,断端相距6mm。作牵拉试验,调整两断端间距,局麻下手术,可同时观察眼位。结果11例A型斜视的上斜肌功能亢进均取得明显改善,无1例过矫。结论可调缝线的上斜肌腱延长术,手术效果肯定,术中可调整,可预防过矫,操作较硅胶带延长术容易,可作为上斜肌减弱术的备选手术。
Objective To avoid the upper oblique muscle paralysis caused by oblique tendon surgery, surgery can not be quantified, overcorrection occurred after operation, and because of the missing end of the re-operation caused by the difficulties and other shortcomings, the implementation of improved oblique tendon lengthening, both weakened On the role of oblique muscles, but also in the timely adjustment of surgery, in order to achieve partial, reversible upper oblique weakening effect. Methods The superior conjunctiva and Tenon’s capsule were opened in the superior temporal quadrant, the upper quadrant was exposed, the upper tendon was exposed, the upper tendon was traced along the direction of the upper tendon with a small strabismus hook, the white upper oblique tendon was gently hooked backwards, Muscle sheath, with two non-absorbency lines, respectively, in the tendon tendon on the pre-sewing suture, about 4mm apart, between the two suture shear tendon, two suture play knot with each other, the ends are 6mm apart. For traction test, adjust the distance between the two ends, under local anesthesia, eye position can be observed at the same time. Results Eleven patients with type A strabismus had significant improvement of suprakeptus hyperthyroidism, none of them was overcorrected. Conclusion Adjustable suture oblique oblique tendon lengthening surgery, the effect of surgery affirmed, intraoperative adjustment can prevent overcorrection, the operation is easier than the silicone tape extension surgery, can be used as an alternative oblique operation on the oblique.