目的:探讨先天性上斜肌麻痹的临床特征以及手术治疗方法。方法:对四川大学华西医院收治的先天性上斜肌麻痹126例患者的临床特征、手术方式和疗效进行回顾分析。结果:我们对126例患者进行了2月至5年的随访,其中治愈50(40.0%)例,改善60(47.6%)例,失败12(9.38%)例。结论:先天性上斜肌麻痹的手术治疗要按减弱直接拮抗剂或配偶肌,加强麻痹肌或间接拮抗肌的原则进行。手术的目的是消除垂直偏斜和代偿头位,避免成年后颜面、颈部和脊柱的畸形,建立双眼单视和恢复正常的眼球功能。
Objective To investigate the efficacy of individualized surgical treatment on congenital superior oblique paralysis. Methods A total of 131 patients (180 eyes) undergoing surgery for congenital superior oblique palsy between October 2015 and January 2018 in West China Hospital of Sichuan University were reviewed. The clinical features, surgical methods and efficacy were analyzed. Results Among the 131 cases, 49 cases were bilateral congenital superior oblique palsy, and 82 cases were unilateral congenital superior oblique palsy; 94 cases were combined with horizontal strabismus; 17 cases (26 eyes) underwent inferior oblique recession, 53 cases (93 eyes) underwent superior oblique tuck, 4 cases underwent superior oblique tuck combined with contralateral superior rectus resection, 37 cases underwent superior oblique tuck combined with contralateral inferior rectus recession, 6 cases underwent inferior oblique recession combined with contralateral superior rectus resection, and 14 cases underwent inferior oblique transposition combined with contralateral superior rectus resection; 18 cases underwent horizontal strabismus correction at one stage, and 76 cases underwent horizontal strabismus correction at the second stage. After Surgery, there were 116 cases cured (88.55%), 15 cases improved (11.45%), and 0 case invalid. Conclusions The diagnosis of congenital superior oblique paralysis should be accurate. Individualized surgery should be designed according to the size and maximum orientation of the squint and the limitation or hyperactivity of the muscles in each diagnostic eye position.